BACKGROUND: Circulatory support with a catheter-based microaxial flow pump (mAFP) plays a major role in the treatment of severe cardiogenic shock. In most patients who fail to recover while on temporary mechanical circulatory support (tMCS) and who are not eligible for heart transplantation, durable left ventricular assist device (dLVAD) implantation is usually considered a reliable option. This study aimed to describe the outcome of dLVAD therapy following mAFP support and to identify predictors of mortality. METHODS: This was a retrospective analysis of data from a multicenter registry on patients who underwent dLVAD implantation following tMCS with a mAFP between January 2017 and October 2022 (n = 332) from 19 European centers. RESULTS: Patients were supported with an Impella 5.5 (n = 92), 5.0 (n = 153) or CP (n = 87) and were transitioned to a HeartWare HVAD (n = 128) or Heartmate 3 (n = 204) during the same period. One hundred and twenty-five patients (39.2%) also required extracorporeal life support before and/or during mAFP therapy. The 30-day and 1-year survival were 87.8% and 71.1%, respectively. The following risk factors for 1-year mortality were identified: age (odds ratio [OR], 1.02), specifically age over 55 years (OR, 1.09), body mass index >30 kg/m2 (OR, 2.2), female sex (OR for male sex, 0.43), elevated total bilirubin (OR, 1.12), and low platelet count (OR, 0.996). CONCLUSIONS: Based on the identified risk factors, a risk score for estimating 1-year mortality was calculated to optimize patient selection for dLVAD implantation.

2nd Department of Internal Medicine Cardiovascular Medicine General Teaching Hospital and 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Anesthesia and Intensive Care IRCCS San Raffaele Scientific Institute Milan Italy

Department of Cardiac and Vascular Surgery University of Mainz Mainz Germany

Department of Cardiac Surgery Heidelberg University Hospital Heidelberg Germany

Department of Cardiac Surgery IRCCS Azienda Ospedaliero Universitaria di Bologna St Orsola University Hospital Bologna Italy

Department of Cardiac Surgery Leipzig Heart Center Leipzig Germany

Department of Cardiac Surgery Schüchtermann Clinic Bad Rothenfelde Germany

Department of Cardiac Surgery University Hospitals Leuven Leuven Belgium

Department of Cardiac Surgery University of Essen Essen Germany

Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands

Department of Cardiothoracic and Vascular Surgery Deutsches Herzzentrum der Charité Berlin Germany

Department of Cardiothoracic Surgery Jena University Hospital Jena Germany

Department of Cardiothoracic Surgery Rigshospitalet Copenhagen Denmark

Department of Cardiothoracic Surgery University Hospital Cologne Cologne Germany

Department of Cardiothoracic Surgery University Hospital RTWH Aachen Aachen Germany

Department of Cardiovascular Surgery Charité Universitätsmedizin Berlin Berlin Germany

Department of Cardiovascular Surgery University Heart Center Hamburg Hamburg Germany

Department of Cardiovascular Surgery University Hospital Duesseldorf Duesseldorf Germany

Department of Cardiovascular Surgery University Hospital Schleswig Holstein Kiel Germany

Department of Surgical Sciences University of Turin Turin Italy

Division of Cardiac Surgery Department of Surgery Medical University of Vienna Vienna Austria

German Center for Cardiovascular Research Berlin Germany

Heart and Diabetes Center Bad Oeynhausen North Rhine Westphalia Germany

Institute of Clinical and Experimental Medicine Prague Czech Republic

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McDonagh T.A., Metra M., Adamo M., et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42:3599–3726. PubMed

Saeed D., Potapov E., Loforte A., et al. Transition from temporary to durable circulatory support systems. J Am Coll Cardiol. 2020;76:2956–2964. PubMed

Eulert-Grehn J.J., Starck C., Kempfert J., Falk V., Potapov E. ECMELLA 2.0: single arterial access technique for a staged approach in cardiogenic shock. Ann Thorac Surg. 2021;111:e135–e137. PubMed

Tsyganenko D., Gromann T.W., Schoenrath F., et al. Predictors of mid-term outcomes in patients undergoing implantation of a ventricular assist device directly after extracorporeal life support. Eur J Cardiothorac Surg. 2019;55:773–779. PubMed

Bertoldi L.F., Pappalardo F., Lubos E., et al. Bridging INTERMACS 1 patients from VA-ECMO to LVAD via Impella 5.0: De-escalate and ambulate. J Crit Care. 2020;57:259–263. PubMed

George T.J., Schaffer J.M., Harrington K.B., et al. Impact of preoperative Impella support on destination left ventricular assist device outcomes. J Card Surg. 2022;37:3576–3583. PubMed

Kormos R.L., Antonides C.F.J., Goldstein D.J., et al. Updated definitions of adverse events for trials and registries of mechanical circulatory support: a consensus statement of the mechanical circulatory support academic research consortium. J Heart Lung Transplant. 2020;39:735–750. PubMed

Fine J.P., Gray R.J. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509.

White I.R., Royston P., Wood A.M. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30:377–399. PubMed

Tibshirani R. Regression shrinkage and selection via the lasso. J R Stat Soc Series B. 1996;58:267–288.

Gerds T.A., Cai T., Schumacher M. The performance of risk prediction models. Biom J. 2008;50:457–479. PubMed

Ott S., Lewin D., Nersesian G., et al. Improving survival in cardiogenic shock-a propensity score-matched analysis of the impact of an institutional allocation protocol to short-term mechanical circulatory support. Life (Basel) 2022;12:1931. PubMed PMC

Akin S., Soliman O., de By T.M.M., et al. Causes and predictors of early mortality in patients treated with left ventricular assist device implantation in the European Registry of Mechanical Circulatory Support (EUROMACS) Intensive Care Med. 2020;46:1349–1360. PubMed PMC

Maxhera B., Albert A., Ansari E., Godehardt E., Lichtenberg A., Saeed D. Survival predictors in ventricular assist device patients with prior extracorporeal life support: selecting appropriate candidates. Artif Organs. 2014;38:727–732. PubMed

Yang J.A., Kato T.S., Shulman B.P., et al. Liver dysfunction as a predictor of outcomes in patients with advanced heart failure requiring ventricular assist device support: use of the Model of End-stage Liver Disease (MELD) and MELD eXcluding INR (MELD-XI) scoring system. J Heart Lung Transplant. 2012;31:601–610. PubMed PMC