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Central Surgical Association

49th Annual Meeting

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Outcomes in Patients Supported with Contemporary Microaxial Left Ventricular Assist Devices
Akbarshakh Akhmerov, Robert Cole, Jaime Moriguchi, *Fardad Esmailian, *Danny Ramzy
Cedars-Sinai Medical Center, West Hollywood, California, United States

Background: Microaxial left ventricular assist devices (LVADs) are capable of bridging patients to recovery, decision, durable devices, and transplantation. Comparative outcomes with the most contemporary and frequently used devices (Impella 5.0 and 5.5), however, are lacking.

Methods: Patients with acutely decompensated heart failure who required Impella 5.0 or 5.5 support were evaluated from April 2013 to June 2021, with last follow up in December 2021. Outcomes were analyzed for the overall cohort and compared according to destination: bridge to transplantation (BTT, N=76), bridge to durable support devices (BTD, N=21), and all other (N=113). Logistic regression was used to identify predictors of survival.

Results: 210 patients (age 57.1 ± 13.5 years; male 88%) received support with either Impella 5.0 (73%, N=153) or Impella 5.5 (27%, N=57, Figure A) for heart failure related to ischemic cardiomyopathy (48%, N=100) and non-ischemic cardiomyopathy (52%, N=110). Nonischemic cardiomyopathy was the most common etiology in BTT patients (79%) and BTD (67%) patients, and ischemic cardiomyopathy was the predominant diagnosis (68%) in all other patients (p<0.001). Prior to Impella 5.0/5.5 insertion, 105 patients (50%) required temporary support with intra-aortic balloon pumps (N=48), ECMO (N=29), or older generation Impella devices (N=52). A significantly higher proportion of non-BTT and non-BTD patients had temporary assist devices prior to Impella 5.0/5.5 insertion, compared with BTT and BTD groups (58%, 42%, and 33%, respectively, p=0.02). There were no significant differences in the proportion of patients requiring intra-aortic balloon pumps (p=0.903) or older generation Impella devices (p=0.155), but a significantly higher proportion of non-BTT/non-BTD patients were supported with ECMO, compared with BTT and BTD (20%, 4%, and 14%, respectively, p=0.006). Overall, 1-month and 1-year survival were 73% (95% CI: 66-78%) and 59% (95% CI: 52-65%). Survival was significantly different across groups (p<0.001, Figure B). The 1-month survival was 50.0% (95% CI: 40.4-58.8%) for non-BTT/non-BTD patients; 98.7% (95% CI: 91.0-99.8%) for BTT patients; and 95.2% (95% CI: 70.7-99.3%) for BTD patients. The 1-year survival was 32.8% (95% CI: 23.5-42.3%) for non-BTT/non-BTD patients; 93.0% (95% CI: 83.9-97.0%) for BTT patients, and 66.7% (95% CI: 42.5-82.5%) for BTD patients. In a Cox proportional hazards model, bridging patients to heart transplantation (adjusted HR 0.08, 95% CI: 0.04-0.17, p<0.001) or a durable MCS device (adjusted HR 0.47, 95% CI: 0.25-0.87, p=0.017) were independently associated with survival.

Conclusions: Contemporary catheter-based, microaxial LVADs provide an effective durable assist devices and transplantation.

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