TY - JOUR
T1 - Temporary mechanical circulatory support for refractory cardiogenic shock before left ventricular assist device surgery
AU - Vallabhajosyula, Saraschandra
AU - Arora, Shilpkumar
AU - Lahewala, Sopan
AU - Kumar, Varun
AU - Shantha, Ghanshyam P.S.
AU - Jentzer, Jacob C.
AU - Stulak, John M.
AU - Gersh, Bernard J.
AU - Gulati, Rajiv
AU - Rihal, Charanjit S.
AU - Prasad, Abhiram
AU - Deshmukh, Abhishek J.
N1 - Publisher Copyright:
© 2018 The Authors.
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Background—There are limited data on the role of temporary mechanical circulatory support (MCS) devices for cardiogenic shock before left ventricular assist device (LVAD) surgery. This study sought to evaluate the trends of use and outcomes of MCS in cardiogenic shock before LVAD surgery. Methods and Results—This was a retrospective cohort study from 2005 to 2014 using the National Inpatient Sample (20% stratified sample of US hospitals). This study identified admissions undergoing LVAD surgery with preoperative cardiogenic shock. Admissions for other cardiac surgery and heart transplant were excluded. Temporary MCS was identified using administrative codes. The primary outcome was hospital mortality and secondary outcomes were hospital costs and lengths of stay in admissions with and without MCS use. In this 10‐year period, 9753 admissions were identified with 40.6% requiring pre‐LVAD MCS. There was a temporal increase in the frequency of cardiogenic shock associated with an increase in non–intra‐aortic balloon pump MCS devices. The cohort receiving MCS had greater in‐hospital myocardial infarction, ventricular arrhythmias, and use of coronary angiography. On multivariable analysis, older age, myocardial infarction, and need for MCS devices were independently predictive of higher in‐hospital mortality. In 696 propensity‐matched pairs, use of MCS was predictive of higher in‐hospital mortality (odds ratio 1.4 [95% confidence interval 1.1–1.6]; P=0.02) and higher hospital costs, but similar lengths of stay. Conclusions—In patients with cardiogenic shock bridged to LVAD therapy, there was a steady increase in preoperative MCS use. Use of MCS identified patients at higher risk for in‐hospital mortality and greater resource utilization.
AB - Background—There are limited data on the role of temporary mechanical circulatory support (MCS) devices for cardiogenic shock before left ventricular assist device (LVAD) surgery. This study sought to evaluate the trends of use and outcomes of MCS in cardiogenic shock before LVAD surgery. Methods and Results—This was a retrospective cohort study from 2005 to 2014 using the National Inpatient Sample (20% stratified sample of US hospitals). This study identified admissions undergoing LVAD surgery with preoperative cardiogenic shock. Admissions for other cardiac surgery and heart transplant were excluded. Temporary MCS was identified using administrative codes. The primary outcome was hospital mortality and secondary outcomes were hospital costs and lengths of stay in admissions with and without MCS use. In this 10‐year period, 9753 admissions were identified with 40.6% requiring pre‐LVAD MCS. There was a temporal increase in the frequency of cardiogenic shock associated with an increase in non–intra‐aortic balloon pump MCS devices. The cohort receiving MCS had greater in‐hospital myocardial infarction, ventricular arrhythmias, and use of coronary angiography. On multivariable analysis, older age, myocardial infarction, and need for MCS devices were independently predictive of higher in‐hospital mortality. In 696 propensity‐matched pairs, use of MCS was predictive of higher in‐hospital mortality (odds ratio 1.4 [95% confidence interval 1.1–1.6]; P=0.02) and higher hospital costs, but similar lengths of stay. Conclusions—In patients with cardiogenic shock bridged to LVAD therapy, there was a steady increase in preoperative MCS use. Use of MCS identified patients at higher risk for in‐hospital mortality and greater resource utilization.
KW - Cardiogenic shock
KW - Critical care
KW - Destination therapy
KW - Left ventricular assist device
KW - Mechanical circulatory support
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U2 - 10.1161/JAHA.118.010193
DO - 10.1161/JAHA.118.010193
M3 - Article
C2 - 30571481
AN - SCOPUS:85057106577
SN - 2047-9980
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 22
M1 - e010193
ER -