Temporary mechanical circulatory support for refractory cardiogenic shock before left ventricular assist device surgery

Saraschandra Vallabhajosyula, Shilpkumar Arora, Sopan Lahewala, Varun Kumar, Ghanshyam P.S. Shantha, Jacob C. Jentzer, John M. Stulak, Bernard J. Gersh, Rajiv Gulati, Charanjit Rihal, Abhiram Prasad, Abhishek J. Deshmukh

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article numbere010193
JournalJournal of the American Heart Association
Volume7
Issue number22
DOIs
StatePublished - Nov 1 2018

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Heart-Assist Devices
Cardiogenic Shock
Hospital Mortality
Hospital Costs
Equipment and Supplies
Length of Stay
Myocardial Infarction
Coronary Angiography
Thoracic Surgery
Cardiac Arrhythmias
Inpatients
Cohort Studies
Retrospective Studies
Odds Ratio
Confidence Intervals
Transplants

Keywords

  • Cardiogenic shock
  • Critical care
  • Destination therapy
  • Left ventricular assist device
  • Mechanical circulatory support

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Vallabhajosyula, S., Arora, S., Lahewala, S., Kumar, V., Shantha, G. P. S., Jentzer, J. C., ... Deshmukh, A. J. (2018). Temporary mechanical circulatory support for refractory cardiogenic shock before left ventricular assist device surgery. Journal of the American Heart Association, 7(22), [e010193]. https://doi.org/10.1161/JAHA.118.010193

Temporary mechanical circulatory support for refractory cardiogenic shock before left ventricular assist device surgery. / Vallabhajosyula, Saraschandra; Arora, Shilpkumar; Lahewala, Sopan; Kumar, Varun; Shantha, Ghanshyam P.S.; Jentzer, Jacob C.; Stulak, John M.; Gersh, Bernard J.; Gulati, Rajiv; Rihal, Charanjit; Prasad, Abhiram; Deshmukh, Abhishek J.

In: Journal of the American Heart Association, Vol. 7, No. 22, e010193, 01.11.2018.

Research output: Contribution to journalArticle

Vallabhajosyula, S, Arora, S, Lahewala, S, Kumar, V, Shantha, GPS, Jentzer, JC, Stulak, JM, Gersh, BJ, Gulati, R, Rihal, C, Prasad, A & Deshmukh, AJ 2018, 'Temporary mechanical circulatory support for refractory cardiogenic shock before left ventricular assist device surgery', Journal of the American Heart Association, vol. 7, no. 22, e010193. https://doi.org/10.1161/JAHA.118.010193
Vallabhajosyula, Saraschandra ; Arora, Shilpkumar ; Lahewala, Sopan ; Kumar, Varun ; Shantha, Ghanshyam P.S. ; Jentzer, Jacob C. ; Stulak, John M. ; Gersh, Bernard J. ; Gulati, Rajiv ; Rihal, Charanjit ; Prasad, Abhiram ; Deshmukh, Abhishek J. / Temporary mechanical circulatory support for refractory cardiogenic shock before left ventricular assist device surgery. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 22.
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abstract = "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.",
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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

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AU - Deshmukh, Abhishek J.

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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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