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Outcomes of patients with cardiogenic shock treated with T andemHeart ® percutaneous ventricular assist device: Importance of support indication and definitive therapies as determinants of prognosis
Author(s) -
Smith LaVone,
Peters Anthony,
Mazimba Sula,
Ragosta Michael,
Taylor Angela M.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27650
Subject(s) - cardiogenic shock , medicine , cardiology , cardiac index , ventricular assist device , shock (circulatory) , percutaneous , univariate analysis , cardiac output , heart failure , hemodynamics , myocardial infarction , multivariate analysis
Objectives The objective of this study was to review the characteristics of patients in cardiogenic shock treated with TandemHeart ® percutaneous ventricular assist device (pVAD) to determine influential predictors of survival. Background The TandemHeart ® pVAD is used in the management of patients with cardiogenic shock resulting from a variety of conditions. Several studies have documented the efficacy of this therapy and outlined its complications. Still, there is little data to guide the effective and appropriate use of this resource. Methods Patients referred for TandemHeart ® pVAD implant for refractory cardiogenic shock at the University of Virginia between September 2007 and October 2015 were retrospectively analyzed. Univariate analysis was used to identify predictors of mortality. Results Fifty‐five patients underwent successful TandemHeart ® implant. Hemodynamics significantly improved following TandemHeart ® implant. Cardiac index increased from 1.8 ± 0.6 to 3.1 ± 1.0 L/min/m 2 ( P = 0.007) and pulmonary capillary wedge pressure decreased from 30. 5 ± 9.9 to 19.6 ± 7.4 mmHg ( P =0.0007). Survival was significantly influenced by implant indication with 23.8% surviving in bridge to recovery vs. 51% in bridge to LVAD or surgery ( P = 0.04). In patients who did not receive definitive therapy, only 4 (13.8%) were weaned from TandemHeart ® support and survived to hospital discharge. Only younger age, 51.8 vs. 62.7 years, predicted survival to hospital discharge ( P = 0.004). Conclusion Mortality from refractory cardiogenic shock is high even with TandemHeart ® support. Our study found that patients with an exit strategy with either cardiac surgery or durable LVAD implant significantly influenced survival to hospital discharge.