Open AccessTemporary Mechanical Circulatory Support for Refractory Cardiogenic Shock Before Left Ventricular Assist Device Surgery
Author(s) -
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 S.,
Prasad Abhiram,
Deshmukh Abhishek J.
Publication year - 2018
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.118.010193
Subject(s) - cardiogenic shock , medicine , myocardial infarction , cardiology , ventricular assist device , retrospective cohort study , confidence interval , odds ratio , cardiac surgery , intra aortic balloon pump , circulatory system , cohort , shock (circulatory) , heart failure , surgery , intra aortic balloon pumping
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.