Outcomes With Contemporary Microaxial Left Ventricular Assist Devices
Akbarshakh Akhmerov, Robert Cole, Jaime Moriguchi, Fardad Esmailian, Danny Ramzy.
Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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 (Figure A), with last follow up in December 2021. Outcomes were compared according to device type (5.0 vs 5.5). Logistic regression was used to identify predictors of survival and transplantation.
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) for heart failure related to ischemic cardiomyopathy (48%, N=100) and non-ischemic cardiomyopathy (52%, N=110). Prior to Impella 5.0/5.5 insertion, 105 patients (50%) (Impella 5.0: 50%; Impella 5.5: 51%, p=0.877) required temporary support with intra-aortic balloon pumps (N=48), ECMO (N=29), or older generation Impella devices (N=52). Among all patients, N=76 (36%) were bridged to heart transplantation and N=21 (10%) were bridged to durable assist devices. There were no significant differences in the proportion of patients bridged to either therapy between the two devices (durable MCS: 11% with Impella 5.0 and 7% with Impella 5.5, p=0.379; heart transplantation: 37% with Impella 5.0 and 35% with Impella 5.5, p=0.839). Overall, 1-month and 1-year survival were 73% (95% CI: 66-78%) and 59% (95% CI: 52-65%). Although a trend toward better survival was noted with Impella 5.5, this was not significant (p=0.323, Figure B): the 1-month and 1-year survival for Impella 5.0 were 70% (95% CI: 62-77%) and 56% (95% CI: 48-64%), respectively, and the 1-month and 1-year survival for Impella 5.5 were 79% (95% CI: 66-87%) and 66% (95% CI: 49-78%), respectively. In a Cox proportional hazards model, heart transplantation (HR 0.08, 95% CI: 0.04-0.17, p<0.001) and durable MCS (HR 0.47, 95% CI: 0.25-0.87, p=0.017) were independently associated with survival. In a multivariable logistic regression, non-ischemic cardiomyopathy diagnosis was associated with heart transplantation (OR 5.6, 95% CI: 2.8-11.7, p<0.001) but device selection (5.5 vs 5.0) was not (OR 1.2, 95% CI: 0.6-2.4, p=0.653).
CONCLUSIONS: Contemporary catheter-based, microaxial LVADs provide an effective bridge to recovery, durable assist devices, and transplantation.
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