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Percutaneous hemodynamic support for cardiogenic shock is increasingly being utilized as a Bridge to Bridge (B2B) strategy for patients prior to durable left ventricular assist device (LVAD) implant. No data exists regarding the efficacy of this B2B strategy.
From 2003 to 2012 we implanted 254 continuous-flow LVADs. From this group we identified a subset of 43 patients with critical cardiogenic shock refractory to inotrope therapy. These patients had previously been classified as Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1. Shock patients were then grouped by the presence of a preoperative TandemHeart (B2B, n = 23) vs. hemodynamic support with an intra-aortic balloon pump (IABP) and/or inotropes alone (noB2B, n = 20).
Baseline characteristics (age, bridge to transplantation status, diabetes, Cr, AST, albumin, BNP, use of inotropes, ejection fraction and right ventricular function by echocardiogram) were similar between groups. Seventeen of 20 patients (85%) in the noB2B group had an IABP placed and 19 of 20 (95%) received an IV inotrope. Pre-LVAD hemodynamics significantly improved in the B2B group following TandemHeart placement: cardiac index (2.7 v. 2.0, within groups P = 0.004), mean pulmonary arterial pressure (23 v. 36 mmHg, P = 0.001), wedge pressure (15 v. 25 mmHg, P = 0.001), and systemic vascular resistance (992 v. 1378, P = 0.012). Post-LVAD outcomes tended to be better in the B2B group compared to the noB2B group: operative mortality (8.6% v. 25%, P = 0.15), frequency of permanent hemodialysis (4.3% v. 20%, P = 0.17) and need for right ventricular assist device placement (17% v. 45%, P = 0.049).
Bridge to Bridge with a TandemHeart appears to be associated with a more favorable early outcome profile than bridging with an IABP and/or inotropes.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Heart Failure: Therapeutic Insights
Abstract Category: 17. Heart Failure: Therapy
Presentation Number: 1306-282
- 2013 American College of Cardiology Foundation