Strategies in the Usage of Temporary Mechanical Circulatory Support

Background: The use of temporary mechanical circulatory support in cardiogenic shock or postcardiotomy heart failure has increased dramatically in recent years. The optimal approach including central or peripheral access, open or percutaneous access, with or without venting is still subject of current discussions. The purpose of this study was to evaluate the impact of different access sites and the influence of left ventricle venting in temporary mechanical circulatory support (MCS).

Method: Between January 2015 and December 2020, a total of 113 patients received temporary circulatory support for cardiogenic shock or postcardiotomy heart failure. Patients were divided into group 1: central ECMO (n = 77), group 2: peripheral ECMO (n = 26) and group 3: temporary RVAD in combination with a temporary LVAD (n = 10). All patients were classified as INTERMACS I or II.

Results: Rate of successful weaning or bridge to durable MCS were highest in group 3 (70%) and lowest in group 1 (35%), in group 2 was the rate 42% (p < 0.001), with a total of 68 (58%) patients transitioned from temporary MCS. Vascular access site complications were highest in group 2 with 54% (p < 0.001). However, 30-day mortality and in-hospital mortality showed no significant differences among patient groups. There were no significant differences regarding infections, major bleeding and neurological events. Predictors for 30-day mortality were age, BMI, COPD, and smoking. Unloading of the left ventricle showed no survival benefit. Patients who could be successfully weaned from temporary MCS, to durable MCS, heart transplant, or discharge without device, had significantly shorter support times (6.0 vs. 9.2 days, p = 0.010) and ventilation hours (221.6 vs. 332.9 hours, p = 0.049).

Conclusion: The majority of patients in acute HF could be successfully weaned or bridged to durable MCS from temporary MCS implantation in an interdisciplinary setting with fast execution of temporary MCS implementation. Interestingly, with no survival benefit in either configuration, with or without left ventricle venting. When weaning is not successful after 6 days on support, there is a high probability for mortality. Patients with percutaneous temporary MCS have an increased successful weaning rate, but higher vascular access site complications.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
28 January 2023