Incorporating a percutaneous ventricular assist device into an existing cardiogenic shock programme - early experience from an asian heart center

ZY, Ng and FE, Tulod and Hwei Sung, Ling and R, Cherian and YC, Lim and RCC, wong and AA, Ambhore and SL, Lim and Q, Qian and JA, Sule and G, Maclaren and K, Ramanathan and AF, Low and HC, Tan and WQ, Lin (2024) Incorporating a percutaneous ventricular assist device into an existing cardiogenic shock programme - early experience from an asian heart center. European Journal of Heart Failure, 26 (S2). p. 416. ISSN 1879-0844

PDF European J of Heart Fail - 2024.pdf Download (312MB)

Abstract

Background: The use of mechanical circulatory support in acute heart failure complicated by cardiogenic shock (CS) is increasing worldwide. We report our early experience with a percutaneous left ventricular assist device (pVAD) in the treatment of CS at an Asian tertiary heart centre. Methods: This is an observational registry of a pVAD implanted for acute myocardial infarction complicated by CS (AMI-CS) or for left ventricular venting in VA-ECMO between 2020 and 2023. Baseline characteristics, procedure details, haemodynamic and echocardiographic data, as well as clinical and safety outcomes were collected. Results: 11 patients were included in our analysis. 8 patients underwent implantation of pVAD for AMI-CS and 3 were implanted as part of a left ventricular venting in VA-ECMO strategy. Indications for left ventricular venting were fulminant myocarditis (n = 2) and haemodynamic support post aortic dissection surgery (n = 1). Mean age was 54.8 years and 72% were male. Mean admission pH was 7.25 (7.06-7.54) and mean lactate was 6.37mmol/L (2.3-16.0). 2 had a cardiac arrest prior to pVAD insertion. 10 were escalated to pVAD after inotropes and intra-aortic balloon pump, while 1 had pVAD for left ventricular venting directly following VA-ECMO. Median support duration was 4 days. Median ejection fraction on echocardiogram was 20% (10-28%). In AMI-CS patients, percutaneous coronary intervention was performed for all but 1 patient who had no clear culprit lesion. None required urgent coronary artery bypass graft surgery. CS to implantation time ranged from 105 to 1800 minutes (mean 609 minutes). Bleeding was the most common complication of pVAD therapy (n = 6), followed by the need for dialysis (n = 4), stroke (n = 2), device failure (n = 2), access site infection (n = 1) and device dislodgment (n = 1). No vascular injuries, limb ischaemia, or procedure and device-related deaths were seen. In-hospital mortality was 54.5%. For patients who survived to discharge, no deaths, durable left ventricular assist device (LVAD) implants or heart transplants were seen at 6 months. One hospitalisation for heart failure was seen at 6 months. Conclusion: From our early pVAD in CS experience, in-hospital mortality was high but patients who survived to discharge had good LVAD and transplant-free survival. Device-related complications were manageable, with no device-related deaths.

Actions (For repository members only: login required)

View Item