A41 - Longitudinal Impact of Temporary Mechanical Circulatory Support on Durable Ventricular Assist Device Outcomes: An IMACS Registry Analysis

Register or Login to View PDF Permissions
Permissions× For commercial reprint enquiries please contact Springer Healthcare:

For permissions and non-commercial reprint enquiries, please visit to start a request.

For author reprints, please email
Information image
Average (ratings)
No ratings
Your rating



Published online:

Support:The development of this supplement was funded by Abiomed.

Correspondence Details:Jaimie Hernandez-Montfort,

Open Access:

The copyright in this work belongs to Radcliffe Medical Media. Only articles clearly marked with the CC BY-NC logo are published with the Creative Commons by Attribution Licence. The CC BY-NC option was not available for Radcliffe journals before 1 January 2019. Articles marked ‘Open Access’ but not marked ‘CC BY-NC’ are made freely accessible at the time of publication but are subject to standard copyright law regarding reproduction and distribution. Permission is required for reuse of this content.

Background: Patients with advanced heart failure and cardiogenic shock (CS) often require temporary circulatory support (TCS) as a bridge to durable ventricular assist devices (dVAD). We aim to characterise longitudinal outcomes of patients with and without CS.

Methods: Between 2013 and 2017, 13,813 adult patients classified as INTERMACS profiles 1–3 with continuous flow left ventricular assist devices or biventricular assist devices were registered into IMACS. Patients were subgrouped according to support type: extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP) or other TCS. Other TCS included all other surgical and percutaneous TCS devices. Estimated survival was compared based on the need for preoperative TCS and by profile.

Results: Preoperative TCS was used in 5,632 (41%). Of these, ECMO was used in 1,138 (20%), IABP in 3,901 (69%) and other TCS in 595 (11%). Patients requiring ECMO had a greater need for biventricular support after dVAD (22% ECMO, 5% IABP, 7% other TCS, p<0.001) with longer post-implant intensive care stays (ECMO 24 days, IABP 14 days, other TCS 12 days, p<0.001). INTERMACS profile 1–3 patients with pre-implant ECMO had the lowest longitudinal survival (82% at 1 month, 44% at 48 months) compared to IABP (93% at 1 month, 51% at 48 months), other TCS (92% at 1 month, 52% at 48 months) and non-TCS (95% at 1 months, 55% at 48 months, p<0.0001). Pre-implant ECMO (HR 2.03) conferred the highest comparative hazard impacting early phase survival (p<0.0001). Within the profile 1 TCS subgroup (overall 1 month survival 87%), ECMO was also associated with inferior survival (82%).

Conclusion: In patients with advanced heart failure and CS, the use of ECMO prior to dVAD was associated with lower longitudinal survival and increased utilisation of biventricular support compared to alternative TCS strategies. Further granular research focused on CS and pre-implant TCS is warranted to further understand these differences.