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.