Microaxial Left Ventricular Assist Device Versus Intraaortic Balloon Pump as a Bridge to Transplant.

Abstract

BACKGROUND:

Heart transplantation (HTx) candidates supported by Impella (Abiomed, Danvers, MA) or intraaortic balloon pump (IABP), who demonstrate evidence of cardiogenic shock, may qualify for waitlist status 2 without exception under the new donor heart allocation system. However limited data comparing Impella versus IABP as a bridge to HTx exist.

METHODS:

The United Network for Organ Sharing database was queried for adults listed and/or transplanted between January 2014 and February 2020. Temporal trends regarding Impella and IABP use were analyzed using the Royston trend test and χ2 test. Waitlist mortality was examined using Fine-Gray competing risks analysis. Post-HTx 180-day survival was analyzed using the Kaplan-Meier method and Cox proportional hazards models.

RESULTS:

Impella use increased from 0.2% in 2014 to 2.6% in 2020 (P < .01) and from 0.4% to 2.2% (P < .01) under the new allocation system. IABP use increased from 4.9% in 2014 to 27.6% in 2020 (P < .01) and from 6.7% to 26.6% (P < .01) under the new allocation system. Post-HTx survival was similar between groups (adjusted hazard ratio, 0.82; 95% CI, 0.38-1.78) despite more preoperative ventilation (3.6% vs 1.1%, P = .01) and higher model for end-stage liver disease excluding international normalized ratio scores (12.4 vs 9.5, P < .01) among Impella-supported recipients. Under the new system Impella-supported candidates were at higher risk of waitlist delisting compared with IABP-supported candidates (subhazard ratio, 2.42; 95% CI, 1.19-4.92).

CONCLUSIONS:

Post-HTx survival is comparable between Impella-supported and IABP-supported recipients despite worse preoperative profiles among Impella-supported recipients. Higher risk of waitlist delisting among Impella-supported candidates under the new allocation system requires close attention.

• Authors: Taylor Nordan, Andre C Critsinelis, Shant H Mahrokhian, Navin K Kapur, Amanda Vest, David DeNofrio, Frederick Y Chen, Gregory S Couper, Masashi Kawabori
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 114 Issue 1 Pg. 160-166 (07 2022) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 34419433 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• End Stage Liver Disease
• Heart Transplantation
• Heart-Assist Devices
• Humans
• Intra-Aortic Balloon Pumping
• Retrospective Studies
• Severity of Illness Index
• Shock, Cardiogenic
• Tissue Donors
• Treatment Outcome