Selective implantation of durable left ventricular assist devices as primary therapy for refractory cardiogenic shock

Abstract

Our data challenge the notion that patients in refractory cardiogenic shock are best served by an initial period of stabilization with temporary devices. Primary implantation of durable LVADs in cardiogenic shock can yield good midterm outcomes and may have potential benefits.

Readmission and resource utilization after orthotopic heart transplant versus ventricular assist device in the National Readmissions Database, 2010–2014

“…The incidence of VAD implantation nearly doubled from 2010 to 2014; whereas the incidence of OHT increased only marginally, a trend that is consistent with previous analyses of national administrative data. 1 In our analysis, index hospitalization mortality after VAD implantation averaged 10% during the years 2010-2014, indicating that procedure-related mortality has continued to decrease after Mulloy et al 14 reported its decrease from 40% to 18% from 2005 to 2009. 1,14 These decreases likely reflect the improvements being made in the field of mechanical circulatory assistance, postoperative and implantation follow-up, and the evolving demographic and comorbidity characteristics of patients.…”

“…1 In our analysis, index hospitalization mortality after VAD implantation averaged 10% during the years 2010-2014, indicating that procedure-related mortality has continued to decrease after Mulloy et al 14 reported its decrease from 40% to 18% from 2005 to 2009. 1,14 These decreases likely reflect the improvements being made in the field of mechanical circulatory assistance, postoperative and implantation follow-up, and the evolving demographic and comorbidity characteristics of patients. 15 From 2010 to 2014, the OHT index hospitalization cost increased by 47% from $140,851 to $206,793, a trend that was consistent with Mulloy et al, 14 who reported a 40% increase from $120,413 to $168,576.…”

“…1,14 These decreases likely reflect the improvements being made in the field of mechanical circulatory assistance, postoperative and implantation follow-up, and the evolving demographic and comorbidity characteristics of patients. 15 From 2010 to 2014, the OHT index hospitalization cost increased by 47% from $140,851 to $206,793, a trend that was consistent with Mulloy et al, 14 who reported a 40% increase from $120,413 to $168,576. Our VAD index hospitalization cost remained stable during the study period at a mean of $213,0 0 0.…”

Early LVAD Implantation in a Patient with Left Ventricular Failure after Aortic Dissection with Left Main Stem Involvement

“…8) While LVAD implantation in these cases as well as in our own followed a period on a temporary cardiopulmonary support system, others recommended primary implantation of durable LVADs as initial therapy for refractory cardiogenic shock including cases caused by acute myocardial infaction. 9) While it may be argued that patients should be given time to recover on temporary circulatory support before implantation of a durable LVAD, it should also be taken into account that myocardial recovery after devastating infarction will usually not be achieved within a few days.…”

Comparison of Outcomes and Mortality in Patients Having Left Ventricular Assist Device Implanted Early -vs- Late After Diagnosis of Cardiomyopathy

“…Left ventricular assistance device (LVAD) therapy improves survival in HF patients and is often implanted in chronic cardiac disease (1)(2). Conversely, data about LVAD implantation at the acute stage of new-onset HF in patients with recently diagnosed cardiomyopathy are scarce and limited to small cohorts (3)(4)(5). Indeed, a cardiomyopathy may sometimes be diagnosed at the critical stage of severe de novo acute HF with cardiogenic shock and heart transplantation remains the best therapeutic option.…”