Can we expect improvements in outcomes with centrifugal vs axial flow left ventricular assist devices in patients transitioned from extracorporeal life support?

Marian Urban, Aleem Siddique, Michael M. Moulton, Anthony W. Castleberry, Helen Mari Merritt-Genore, Timothy Ryan, Brian Lowes, John Y. Um

Research output: Contribution to journalArticle

Abstract

Background: Several patient-related characteristics have been associated with inferior outcomes following durable left ventricular assist device (LVAD) implantation in patients transitioned from venoarterial extracorporeal membrane oxygenation (VA ECMO). The impact of LVAD pump type used is less well-known. Methods: We compared outcomes between patents who received axial and centrifugal flow LVADs following stabilization with VA ECMO. Results: From January 2011 to December 2018, we implanted 28 LVADs in patients transitioned from VA ECMO. This included 17 axial flow devices (HeartMate II LVAD, Abbott Laboratories, Chicago, IL) and 11 centrifugal flow pumps (eight HeartWare HVADs; Medtronic, Minneapolis, MN and three HeartMate 3 LVAS pumps; Abbott Laboratories, Chicago, IL). There was no difference in hospital mortality (23.5% vs 18.2%, P =.74) or 1-year survival (P =.31) between the devices. There were no differences in adverse event rates between the two pump types, apart from a higher rate of gastrointestinal bleeding in patients who received centrifugal flow pumps (1.44 events per 100 patient-months vs 14.67 events per 100 patient-months, P =.010). Preimplantation levels of alanine aminotransferase (hazard ratio [HR], 1.001; 95% confidence interval [CI], 1.000 to 1.002; P =.004) and elevated serum creatinine level (HR, 3.480; 95% CI, 1.121–10.807; P =.031) emerged as significant predictors of decreased 1-year survival. Conclusions: Preimplantation optimization of end-organ function is the single most important determinant of successful post-LVAD survival in patients transitioned from extracorporeal life support. There is no association of pump type with LVAD outcomes up to 1-year post implantation.

Original languageEnglish (US)
Pages (from-to)1228-1234
Number of pages7
JournalJournal of Cardiac Surgery
Volume34
Issue number11
DOIs
StatePublished - Nov 1 2019

Fingerprint

Extracorporeal Membrane Oxygenation
Heart-Assist Devices
Survival
Confidence Intervals
Interleukin-11
Equipment and Supplies
Patents
Hospital Mortality
Alanine Transaminase
Creatinine
Hemorrhage
Serum

Keywords

  • clinical review
  • left ventricular assist device
  • mechanical circulatory support
  • venoarterial extracorporeal membrane oxygenation

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{00c4b7d026804857b6324e5072338247,
title = "Can we expect improvements in outcomes with centrifugal vs axial flow left ventricular assist devices in patients transitioned from extracorporeal life support?",
abstract = "Background: Several patient-related characteristics have been associated with inferior outcomes following durable left ventricular assist device (LVAD) implantation in patients transitioned from venoarterial extracorporeal membrane oxygenation (VA ECMO). The impact of LVAD pump type used is less well-known. Methods: We compared outcomes between patents who received axial and centrifugal flow LVADs following stabilization with VA ECMO. Results: From January 2011 to December 2018, we implanted 28 LVADs in patients transitioned from VA ECMO. This included 17 axial flow devices (HeartMate II LVAD, Abbott Laboratories, Chicago, IL) and 11 centrifugal flow pumps (eight HeartWare HVADs; Medtronic, Minneapolis, MN and three HeartMate 3 LVAS pumps; Abbott Laboratories, Chicago, IL). There was no difference in hospital mortality (23.5{\%} vs 18.2{\%}, P =.74) or 1-year survival (P =.31) between the devices. There were no differences in adverse event rates between the two pump types, apart from a higher rate of gastrointestinal bleeding in patients who received centrifugal flow pumps (1.44 events per 100 patient-months vs 14.67 events per 100 patient-months, P =.010). Preimplantation levels of alanine aminotransferase (hazard ratio [HR], 1.001; 95{\%} confidence interval [CI], 1.000 to 1.002; P =.004) and elevated serum creatinine level (HR, 3.480; 95{\%} CI, 1.121–10.807; P =.031) emerged as significant predictors of decreased 1-year survival. Conclusions: Preimplantation optimization of end-organ function is the single most important determinant of successful post-LVAD survival in patients transitioned from extracorporeal life support. There is no association of pump type with LVAD outcomes up to 1-year post implantation.",
keywords = "clinical review, left ventricular assist device, mechanical circulatory support, venoarterial extracorporeal membrane oxygenation",
author = "Marian Urban and Aleem Siddique and Moulton, {Michael M.} and Castleberry, {Anthony W.} and Merritt-Genore, {Helen Mari} and Timothy Ryan and Brian Lowes and Um, {John Y.}",
year = "2019",
month = "11",
day = "1",
doi = "10.1111/jocs.14232",
language = "English (US)",
volume = "34",
pages = "1228--1234",
journal = "Journal of Cardiac Surgery",
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publisher = "Wiley-Blackwell",
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TY - JOUR

T1 - Can we expect improvements in outcomes with centrifugal vs axial flow left ventricular assist devices in patients transitioned from extracorporeal life support?

AU - Urban, Marian

AU - Siddique, Aleem

AU - Moulton, Michael M.

AU - Castleberry, Anthony W.

AU - Merritt-Genore, Helen Mari

AU - Ryan, Timothy

AU - Lowes, Brian

AU - Um, John Y.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Background: Several patient-related characteristics have been associated with inferior outcomes following durable left ventricular assist device (LVAD) implantation in patients transitioned from venoarterial extracorporeal membrane oxygenation (VA ECMO). The impact of LVAD pump type used is less well-known. Methods: We compared outcomes between patents who received axial and centrifugal flow LVADs following stabilization with VA ECMO. Results: From January 2011 to December 2018, we implanted 28 LVADs in patients transitioned from VA ECMO. This included 17 axial flow devices (HeartMate II LVAD, Abbott Laboratories, Chicago, IL) and 11 centrifugal flow pumps (eight HeartWare HVADs; Medtronic, Minneapolis, MN and three HeartMate 3 LVAS pumps; Abbott Laboratories, Chicago, IL). There was no difference in hospital mortality (23.5% vs 18.2%, P =.74) or 1-year survival (P =.31) between the devices. There were no differences in adverse event rates between the two pump types, apart from a higher rate of gastrointestinal bleeding in patients who received centrifugal flow pumps (1.44 events per 100 patient-months vs 14.67 events per 100 patient-months, P =.010). Preimplantation levels of alanine aminotransferase (hazard ratio [HR], 1.001; 95% confidence interval [CI], 1.000 to 1.002; P =.004) and elevated serum creatinine level (HR, 3.480; 95% CI, 1.121–10.807; P =.031) emerged as significant predictors of decreased 1-year survival. Conclusions: Preimplantation optimization of end-organ function is the single most important determinant of successful post-LVAD survival in patients transitioned from extracorporeal life support. There is no association of pump type with LVAD outcomes up to 1-year post implantation.

AB - Background: Several patient-related characteristics have been associated with inferior outcomes following durable left ventricular assist device (LVAD) implantation in patients transitioned from venoarterial extracorporeal membrane oxygenation (VA ECMO). The impact of LVAD pump type used is less well-known. Methods: We compared outcomes between patents who received axial and centrifugal flow LVADs following stabilization with VA ECMO. Results: From January 2011 to December 2018, we implanted 28 LVADs in patients transitioned from VA ECMO. This included 17 axial flow devices (HeartMate II LVAD, Abbott Laboratories, Chicago, IL) and 11 centrifugal flow pumps (eight HeartWare HVADs; Medtronic, Minneapolis, MN and three HeartMate 3 LVAS pumps; Abbott Laboratories, Chicago, IL). There was no difference in hospital mortality (23.5% vs 18.2%, P =.74) or 1-year survival (P =.31) between the devices. There were no differences in adverse event rates between the two pump types, apart from a higher rate of gastrointestinal bleeding in patients who received centrifugal flow pumps (1.44 events per 100 patient-months vs 14.67 events per 100 patient-months, P =.010). Preimplantation levels of alanine aminotransferase (hazard ratio [HR], 1.001; 95% confidence interval [CI], 1.000 to 1.002; P =.004) and elevated serum creatinine level (HR, 3.480; 95% CI, 1.121–10.807; P =.031) emerged as significant predictors of decreased 1-year survival. Conclusions: Preimplantation optimization of end-organ function is the single most important determinant of successful post-LVAD survival in patients transitioned from extracorporeal life support. There is no association of pump type with LVAD outcomes up to 1-year post implantation.

KW - clinical review

KW - left ventricular assist device

KW - mechanical circulatory support

KW - venoarterial extracorporeal membrane oxygenation

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