652 Benefits of Ambulatory Axillary Intra-Aortic Balloon Pump for Circulatory Support as Bridge to Heart Transplant

Introduction: The intra-aortic balloon pump (IABP) and Impella are left ventricular unloading devices with peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) in place and later serve as bridging therapy when VA-ECMO is terminated. We aimed to determine the potential differences in clinical outcomes and rate of complications between the two combinations of mechanical circulatory support. Methods: This was a retrospective, single institutional cohort study conducted in the intensive care unit (ICU) of Queen Elizabeth Hospital, Hong Kong. Inclusion criteria included all patients aged ⩾18 years, who had VA-ECMO support, and who had left ventricular unloading by either IABP or Impella between January 1, 2018 and October 31, 2020. Patients <18 years old, with central VA-ECMO, who did not require left ventricular unloading, or who underwent surgical venting procedures were excluded. The primary outcome was ECMO duration. Secondary outcomes included length of stay (LOS) in the ICU, hospital LOS, mortality, and complication rate. Results: Fifty-two patients with ECMO + IABP and 14 patients with ECMO + Impella were recruited. No statistically significant difference was observed in terms of ECMO duration (2.5 vs 4.6 days, p = 0.147), ICU LOS (7.7 vs 10.8 days, p = 0.367), and hospital LOS (14.8 vs 16.5 days, p = 0.556) between the two groups. No statistically significant difference was observed in the ECMO, ICU, and hospital mortalities between the two groups. Specific complications related to the ECMO and Impella combination were also noted. Conclusions: Impella was not shown to offer a statistically significant clinical benefit compared with IABP in conjunction with ECMO. Clinicians should be aware of the specific complications of using Impella.

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Racial Differences in In-Hospital Outcomes after the Use of Temporary Mechanical Circulatory Support as a Bridge to Heart Transplant

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2021.01.1136 ◽

2021 ◽

Vol 40 (4) ◽

pp. S404-S405

Author(s):

E. Siddiqui ◽

A.K. Okoh ◽

M. Tibuakuu ◽

S. Hirji ◽

I. Hameed ◽

...

Keyword(s):

Racial Differences ◽

Heart Transplant ◽

Mechanical Circulatory Support ◽

Circulatory Support ◽

Hospital Outcomes

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Intra-aortic balloon pump as a bridge therapy to heart transplant in refractory heart failure

European Heart Journal ◽

10.1093/ehjci/ehaa946.1234 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

G.A.B Boros ◽

V.S.C Bellini ◽

D Fatori ◽

C Bernoche ◽

M.F Macatrao-Costa ◽

...

Keyword(s):

Heart Failure ◽

Intensive Care ◽

Heart Transplant ◽

Insertion Site ◽

Laboratory Data ◽

Central Venous Oxygen Saturation ◽

Single Center ◽

Intra Aortic Balloon Pump ◽

The Impact ◽

Bridge Therapy

Abstract Background The role of intra-aortic balloon pump (IABP) in advanced heart failure (HF) treatment is still under debate. Some heart transplant (HTx) candidates on the waiting list require mechanical support, and IABP may be the simple and most available device. Purpose Describe the impact of IABP treatment in advanced HF patients who underwent HTx. Methods We retrospectively analysis patients who underwent HTx from a single center intensive care unit (ICU), between 2009 and 2018, to evaluate the use of IABP as bridge therapy. Selection included decompensated chronic HF patients that required intensive care with optimized intravenous drugs before IABP placement. Exclusion criteria were acute myocardial infarction or cardiac surgery 90 days prior to admission, and implant of ventricular assist device before HTx. Results We included 134 HF patients with IABP therapy before HTx. Insertion site was exclusively femoral. Mean time of IABP onset to HTx were 26±21 days, and hospital admission to HTx 65±45 days. The main cardiomyopathy etiology was Chagas Disease (46%) and mean LVEF was 23±6% (TABLE 1). Clinical and laboratory data were compared before and 96 hours after IABP therapy. Mean central venous oxygen saturation (SvO2) increased from 49.7±14.6% to 67.4±11.3% (p<0.001), creatinine decreased from 1.77±0.9 mg/dL to 1.40±0.6 mg/dL (p<0.001), and urine output increased from 1552±886 mL/24h to 2189±1029 mL/24h (p<0.001). These differences were sustained or improved until the day before HTx (FIGURE 1). After 96 hours dobutamine was maintained in 98% of patients, nitroprusside increased from 56% to 67%, milrinone decreased from 26% to 20%, and norepinephrine decreased from 18% to 3%. Significant IABP complications were few (5.2%; n=7: 3 infections, 2 major bleeding, 2 arterial injury). Conclusion In this single center ICU sample, IABP improved hemodynamic status and renal function in refractory HF patients waiting for HTx. IABP can be a reasonable, available and effective bridging therapy. Figure 1 Funding Acknowledgement Type of funding source: None

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Complications and outcome of the long-term use of the intra-aortic balloon pump in patients with end-stage heart failure

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.034 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

M Stratinaki ◽

E Bousoula ◽

I Malakos ◽

M Zymatoura ◽

E Fountas ◽

...

Keyword(s):

Heart Failure ◽

Pharmacological Therapy ◽

Circulatory Support ◽

Intra Aortic Balloon Pump ◽

Funding Sources ◽

Iabp Support ◽

End Stage Heart Failure ◽

The Mean ◽

End Stage

Abstract Funding Acknowledgements Type of funding sources: None. Background Intra-aortic balloon pump (IABP) can be used as circulatory support in order to stabilize haemodynamically compromised patients as either a bridge to therapy or to further mechanical support. Based on the current literature its use should be limited to up to two weeks and there are not enough data regarding its long term use’s efficacy and possible complications. Purpose To review the possible complications of the long-term use of IABP Methods We restrospectively analysed the data from 24 consecutive patients with end-stage heart failure (ESHF) who received long-term IABP support and recorded the complications during their hospitalization as well as their outcome. Results 24 patients (14 male and 10 female) were included. In 5 of them ESHF was attributed to ischemic cardiomyopathy and the in 19 to dilated cardiomyopathy. Their mean age was 45.6+/-14 years. The mean duration of IABP support was 70.2 days (minimum 30days maximum 192 days). The mean ejection fraction (EF) was 20%. Regarding the pharmacological therapy, 12/24 patients were on dobutamine, 4/24 on dobutamine and milrinone and 8/24 on dobutamine and noradrenaline. Regarding the clinical course of these patients, 7/24 underwent heart transplantation, 2/24 managed to wean from IABP, 5/24 received left lentrivular assist device (LVAD), 6/24 received biventricular assist veice (BiVAD) and 4/24 died. In terms of complications they were recorded as following : infection 7/24, bleeding 3/24, thrombosis 4/24, heparin-induced thrombocytopenia(HIT) 5/24, hematoma 4/24, ischemia 0/24 and rupture 1/24. Conclusions Although not indicated by the current guidelines, long term IABP can be used as a relatively safe circulatory support method.

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Mechanical circulatory support costly in paediatric heart transplant

PharmacoEconomics & Outcomes News ◽

10.1007/s40274-018-4983-2 ◽

2018 ◽

Vol 804 (1) ◽

pp. 19-19

Keyword(s):

Heart Transplant ◽

Mechanical Circulatory Support ◽

Circulatory Support

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Intra-aortic balloon pump versus percutaneous Impella© in emergency revascularisation for myocardial infarction and cardiogenic shock: systematic review

Perfusion ◽

10.1177/02676591211037026 ◽

2021 ◽

pp. 026765912110370

Author(s):

Kristina Frain ◽

Paul Rees

Keyword(s):

Myocardial Infarction ◽

Systematic Review ◽

Cardiogenic Shock ◽

Survival Rates ◽

Circulatory Support ◽

Future Research ◽

Eligibility Criteria ◽

Intra Aortic Balloon Pump ◽

Mesh Terms ◽

Randomised Controlled

Objectives: Mortality rates in patients with acute myocardial infarction and cardiogenic shock (AMI-CS) remain persistently high despite advances over the past decade in percutaneous mechanical circulatory support. This systematic review aims to analyse the existing literature to compare mortality outcomes in patients mechanically supported by intra-aortic balloon pump or percutaneous Impella 2.5/CP© for AMI-CS undergoing emergency revascularisation. Methods: The following MeSH terms were applied to the databases Ovid Medline, Ovid Embase, Cochrane and Web of Science: ‘Intra-aortic balloon pump’, ‘Impella’, ‘Cardiogenic shock’, ‘Myocardial Infarction’ and ‘Mortality’. This yielded 2643 studies. Using predefined inclusion and exclusion criteria, the studies were initially screened by title and abstract before full text analysis. Results: Fourteen studies met eligibility criteria: two randomised controlled trials (RCTs) and 12 observational studies. Data from a total of 21,006 patients were included across the studies. Notably, one study claimed reduced mortality with IABP versus control, and one study concluded that Impella© improved survival rates over the IABP. The average 30-day all-cause mortality in patients supported by IABP was 38.1%, 54.3% in Impella© groups and 39.4% in control groups. Conclusion: AMI-CS presents an important cohort of patients in whom conducting RCTs is difficult. As a result, the literature is limited. Analysis of the available literature suggests that there is insufficient evidence to support superior survival in those supported by IABP or Impella© when compared to control despite suggestions that the Impella© offers superior haemodynamic support. Limitations of the studies have been discussed to outline suggestions for future research.

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Abstract 16314: Late Survival After Atrial Switch in Transposition of the Great Arteries: Results From a Multi-institutional Study

Circulation ◽

10.1161/circ.142.suppl_3.16314 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Alexandra van Dissel ◽

Alexander Opotowsky ◽

Jamil Aboulhosn ◽

Martijn Kauling ◽

Salil Ginde ◽

...

Keyword(s):

Heart Failure ◽

Heart Transplant ◽

Cumulative Incidence ◽

Primary Outcome ◽

Pacemaker Implantation ◽

Circulatory Support ◽

Atrial Switch ◽

Increased Risk ◽

Late Survival

Background: Although several factors have been cited for risk stratification in patients with simple transposition of the great arteries (dTGA), no single predictor emerges consistently. We aimed to assess survival and determine factors associated with survival in a large cohort of dTGA adults with atrial switch. Methods and Results: We included 1,169 dTGA adults (median age 28.1 years, 38.7% female) under regular follow-up at 28 institutions between 2002 and 2019. The primary outcome was a composite of death, mechanical circulatory support (MCS) and heart transplant. During a median follow-up of 9.2 [IQR 5.5-14.2] years, 67 (5.7%) patients died, six (0.5%) patients underwent MCS and 21 (1.8%) had a heart transplant. Cumulative incidence of composite endpoint at 15 years was 12.8% [95% CI 9.8 - 15.7], see Figure). Median age at time of primary outcome was 39.5 [IQR 33.9 - 45.1] years. Leading causes of death were worsening of heart failure (34%), non-cardiac (21%) and sudden unexplained death (12%). In multivariable Cox analyses for baseline variables, age, VSD, ventricular arrhythmia and heart failure admission were each associated with increased risk of the outcome, whereas prior pacemaker (26% of patients) was not. New pacemaker implantation was performed in 107 (9.1%), ICD in 109 (9.3%), and cardiac surgery in 35 (3%) patients. Patients who died were more likely to develop arrhythmias, be admitted for heart failure or require surgery during follow-up. Conclusion: In this large contemporary cohort of dTGA adults after atrial switch, late survival was excellent and seemed to be determined by arrhythmia and heart failure-related complications. Few patients underwent advanced heart failure therapies. Figure. Cumulative incidence of the composite primary outcome (MCS, heart transplant or death) over a period of 15 years from first visit at an adult congenital heart disease clinic since 2002. Shading represents upper and lower 95% confidence limits.

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