Abstract 13864: Bridging Cardiogenic Shock Patients with Short Term Ventricular Support at a Community Hospital to Long Term Ventricular Support at a Tertiary Hospital - Feasibility and Outcome.
Purpose: Patients in severe cardiogenic shock require immediate circulatory support to improve their outcomes. We aimed to compare outcomes of patients implanted with a short-term ventricular assist device (STVAD) in a community hospital (CH) as a bridge to long-term ventricular assist device (LTVAD), to those receiving both implants at the same tertiary hospital (TH).
Methods: Retrospective review of all patients with STVAD that were bridged to a LTVAD in our tertiary center from 1997 to May 2010.Outcomes were analyzed according to STVAD implant location and survival was censored for heart transplantation.
Results: We identified 36 patients. Mean age was 52±16 years, 74% males and 30% diabetics. Reasons for STVAD implantation were an acute myocardial infarction (AMI) in 39%, post-cardiotomy in 36%, decompensated chronic heart failure (HF) in 20% and acute HF in 3%. Left ventricular ejection fraction was 17±7%, 66% had an intraortic balloon pump prior to STVAD and 86% were INTERMACS profile 1. A STVAD was implanted in a CH in 19 (53%) patients. Patients from the CH had less diabetes (16% vs. 47%; p=0.042) and more previous cardiotomy (56% vs. 18%; p=0.03) compared with those in whom the STVAD was implanted in the TH. All patients at the CH were Intermacs 1 compared with 71% at the TH (p=0.016). Patients from the CH tended to die sooner after LTVAD implant although long-term survival was similar (see figure). At 1 month follow-up, 84% from the CH were alive or transplanted versus 100% from the TH. At 1 year follow-up, 66% from the CH were alive or transplanted vs. 60% from the TH. Median follow-up was 15 months.
Conclusion: It is feasible to implant a STVAD in patients with cardiogenic shock in a CH as a bridge to a LTVAD in a TH. This approach provides similar outcomes as when the bridge to LTVAD is performed in the TH and excellent outcome compared to historical cardiogenic shock data.
- © 2011 by American Heart Association, Inc.