The best combination of mechanical circulatory support used in critical stage of heart failure in the six years retrospective analysis

Introduction

Despite the optimal medical therapy with inotrope use in acute or decompensated chronic heart failure (HF) temporary circulatory mechanical support (TCMS) is sometimes necessary to receive hemodynamic stabilization and allow the best next step in management.

Purpose

The main purpose of the study was to check mortality in patients with critical stage of HF treated with intraaortic balloon pump (IABP), in combinations with other TCMS and/or durable methods of mechanical circulatory support (MCS) used in daily clinical practice at cardiac intensive care unit for almost 6 years.

Material and method

It was retrospective cohort study, approved by the Bioethics Committee. Data from 47 patients (35 men - 74%), median age 61.5 year (IQR 16) with acute or decompensated chronic HF was analysed. Stage of HF was defined by ejection fraction (EF), NT-proBNP concentration, Intermacs profiles 1 and 2, end-organ dysfunction as acute kidney injury (AKI) with necessity of continuous renal replacement therapy (CRRT) and respiratory failure with mechanical ventilation (MV) at the time of TCMS implantation. Results are presented in table 1. Methods of MCS used in the study patients and frequency of mortality is presented in table 2

Results

Although, different configurations of IABP with TCMS and with durable MCS were checked the only two were enable for statistical analysis. It was IABP with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and IABP with left ventricular assist device (LVAD). Results of statistical analysis are shown in table 2 .

Significantly better survival in patients treated with IABP and LVAD in comparison to treatment with IABP and V-A ECMO can be explained by shorter way from start of HF symptoms exacerbation to durable MCS implantation and all the more so because Intermacs classification did not differentiate both groups of patients. However, therapy with IABP in less extend supports myocardial function than V-A ECMO but is better tolerated and has less complications than V-A ECMO. It is especially important when TCMS lasting long.

Conclusions

The lowest frequency of death was observed in configuration of IABP with LVAD. Supraisingly, the classification of HF according to the Intermaks profiles 1 and 2 defined before TCMS implantation, did not influence frequency of deaths. In group treated with IABP and V-A ECMO was significantly more patients with AKI and necessity of CRRT.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.