P2774Long-term outcomes of patients treated with mini-invasive mechanical circulatory support for cardiogenic shock or refractory cardiac arrest

Abstract

Introduction: Mini-invasive mechanical circulatory support (MCS) systems are increasingly used in patients suffering from severe or rapidly progressing cardiogenic shock and from refractory cardiac arrest. However, current evidence on long-term outcomes of this therapeutic approach is still insufficient. Purpose: The aim of our study was to assess one-year mortality in patients treated with MCS for severe circulatory collapse. Methods: We analyzed data from a group of patients treated with mini-invasive MCS in our center from March 2008 until March 2016. One-year survival data were obtained from all subjects. Mortality of patients with severe or rapidly progressing cardiogenic shock (CS group), subjects with refractory cardiac arrest treated by extracorporeal cardiopulmonary resuscitation (ECPR group) and patients with non-urgent MCS insertions for support of high-risk interventions (NU group) was compared using log-rank test. Results: One-hundred-and-twenty-nine individuals were enrolled into the study. TandemHeart system was used in 16 patients, PulseCath in 14 subjects, Impella 2.5 in 2 individuals and extracorporeal membrane oxygenation in veno-arterial configuration (VA-ECMO) in 111 patients. One-year mortality in the CS group (N=87) was 40.2%, in the ECPR group (N=33) 75.8% and in the NU group (N=23) 8.7%, P<0.001. In a subgroup of VA-ECMO treated patients, on-year mortality in CS individuals (N=71) reached 43.7%, mortality of ECPR (N=33) was 75.8% and mortality in NU subjects (N=7) was 14.3%, P<0.001. Conclusion: Mini-invasive MCS represents often last chance to survive severe circulatory collapse. The highest survival rate was found in patients with nonurgent MCS use, followed by CS patients and the worst survival was observed in the ECPR group. Nevertheless, our data indicate that this therapeutic option offers considerable long-term survival in these patients with extremely high predicted mortality (Figure presented).