IMPACT OF HEMOLYSIS DURING MICRO-AXIAL FLOW PUMP SUPPORT ON EARLY OUTCOMES AFTER DURABLE LVAD IMPLANTATION: INSIGHTS FROM AN INTERNATIONAL REGISTRY

Aim and Background: The impact of hemolysis during micro-axial flow pump (mAFP, Impella, Abiomed) support on early outcomes after durable left ventricular assist device (d-LVAD) implantation is unknown. Methods: Among 341 patients undergoing d-LVAD implantation after mAFP support, between January 2017 and December 2022, at 19 international Institutions, 311 were retrospectively included (male gender 82.6%, median age 58 years, Impella 5.0/5.5 72.3%, HeartMate III 57.7%). The incidence and predictors of hemolysis, as well as its impact on early post-d-LVAD outcomes were assessed. The primary outcome was a composite of hemocompatibility-related adverse events (HRAEs: stroke, gastrointestinal bleeding, pump thrombosis). Results: Hemolysis occurred in 40.8% of the patients. Impella 2.5/CP vs. 5.0/5.5 was the single independent predictor of hemolysis (adj-HR 2.68, 95%CI 1.04-6.94, p=0.031). Post- d-LVAD HRAEs occurred more frequently among patients with hemolysis (31.9% vs. 20.6%, p=0.041), mainly driven by hemorrhagic stroke and gastro-intestinal bleeding. At multivariate analysis, hemolysis remained independently associated with HRAEs (adj-HR 1.62, 95%CI 1.02-2.58, p=0.041), together with higher body surface area (p<0.001) and female sex (p=0.004). Patients with hemolysis were more likely to need a temporary right ventricular assist device following d-LVAD implantation (28.3% vs. 16.8%, p=0.012) and to undergo early heart transplantation (17.4% vs. 8.6%, p=0.031), while no difference in mortality was observed (23.6% vs 21.2%, p=0.355). Conclusions: Among patients undergoing d-LVAD implantation with mAFP bridge, hemolysis during mAFP support is common, occurs more frequently among patients supported with Impella 2.5/CP, and is an independent predictor of post- d-LVAD early HRAEs, mainly driven by bleeding events

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Journal
Journal of Cardiovascular Medicine
Published
2024-12-01
DOI
https://doi.org/10.2459/01.jcm.0001096324.76097.a5
Primary Topic
Mechanical Circulatory Support Devices
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article
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article

IMPACT OF HEMOLYSIS DURING MICRO-AXIAL FLOW PUMP SUPPORT ON EARLY OUTCOMES AFTER DURABLE LVAD IMPLANTATION: INSIGHTS FROM AN INTERNATIONAL REGISTRY

Julia Stein, Cathrine M. Moeller, Anna L. Meyer, Assad Haneya et al.
Journal of Cardiovascular Medicine
Mechanical Circulatory Support Devices
article

IMPACT OF HEMOLYSIS DURING MICRO-AXIAL FLOW PUMP SUPPORT ON EARLY OUTCOMES AFTER DURABLE LVAD IMPLANTATION: INSIGHTS FROM AN INTERNATIONAL REGISTRY

Julia Stein, Cathrine M. Moeller, Anna L. Meyer, Assad Haneya, Gaik Nersesian, Massimo Boffini, Finn Gustafsson, Jan Fritz Gummert, M. Szymanski, Daniel Lewin, Antonio Loforte, Payam Akhyari, D. Saeed, Daniel Zimpfer, Michael Billion, Ilija Djordjevic, Antonio Spitaleri, Evgenij Potapov, B. Schmack, Jan Bělohlávek, Marina Pieri, Ihor Krasivskyi, Ivan Netuka, Mehmet Oezkur, K. Jawad, Silke Hofmann, Bart Meyns, Guglielmo Gallone, J. J. Sandra Kooij, A. Bernhardt, Pia Lanmüller, Gloria Färber, Salvador Hernández, G. Monteleone, Mauro Rinaldi, M. Medina, Mara Scandroglio
article en

Abstract

Aim and Background: The impact of hemolysis during micro-axial flow pump (mAFP, Impella, Abiomed) support on early outcomes after durable left ventricular assist device (d-LVAD) implantation is unknown. Methods: Among 341 patients undergoing d-LVAD implantation after mAFP support, between January 2017 and December 2022, at 19 international Institutions, 311 were retrospectively included (male gender 82.6%, median age 58 years, Impella 5.0/5.5 72.3%, HeartMate III 57.7%). The incidence and predictors of hemolysis, as well as its impact on early post-d-LVAD outcomes were assessed. The primary outcome was a composite of hemocompatibility-related adverse events (HRAEs: stroke, gastrointestinal bleeding, pump thrombosis). Results: Hemolysis occurred in 40.8% of the patients. Impella 2.5/CP vs. 5.0/5.5 was the single independent predictor of hemolysis (adj-HR 2.68, 95%CI 1.04-6.94, p=0.031). Post- d-LVAD HRAEs occurred more frequently among patients with hemolysis (31.9% vs. 20.6%, p=0.041), mainly driven by hemorrhagic stroke and gastro-intestinal bleeding. At multivariate analysis, hemolysis remained independently associated with HRAEs (adj-HR 1.62, 95%CI 1.02-2.58, p=0.041), together with higher body surface area (p<0.001) and female sex (p=0.004). Patients with hemolysis were more likely to need a temporary right ventricular assist device following d-LVAD implantation (28.3% vs. 16.8%, p=0.012) and to undergo early heart transplantation (17.4% vs. 8.6%, p=0.031), while no difference in mortality was observed (23.6% vs 21.2%, p=0.355). Conclusions: Among patients undergoing d-LVAD implantation with mAFP bridge, hemolysis during mAFP support is common, occurs more frequently among patients supported with Impella 2.5/CP, and is an independent predictor of post- d-LVAD early HRAEs, mainly driven by bleeding events

Journal of Cardiovascular MedicineVol. 25(Supplement 1Supplement 1)
Vita-Salute San Raffaele University (IT), Universität Hamburg (DE), Johannes Gutenberg University Mainz (DE), Charles University (CZ), Heidelberg University (DE), Heart and Diabetes Center North Rhine-Westphalia (DE), University Hospital Heidelberg (DE), Rigshospitalet (DK), University Medical Center Utrecht (NL), Düsseldorf University Hospital (DE), Deutsches Herzzentrum der Charité (DE), University Medical Center Hamburg-Eppendorf (DE), Schüchtermann-Klinik (DE), University Hospital Schleswig-Holstein (DE), Leipzig Heart Institute (DE), Institute of Clinical and Experimental Medicine (CZ), Jena University Hospital (DE), Istituti di Ricovero e Cura a Carattere Scientifico (IT), University Hospital Cologne (DE), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), Heinrich Heine University Düsseldorf (DE), University of Turin (IT), Medical University of Vienna (AT), Charité - Universitätsmedizin Berlin (DE), University of Lübeck (DE), KU Leuven (BE)
Openalex Percentile: Top 79%
Mechanical Circulatory Support Devices
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