Impact of Hemolysis During Microaxial Flow Pump Support on Early Outcomes After Durable Left Ventricular Assist Device Implantation

The impact of hemolysis during microaxial flow pump (mAFP; Impella, Danvers, Massachusetts, US) support on early outcomes after durable left ventricular assist device (d-LVAD) implantation is unknown. Three hundred and eleven consecutive patients undergoing d-LVAD implantation after mAFP support (Impella 5.0/5.5 72.3%) were retrospectively included. The incidence and predictors of hemolysis (plasma-free hemoglobin >20 mg/dl or lactic dehydrogenase (LDH) >2.5-fold the upper reference limit) before d-LVAD implantation were assessed, along with its impact on early post-d-LVAD outcomes. The primary outcome was a composite of hemocompatibility-related adverse events (HRAEs: stroke/gastrointestinal bleeding/pump thrombosis). Hemolysis occurred in 40.8%. Impella 2.5/CP versus 5.0/5.5 was the single independent predictor of hemolysis (adj-hazard ratio [HR] = 2.68, 95% confidence interval [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 gastrointestinal bleeding. At multivariate analysis, hemolysis remained independently associated with HRAEs (adj-HR = 1.62, 95% CI = 1.02-2.58; p = 0.041). 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), with no difference in mortality (23.6% vs . 21.2%; p = 0.355). In conclusion, among patients undergoing d-LVAD implantation with mAFP bridge, hemolysis is common, occurs more frequently among patients supported with Impella 2.5/CP, and is an independent predictor of post-d-LVAD HRAEs.

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Journal
ASAIO Journal
Published
2025-05-06
DOI
https://doi.org/10.1097/mat.0000000000002451
Citations
3
Primary Topic
Mechanical Circulatory Support Devices
Type
article
Field-Weighted Citation Impact
2.02
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article

Impact of Hemolysis During Microaxial Flow Pump Support on Early Outcomes After Durable Left Ventricular Assist Device Implantation

Julia Stein, Anna L. Meyer, Assad Haneya, Gaik Nersesian et al.
3 citations
ASAIO Journal
Mechanical Circulatory Support Devices
2.02
article

Impact of Hemolysis During Microaxial Flow Pump Support on Early Outcomes After Durable Left Ventricular Assist Device Implantation

Julia Stein, Anna L. Meyer, Assad Haneya, Gaik Nersesian, Massimo Boffini, Finn Gustafsson, Jan Fritz Gummert, Evgenij V Potapov, Daniel Lewin, Antonio Loforte, Payam Akhyari, Daniel Zimpfer, A. Bernhardt, Janajade Kooij, Diyar Saeed, Michael Billion, Ilija Djordjevic, Antonio Spitaleri, Khalil Jawad, Mauro Rinaldi, Jan Bělohlávek, Marina Pieri, Ihor Krasivskyi, Gaetano Maria De Ferrari, Sebastian Rojas Hernandez, Ivan Netuka, Mehmet Oezkur, Bart Meyns, Guglielmo Gallone, Christian H. Moeller, Marta Medina, Bastian Schmack, Gloria Färber, Mariusz K. Szymanski, Steffen Hofmann, Pia Lanmüeller, Anna Mara Scandroglio
article en
3 citations

Abstract

The impact of hemolysis during microaxial flow pump (mAFP; Impella, Danvers, Massachusetts, US) support on early outcomes after durable left ventricular assist device (d-LVAD) implantation is unknown. Three hundred and eleven consecutive patients undergoing d-LVAD implantation after mAFP support (Impella 5.0/5.5 72.3%) were retrospectively included. The incidence and predictors of hemolysis (plasma-free hemoglobin >20 mg/dl or lactic dehydrogenase (LDH) >2.5-fold the upper reference limit) before d-LVAD implantation were assessed, along with its impact on early post-d-LVAD outcomes. The primary outcome was a composite of hemocompatibility-related adverse events (HRAEs: stroke/gastrointestinal bleeding/pump thrombosis). Hemolysis occurred in 40.8%. Impella 2.5/CP versus 5.0/5.5 was the single independent predictor of hemolysis (adj-hazard ratio [HR] = 2.68, 95% confidence interval [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 gastrointestinal bleeding. At multivariate analysis, hemolysis remained independently associated with HRAEs (adj-HR = 1.62, 95% CI = 1.02-2.58; p = 0.041). 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), with no difference in mortality (23.6% vs . 21.2%; p = 0.355). In conclusion, among patients undergoing d-LVAD implantation with mAFP bridge, hemolysis is common, occurs more frequently among patients supported with Impella 2.5/CP, and is an independent predictor of post-d-LVAD HRAEs.

ASAIO JournalVol. 72(3)
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), Medizinische Hochschule Hannover (DE), Wroclaw Medical University (PL), 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), German Centre for Cardiovascular Research (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)
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Openalex Percentile: Top 14%
Mechanical Circulatory Support Devices
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