Impact of partial- to full-support escalation with microaxial flow pumps prior to durable left ventricular assist device implantation

OBJECTIVES: Microaxial flow pumps (mAFP) effectively bridge cardiogenic shock patients to durable left ventricular assist device (dLVAD) implantation. The partial-support mAFPs provide only up to 3.5 L/min, which might be insufficient for an effective circulatory support and preconditioning for a dLVAD implantation. Alternatively, patients with refractory shock on partial-support may benefit from an escalation to a full-support mAFP. METHODS: A retrospective analysis of 130 patients was performed across 17 European cardiac centers who underwent dLVAD implantation following mAFP with or without venoarterial extracorporeal life support (VA-ECLS) between February 2015 and August 2022. Ninety-two patients (70.8%) were bridged on partial-support mAFP, while 38 patients (29.2%) underwent an escalation to full-support mAFP. RESULTS: Median support duration was significantly longer in the escalation group (7d [4, 11] vs 12d [9, 21], p < 0.001). Patients in the escalation group were more likely to be weaned from va-ECLS before dLVAD implantation, 10 (71.4%) vs 6 (11.3%), p < 0.001. 30-day survival was similar between the escalation and no-escalation groups, 89.5% vs 84.8% (IPTW-weighted OR 1.00 [95% CI: 0.46, 2.22], p = 0.992). Estimated 1-year survival was higher in the escalation group: 84.0% [95% CI: 73.0, 96.6] vs 63.7% [95% CI: 54.3, 74.6], HR 0.41 [95% CI: 0.17, 0.99], p = 0.048. Patients with combination of partial-support mAFP and VA-ECLS had a higher mortality risk than all other patients, HR 2.06 [95% CI: 1.16, 3.36], p = 0.013. CONCLUSIONS: In patients with partial-support mAFP and concomitant VA-ECLS, an escalation to a full-support mAFP may translate to improved survival and should be considered to facilitate VA-ECLS weaning.

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Journal
European Journal of Cardio-Thoracic Surgery
Published
2026-05-01
DOI
https://doi.org/10.1093/ejcts/ezag165
Primary Topic
Mechanical Circulatory Support Devices
Type
article
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article

Impact of partial- to full-support escalation with microaxial flow pumps prior to durable left ventricular assist device implantation

Anna L. Meyer, Daniel Lewin, Payam Akhyari, S Ott et al.
European Journal of Cardio-Thoracic Surgery
Mechanical Circulatory Support Devices
article

Impact of partial- to full-support escalation with microaxial flow pumps prior to durable left ventricular assist device implantation

Anna L. Meyer, Daniel Lewin, Payam Akhyari, S Ott, Michael Billion, Bastian Schmack, Gloria Färber, Mariusz K. Szymanski, Pia Lanmüeller, Mara Scandroglio, A Loforte, Gaik Nersesian, Felix Schoenrath, Janajade Koij, Leonard Pitts, Ivan Netuka, Christian H Moller, Diyar Saeed, Sebastian V Rojas³, Assad Haneya, Marina Pieri, Alexander Bernhardt, Ihor Krasivski, Evgenij Potapov
article en

Abstract

OBJECTIVES: Microaxial flow pumps (mAFP) effectively bridge cardiogenic shock patients to durable left ventricular assist device (dLVAD) implantation. The partial-support mAFPs provide only up to 3.5 L/min, which might be insufficient for an effective circulatory support and preconditioning for a dLVAD implantation. Alternatively, patients with refractory shock on partial-support may benefit from an escalation to a full-support mAFP. METHODS: A retrospective analysis of 130 patients was performed across 17 European cardiac centers who underwent dLVAD implantation following mAFP with or without venoarterial extracorporeal life support (VA-ECLS) between February 2015 and August 2022. Ninety-two patients (70.8%) were bridged on partial-support mAFP, while 38 patients (29.2%) underwent an escalation to full-support mAFP. RESULTS: Median support duration was significantly longer in the escalation group (7d [4, 11] vs 12d [9, 21], p < 0.001). Patients in the escalation group were more likely to be weaned from va-ECLS before dLVAD implantation, 10 (71.4%) vs 6 (11.3%), p < 0.001. 30-day survival was similar between the escalation and no-escalation groups, 89.5% vs 84.8% (IPTW-weighted OR 1.00 [95% CI: 0.46, 2.22], p = 0.992). Estimated 1-year survival was higher in the escalation group: 84.0% [95% CI: 73.0, 96.6] vs 63.7% [95% CI: 54.3, 74.6], HR 0.41 [95% CI: 0.17, 0.99], p = 0.048. Patients with combination of partial-support mAFP and VA-ECLS had a higher mortality risk than all other patients, HR 2.06 [95% CI: 1.16, 3.36], p = 0.013. CONCLUSIONS: In patients with partial-support mAFP and concomitant VA-ECLS, an escalation to a full-support mAFP may translate to improved survival and should be considered to facilitate VA-ECLS weaning.

European Journal of Cardio-Thoracic Surgery
Vita-Salute San Raffaele University (IT), Universität Hamburg (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), Humboldt-Universität zu Berlin (DE), Düsseldorf University Hospital (DE), IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT), Helios Klinikum Krefeld (DE), Deutsches Herzzentrum der Charité (DE), University Medical Center Hamburg-Eppendorf (DE), Schüchtermann-Klinik (DE), University Hospital Schleswig-Holstein (DE), Azienda USL di Bologna (IT), Essen University Hospital (DE), Universitätsklinikum Aachen (DE), German Centre for Cardiovascular Research (DE), Institute of Clinical and Experimental Medicine (CZ), Department of Medical Sciences (BY), 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), University of Duisburg-Essen (DE), Charité - Universitätsmedizin Berlin (DE), RWTH Aachen University (DE), University of Lübeck (DE), University of Bologna (IT), KU Leuven (BE)
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Mechanical Circulatory Support Devices
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