Heart failure & cardiomyopathies
Multicentre Comparison of Various Microaxial Pump Devices as a Bridge to Durable Assist Device Implantation
Authors' conclusion
High-flow mAFP devices (+5) provided superior haemodynamic support, enhanced left ventricular unloading, and reduced dependence on catecholamines compared to lower-flow CP devices. These improvements were associated with lower rates of right ventricular failure, renal dysfunction, and liver injury. However, no statistically significant difference was observed between mAFP groups regarding 30-day mortality rates.
Study context
- Population
- Patients with acute decompensated advanced heart failure transitioning from temporary microaxial flow pump (Impella®) support to durable left ventricular assist device (LVAD) implantationpatients who received preoperative microaxial flow pump (mAFP) support prior to LVAD implantation
- Participants
- 339 patients
- Exposure
- High-flow vs lower-flow mAFP support as bridge to LVAD
- 5+n = 247
- CPn = 92
- Outcome
- Mobilization status
Methodological details19 high-volume European centres, 7.5-year period, median follow-up of 1 year
- 19 high-volume European centres
- 7.5-year period
- Median follow-up of 1 year
Main finding
As reported in the abstract
- Higher rates of full and partial mobilization in the 5+ group compared to the CP group
- P < 0.001
Observational data: associations, not effects.
Further findings
Extracorporeal life support (ECLS) required · more frequent in the CP group
P < 0.001
RVAD implantation · more common in the CP group
P = 0.026
Reduction in vasoactive inotropic scores and inotropic scores
- Greater reduction in vasoactive inotropic scores in the 5+ group
- P = 0.006
- Greater reduction in inotropic scores in the 5+ group
- P = 0.008
Liver dysfunction, renal failure, need for dialysis
- Liver dysfunction more prevalent in the CP group
- P = 0.016
- Renal failure more prevalent in the CP group
- P = 0.041
- Need for dialysis more prevalent in the CP group
- P = 0.013
LVAD operative duration and cardiopulmonary bypass time
- No significant difference in LVAD operative duration
- P = 0.637
- No significant difference in cardiopulmonary bypass time
- P = 0.408
Baseline characteristics
- Baseline demographic and clinical characteristics comparable between groups, except mobilization status
Original publication
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