Multicentre comparison of various microaxial pump devices as a bridge to durable assist device implantation
Abstract Aims Patients with acute decompensated advanced heart failure requiring left ventricular assist device (LVAD) implantation often experience progressive cardiac function deterioration, negatively impacting surgical outcomes. This study aimed to assess the efficacy of different microaxial flo...
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2025-08-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.15282 |
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| author | Marta L. Medina Daniel Lewin Hendrik Treede Sebastian V. Rojas Alexander Bernhardt Michael Billion Anna L. Meyer Ivan Netuka Janajade Kooij Marina Pieri Antonio Loforte Mauro Rinaldi Mariusz K. Szymanski Adriaan O. Kraajieveld Christian J.H. Moeller Payam Akhyari Khalil Jawad Bastian Schmack Gloria Färber Assad Haneya Daniel Zimpfer Gaik Nersesian Ilija Djordjevic Diyar Saeed Finn Gustafsson Anna M. Scandroglio Bart Meyns Steffen Hofmann Jan Belohlavek Jan Gummert Pia Lanmueller Evgenij V. Potapov Mehmet Oezkur |
| author_facet | Marta L. Medina Daniel Lewin Hendrik Treede Sebastian V. Rojas Alexander Bernhardt Michael Billion Anna L. Meyer Ivan Netuka Janajade Kooij Marina Pieri Antonio Loforte Mauro Rinaldi Mariusz K. Szymanski Adriaan O. Kraajieveld Christian J.H. Moeller Payam Akhyari Khalil Jawad Bastian Schmack Gloria Färber Assad Haneya Daniel Zimpfer Gaik Nersesian Ilija Djordjevic Diyar Saeed Finn Gustafsson Anna M. Scandroglio Bart Meyns Steffen Hofmann Jan Belohlavek Jan Gummert Pia Lanmueller Evgenij V. Potapov Mehmet Oezkur |
| author_sort | Marta L. Medina |
| collection | DOAJ |
| description | Abstract Aims Patients with acute decompensated advanced heart failure requiring left ventricular assist device (LVAD) implantation often experience progressive cardiac function deterioration, negatively impacting surgical outcomes. This study aimed to assess the efficacy of different microaxial flow pump (mAFP) support devices (Impella®) in achieving optimal left ventricular unloading for preconditioning and facilitating definitive treatment in this high‐risk patient cohort. Methods and results A retrospective analysis was conducted across 19 high‐volume European centres. The study population included patients transitioning from temporary to durable circulatory support over a 7.5‐year period, with a median follow‐up of 1 year. Patients were categorized based on mAFP support capacity: those receiving high‐flow support (>5 L/min, ‘5+’) and those with lower‐flow support (3.5 L/min, ‘CP’). Patients who were initially treated with CP but subsequently upgraded to 5+ support were classified in the 5+ group. Demographic and clinical characteristics, mobilization, right heart function, and organ dysfunction outcomes were analysed. A total of 339 patients received preoperative mAFP support prior to LVAD implantation. The 5+ group comprised 247 patients (73%), including 38 patients who were upgraded from CP, while the CP group included 92 patients (27%). Baseline demographic and clinical characteristics were comparable between groups, except for mobilization status, which showed significant differences (P < 0.001). Patients in the 5+ group achieved higher rates of full and partial mobilization compared to the CP group. Extracorporeal life support (ECLS) was more frequently required in the CP group than in the 5+ group (40.5% vs. 33.8%; P < 0.001). Additionally, right ventricular assist device (RVAD) implantation was significantly more common in the CP group (29.2% vs. 18.2%; P = 0.026). Patients in the 5+ group demonstrated greater reductions in both vasoactive inotropic scores (P = 0.006) and inotropic scores (P = 0.008). Furthermore, liver dysfunction (P = 0.016), renal failure (P = 0.041), and the need for dialysis (P = 0.013) were significantly more prevalent in the CP group. There were no significant differences between the two groups in terms of LVAD operative duration (P = 0.637) or cardiopulmonary bypass time (P = 0.408). Conclusions 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. |
| format | Article |
| id | doaj-art-dd5c1780cfd842fa8729872218ee3d06 |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-dd5c1780cfd842fa8729872218ee3d062025-08-20T03:36:08ZengWileyESC Heart Failure2055-58222025-08-011242552256410.1002/ehf2.15282Multicentre comparison of various microaxial pump devices as a bridge to durable assist device implantationMarta L. Medina0Daniel Lewin1Hendrik Treede2Sebastian V. Rojas3Alexander Bernhardt4Michael Billion5Anna L. Meyer6Ivan Netuka7Janajade Kooij8Marina Pieri9Antonio Loforte10Mauro Rinaldi11Mariusz K. Szymanski12Adriaan O. Kraajieveld13Christian J.H. Moeller14Payam Akhyari15Khalil Jawad16Bastian Schmack17Gloria Färber18Assad Haneya19Daniel Zimpfer20Gaik Nersesian21Ilija Djordjevic22Diyar Saeed23Finn Gustafsson24Anna M. Scandroglio25Bart Meyns26Steffen Hofmann27Jan Belohlavek28Jan Gummert29Pia Lanmueller30Evgenij V. Potapov31Mehmet Oezkur32Department of Cardiac and Vascular Surgery University Medical Center of the Johannes Gutenberg University Mainz Mainz GermanyDepartment of Cardiothoracic and Vascular Surgery Deutsches Herzzentrum der Charité (DHZC) Berlin GermanyDepartment of Cardiac and Vascular Surgery University Medical Center of the Johannes Gutenberg University Mainz Mainz GermanyHeart and Diabetes Center, North Rhine‐Westphalia Bad Oeynhausen GermanyDepartment of Cardiovascular Surgery University Heart Center Hamburg Hamburg GermanyDepartment of Cardiac Surgery Schüchtermann Clinic Bad Rothenfelde GermanyDepartment of Cardiac Surgery Heidelberg University Hospital Heidelberg GermanyInstitute of Clinical and Experimental Medicine Prague Czech RepublicDepartment of Cardiac Surgery University Hospitals Leuven Leuven BelgiumDepartment of Anesthesia and Intensive Care IRCCS San Raffaele Scientific Institute Milan ItalyDeparment of Cardiac Surgery, IRCCS Bologna St. Orsola University Hospital Bologna ItalyDepartment of Surgical Sciences University of Turin Turin ItalyDepartment of Cardiology University Medical Center Utrecht Utrecht NetherlandsDepartment of Cardiology University Medical Center Utrecht Utrecht NetherlandsDepartment of Cardiothoracic Surgery Rigshospitalet Copenhagen DenmarkDepartment of Cardiovascular Surgery University Hospital Duesseldorf Duesseldorf GermanyDepartment of Cardiac Surgery Leipzig Heart Center Leipzig GermanyDepartment of Cardiac Surgery University of Essen Essen GermanyDepartment of Cardiothoracic Surgery Jena University Hospital Jena GermanyDepartment of Cardiovascular Surgery University Hospital Schleswig‐Holstein Kiel GermanyDepartment of Surgery, Division of Cardiac Surgery Medical University of Vienna Vienna AustriaDepartment of Cardiothoracic and Vascular Surgery Deutsches Herzzentrum der Charité (DHZC) Berlin GermanyDepartment of Cardiothoracic Surgery University Hospital Cologne Cologne GermanyDepartment of Cardiac Surgery Leipzig Heart Center Leipzig GermanyDepartment of Cardiothoracic Surgery Rigshospitalet Copenhagen DenmarkDepartment of Anesthesia and Intensive Care IRCCS San Raffaele Scientific Institute Milan ItalyDepartment of Cardiac Surgery University Hospitals Leuven Leuven BelgiumDepartment of Cardiac Surgery Schüchtermann Clinic Bad Rothenfelde GermanyInstitute of Clinical and Experimental Medicine Prague Czech RepublicHeart and Diabetes Center, North Rhine‐Westphalia Bad Oeynhausen GermanyDepartment of Cardiothoracic and Vascular Surgery Deutsches Herzzentrum der Charité (DHZC) Berlin GermanyDepartment of Cardiothoracic and Vascular Surgery Deutsches Herzzentrum der Charité (DHZC) Berlin GermanyDepartment of Cardiac and Vascular Surgery University Medical Center of the Johannes Gutenberg University Mainz Mainz GermanyAbstract Aims Patients with acute decompensated advanced heart failure requiring left ventricular assist device (LVAD) implantation often experience progressive cardiac function deterioration, negatively impacting surgical outcomes. This study aimed to assess the efficacy of different microaxial flow pump (mAFP) support devices (Impella®) in achieving optimal left ventricular unloading for preconditioning and facilitating definitive treatment in this high‐risk patient cohort. Methods and results A retrospective analysis was conducted across 19 high‐volume European centres. The study population included patients transitioning from temporary to durable circulatory support over a 7.5‐year period, with a median follow‐up of 1 year. Patients were categorized based on mAFP support capacity: those receiving high‐flow support (>5 L/min, ‘5+’) and those with lower‐flow support (3.5 L/min, ‘CP’). Patients who were initially treated with CP but subsequently upgraded to 5+ support were classified in the 5+ group. Demographic and clinical characteristics, mobilization, right heart function, and organ dysfunction outcomes were analysed. A total of 339 patients received preoperative mAFP support prior to LVAD implantation. The 5+ group comprised 247 patients (73%), including 38 patients who were upgraded from CP, while the CP group included 92 patients (27%). Baseline demographic and clinical characteristics were comparable between groups, except for mobilization status, which showed significant differences (P < 0.001). Patients in the 5+ group achieved higher rates of full and partial mobilization compared to the CP group. Extracorporeal life support (ECLS) was more frequently required in the CP group than in the 5+ group (40.5% vs. 33.8%; P < 0.001). Additionally, right ventricular assist device (RVAD) implantation was significantly more common in the CP group (29.2% vs. 18.2%; P = 0.026). Patients in the 5+ group demonstrated greater reductions in both vasoactive inotropic scores (P = 0.006) and inotropic scores (P = 0.008). Furthermore, liver dysfunction (P = 0.016), renal failure (P = 0.041), and the need for dialysis (P = 0.013) were significantly more prevalent in the CP group. There were no significant differences between the two groups in terms of LVAD operative duration (P = 0.637) or cardiopulmonary bypass time (P = 0.408). Conclusions 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.https://doi.org/10.1002/ehf2.15282Microaxial flow pumpDurable mechanical circulatory supportCardiogenic shockImpellaLeft heart failure |
| spellingShingle | Marta L. Medina Daniel Lewin Hendrik Treede Sebastian V. Rojas Alexander Bernhardt Michael Billion Anna L. Meyer Ivan Netuka Janajade Kooij Marina Pieri Antonio Loforte Mauro Rinaldi Mariusz K. Szymanski Adriaan O. Kraajieveld Christian J.H. Moeller Payam Akhyari Khalil Jawad Bastian Schmack Gloria Färber Assad Haneya Daniel Zimpfer Gaik Nersesian Ilija Djordjevic Diyar Saeed Finn Gustafsson Anna M. Scandroglio Bart Meyns Steffen Hofmann Jan Belohlavek Jan Gummert Pia Lanmueller Evgenij V. Potapov Mehmet Oezkur Multicentre comparison of various microaxial pump devices as a bridge to durable assist device implantation ESC Heart Failure Microaxial flow pump Durable mechanical circulatory support Cardiogenic shock Impella Left heart failure |
| title | Multicentre comparison of various microaxial pump devices as a bridge to durable assist device implantation |
| title_full | Multicentre comparison of various microaxial pump devices as a bridge to durable assist device implantation |
| title_fullStr | Multicentre comparison of various microaxial pump devices as a bridge to durable assist device implantation |
| title_full_unstemmed | Multicentre comparison of various microaxial pump devices as a bridge to durable assist device implantation |
| title_short | Multicentre comparison of various microaxial pump devices as a bridge to durable assist device implantation |
| title_sort | multicentre comparison of various microaxial pump devices as a bridge to durable assist device implantation |
| topic | Microaxial flow pump Durable mechanical circulatory support Cardiogenic shock Impella Left heart failure |
| url | https://doi.org/10.1002/ehf2.15282 |
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