Outcomes of patients with cardiogenic shock treated with TandemHeart® percutaneous ventricular assist device: Importance of support indication and definitive therapies as determinants of prognosis

OBJECTIVES: The objective of this study was to review the characteristics of patients in cardiogenic shock treated with TandemHeart® percutaneous ventricular assist device (pVAD) to determine influential predictors of survival. BACKGROUND: The TandemHeart® pVAD is used in the management of patients with cardiogenic shock resulting from a variety of conditions. Several studies have documented the efficacy of this therapy and outlined its complications. Still, there is little data to guide the effective and appropriate use of this resource. METHODS: Patients referred for TandemHeart® pVAD implant for refractory cardiogenic shock at the University of Virginia between September 2007 and October 2015 were retrospectively analyzed. Univariate analysis was used to identify predictors of mortality. RESULTS: Fifty-five patients underwent successful TandemHeart® implant. Hemodynamics significantly improved following TandemHeart® implant. Cardiac index increased from 1.8 ± 0.6 to 3.1 ± 1.0 L/min/m2 (P = 0.007) and pulmonary capillary wedge pressure decreased from 30. 5 ± 9.9 to 19.6 ± 7.4 mmHg (P =0.0007). Survival was significantly influenced by implant indication with 23.8% surviving in bridge to recovery vs. 51% in bridge to LVAD or surgery (P = 0.04). In patients who did not receive definitive therapy, only 4 (13.8%) were weaned from TandemHeart® support and survived to hospital discharge. Only younger age, 51.8 vs. 62.7 years, predicted survival to hospital discharge (P = 0.004). CONCLUSION: Mortality from refractory cardiogenic shock is high even with TandemHeart® support. Our study found that patients with an exit strategy with either cardiac surgery or durable LVAD implant significantly influenced survival to hospital discharge.