Surgical Microaxial Pump Catheters as Bridge to Permanent Mechanical Circulatory Support in Patients with Left Ventricular Failure: Who Makes It?

Objectives: Surgical microaxial pump catheters (maPC) are increasingly used to bridge patients with left ventricular (LV) failure to permanent mechanical circulatory support (MCS), as they can provide temporary LV support with up to 5.0 to 5.5 L/min and mimic hemodynamic status of left ventricular assist device (LVAD) implantation. Here, we describe our first experiences using surgical maPCs as bridge to permanent MCS.

Methods: Between 11/2018 and 08/2020, a total of 48 patients with LV failure were treated in our center with surgical maPCs. Patients in whom surgical maPC could be weaned after sufficient restitution of LV function (n = 17) were excluded from this study. The remaining 31 patients could not be weaned from LV mechanical support and, hence, were retrospectively analyzed in this study comparing patients who directly transitioned to permanent MCS/heart transplantation (pMCS/HTx) with those who remained on temporary MCS (tMCS).

Result: Permanent MCS was initiated in six patients (19.5%) via LVAD implantation with 66.7% of the patients requiring additional temporary RVAD implantation, while two patients (6.5%) received HTx. Thirty-day survival was 100% in the pMCS/HTx-group. In the remaining 23 patients (79.3%), permanent MCS was not initiated due to persistent multi organ failure and/or septic shock (74.9%) or futile cerebral insult/hemorrhage (26.1%), leading to 100% mortality within 24 hours after withdrawal of maPC support. Mean duration on maPC support was 14.0 ± 4.8 days for the pMCS/HTx-group and 11.2± 15.8 for the tMCS group. There were no significant differences between both groups regarding patient characteristics; however, pMCS/HTx patients tended to be younger (55.0 ± 11.7 vs. 63.3 ± 10.3, p = 0.05) and with less incidence of cardiac surgery leading to LV failure (25.0 vs. 56.5%, p = 0.12). Notably, concomitant need for additional RV or circulatory support via ECLS was also comparable in both groups (62.5 vs. 56.5%, p = 0.77). Furthermore, although not statistically significant, there was a trend toward more impaired end-organ function in the pMCS-group, with higher lactate, creatine and bilirubin values at time of maPC initiation.

Conclusion: Surgical maPCs can be employed to successfully bridge patients with left ventricular failure to permanent MCS/HTx, either as isolated temporary LV support or in combination with ECLS in cases of biventricular failure. However, more studies are strongly warranted to further determine patient selection criteria and elucidate on optimal MCS treatment strategies.

Publication History

Article published online:
19 February 2021