Validation Study of a Survival Predictor Formula for Patients Bridged from Extracorporeal Life Support (ECLS) to Durable Mechanical Circulatory Support Systems: On behalf of Durable MCS after ECLS Study Group

Background: Our group recently published the largest series of patients who were supported with durable mechanical circulatory support systems (MCS) after extra corporeal life support (ECLS). Based on those data (up to June 2018), a formula was generated that predict 1 year survival. However, no validation studies have been performed yet. The aim of this study was to validate the previously described survival predictor.

Method: Data of patients undergoing durable MCS implantation between June 2018 and December 2021 at 11 heart centers (including additional centers not included in the primary study) are collected and evaluated. Inclusion criteria were patients with ECLS support prior to durable MCS implantation. The primary outcome was 1 year survival. The probability of 1-year survival was calculated based on the published formula including age, gender, BMI, history of previous cardiac surgeries or atrial fibrillation, MELD XI score, and lactate value on ECLS prior to durable MCS implantation. The expected survival was compared with the observed year survival using ROC Curve and Brier Score.

Results: A total of 163 patients met the inclusion criteria. Three out of these patients had missing data needed for score calculation and were excluded. The average age of the remaining 160 patients was 57 years (IQR: 49–63). The majority of the patients (84%) were male and 28% of the patients had dilative cardiomyopathy. Up to 33% of the patients had history of cardiopulmonary resuscitation prior to the ECLS implantation. The median ECLS support duration prior to durable device implantation was 5 days (IQR: 3–9). Type of implanted pump included HeartWare HVAD (39%), HeartMate III (57%), and other pumps (4%). Postoperative complications included right heart failure requiring temporary right VAD in 42% of patients and bleeding requiring resternotomy in 27%. The 30-day, 1-year, and 2-year survival rates were 87, 70, and 64%, respectively. The analyses of predicted and observed year mortality show a specificity of 68% and a sensitivity of 73%. Area under the ROC curve was 0.76 and the Brier score was 0.20.

Conclusion: The survival prediction formula enables a good estimation of 1 year survival in these patient populations. The survival rate has significantly improved compared with our previous study possibly related to better patient selection in the recent years. Nevertheless, it remains lower than the outcome after conventional durable MCS implantation cases.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
28 January 2023