Longitudinal Impact of Temporary Mechanical Circulatory Support on Durable Left Ventricular Assist Device Outcomes: An IMACS Registry Analysis

Purpose To characterize longitudinal outcomes of durable LVAD patients presenting with preoperative cardiogenic shock according to temporary circulatory support (TCS) management strategy. Methods Patients (n=13813) enrolled into IMACS (2013-2017) supported with continuous flow LVADs were analyzed. Patients were grouped according to use of TCS vs. no TCS by Profile. TCS patients were subgrouped according to support type (ECMO, IABP, other-TCS) and morbidity and mortality were analyzed. Results TCS was used in 5631 (42%) patients in IMACS. Of these, ECMO was used in 1138 (20%), IABP in 3901 (69%), and other-TCS in 595 (11%). More patients on ECMO had ischemic cardiomyopathy (52% ECMO, 44% IABP, 42% Other-TCS, 40% no-TCS, p Conclusion In cardiogenic shock patients, the use of ECMO prior to LVAD was associated with lower survival, longer ICU stay and more RV failure compared to other TCS. ECMO patients with persistent RV failure have the worst prognosis.