Contemporary Outcomes for Cardiogenic Shock Patients Bridged to Advanced Heart Therapies with Temporary Mechanical Circulatory Support

Purpose The use of temporary mechanical circulatory support (tMCS) as a bridge to advanced heart replacement therapies (HRT) has increased in the context of the new heart transplant allocation system. As such, it is important to assess contemporary outcomes for this patient population. The purpose of this study was to assess outcomes of cardiogenic shock patients that were bridged with tMCS to HRT since the allocation system changes. Methods All adult cardiogenic shock patients that were bridged with tMCS to either heart transplantation (OHT) or durable left ventricular assist device (LVAD) at our center between October 2018 and September 2020 were identified. The tMCS devices included extracorporeal membrane oxygenation (ECMO), Impella, or temporary surgical VAD. Early and late clinical outcomes were assessed. Results A total of 33 cardiogenic shock patients were bridged to HRT using tMCS devices (OHT = 12, LVAD = 21). Most patients were male (84.9%) and the median age for all patients was 53 years. In terms of initial tMCS therapy, ECMO was used most commonly (64%) followed by Impella (24%) and temporary surgical VAD (12%). Ten patients (30%) required a second bridge-to-bridge device prior to HRT. Median duration of tMCS support for OHT and LVAD patients were 15.5 days (IQR 6.25-25) and 8 days (IQR 5-18.5), respectively. There were no in-hospital or 30-day mortality events. There was one late death in the VAD group at 16 months. Kaplan-meier curve (Figure 1) shows overall survival with median follow up of 8 months. Conclusion Cardiogenic shock patients can be bridged to HRT using contemporary tMCS technology and management with excellent early- and mid-term outcomes.