Rates and impact of vascular complications in mechanical circulatory support

Area of Science:

• Cardiology
• Vascular Surgery
• Critical Care Medicine

Background:

• Mechanical circulatory support (MCS) devices are crucial for hemodynamic support in critical cardiac conditions.
• Vascular complications are a significant concern with MCS, impacting patient morbidity and mortality.
• Data on vascular complication rates and predictors for large-bore access MCS in the current era are limited.

Purpose of the Study:

• To analyze the rates and predictors of vascular complications associated with contemporary large-bore access Mechanical Circulatory Support (MCS) devices.
• To compare in-hospital outcomes among patients experiencing vascular complications with different MCS devices.

Main Methods:

• A retrospective analysis of cardiac hospitalizations utilizing MCS devices (IABP, Impella, ECMO) from 2015-2019 was conducted using the National Inpatient Sample database.
• Rates of vascular complications and in-hospital mortality were analyzed.
• Multivariable logistic regression was employed to identify predictors of vascular complications and compare outcomes across different MCS types.

Main Results:

• The study included 221,700 hospitalizations with MCS; IABP was most common (68%).
• Vascular complication rates were highest with ECMO (15.8%), followed by Impella (5.6%) and IABP (3.0%).
• Peripheral arterial disease (PAD) was the strongest predictor (aOR 10.96), and ECMO use showed significantly higher odds of complications (aOR 5.35) compared to IABP.

Conclusions:

• Contemporary MCS use is associated with considerable vascular complications and in-hospital mortality.
• Key predictors include larger arteriotomy size, female gender, and peripheral arterial disease.
• Effective vascular access management is critical for mitigating major complications in MCS patients.