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Impact of Hemolysis During Microaxial Flow Pump Support on Early Outcomes After Durable Left Ventricular Assist
Guglielmo Gallone1, Daniel Lewin2,3, Antonio Spitaleri4
1From the City of Health and Science Hospital, Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy.
The impact of hemolysis during microaxial flow pump (mAFP; Impella, Danvers, Massachusetts, US) support on early outcomes after durable left ventricular assist device (d-LVAD) implantation is unknown. Three hundred and eleven consecutive patients undergoing d-LVAD implantation after mAFP support (Impella 5.0/5.5 72.3%) were retrospectively included. The incidence and predictors of hemolysis (plasma-free hemoglobin >20 mg/dl or lactic dehydrogenase (LDH) >2.5-fold the upper reference limit) before d-LVAD implantation were assessed, along with its impact on early post-d-LVAD outcomes. The primary outcome was a composite of hemocompatibility-related adverse events (HRAEs: stroke/gastrointestinal bleeding/pump thrombosis). Hemolysis occurred in 40.8%. Impella 2.5/CP versus 5.0/5.5 was the single independent predictor of hemolysis (adj-hazard ratio [HR] = 2.68, 95% confidence interval [CI] = 1.04-6.94, p = 0.031). Post-d-LVAD HRAEs occurred more frequently among patients with hemolysis (31.9% vs. 20.6%; p = 0.041), mainly driven by hemorrhagic stroke and gastrointestinal bleeding. At multivariate analysis, hemolysis remained independently associated with HRAEs (adj-HR = 1.62, 95% CI = 1.02-2.58; p = 0.041). Patients with hemolysis were more likely to need a temporary right ventricular assist device following d-LVAD implantation (28.3% vs. 16.8%; p = 0.012), with no difference in mortality (23.6% vs . 21.2%; p = 0.355). In conclusion, among patients undergoing d-LVAD implantation with mAFP bridge, hemolysis is common, occurs more frequently among patients supported with Impella 2.5/CP, and is an independent predictor of post-d-LVAD HRAEs.
The impact of hemolysis during microaxial flow pump (mAFP; Impella, Danvers, Massachusetts, US) support on early outcomes after durable left ventricular assist device (d-LVAD) implantation is unknown. Three hundred and eleven consecutive patients undergoing d-LVAD implantation after mAFP support (Impella 5.0/5.5 72.3%) were retrospectively included. The incidence and predictors of hemolysis (plasma-free hemoglobin >20 mg/dl or lactic dehydrogenase (LDH) >2.5-fold the upper reference limit) before d-LVAD implantation were assessed, along with its impact on early post-d-LVAD outcomes. The primary outcome was a composite of hemocompatibility-related adverse events (HRAEs: stroke/gastrointestinal bleeding/pump thrombosis). Hemolysis occurred in 40.8%. Impella 2.5/CP versus 5.0/5.5 was the single independent predictor of hemolysis (adj-hazard ratio [HR] = 2.68, 95% confidence interval [CI] = 1.04-6.94, p = 0.031). Post-d-LVAD HRAEs occurred more frequently among patients with hemolysis (31.9% vs. 20.6%; p = 0.041), mainly driven by hemorrhagic stroke and gastrointestinal bleeding. At multivariate analysis, hemolysis remained independently associated with HRAEs (adj-HR = 1.62, 95% CI = 1.02-2.58; p = 0.041). Patients with hemolysis were more likely to need a temporary right ventricular assist device following d-LVAD implantation (28.3% vs. 16.8%; p = 0.012), with no difference in mortality (23.6% vs . 21.2%; p = 0.355). In conclusion, among patients undergoing d-LVAD implantation with mAFP bridge, hemolysis is common, occurs more frequently among patients supported with Impella 2.5/CP, and is an independent predictor of post-d-LVAD HRAEs.
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