Surgically Implanted Percutaneous Assist Device After Left Ventricular Assist Device Malfunction as a Bridge to...

Area of Science:

• Cardiology
• Mechanical Circulatory Support

Background:

• Durable left ventricular assist devices (dLVADs) can malfunction, leading to cardiogenic shock or inadequate cardiac unloading.
• Current management often involves emergent dLVAD exchange or orthotopic heart transplantation (OHT).

Purpose of the Study:

• To evaluate the use of a microaxial flow pump (mAFP) as a bridge-to-decision strategy in patients experiencing dLVAD malfunction.
• To assess the impact of mAFP on end-organ perfusion and left ventricular unloading.

Main Methods:

• A case series of four patients with malfunctioning dLVADs who received an mAFP (Impella 5.5).
• Assessment of hemodynamic parameters, end-organ perfusion, and ventricular unloading before and after mAFP initiation.

Main Results:

• The mAFP improved end-organ perfusion and increased left ventricular unloading in all four cases.
• Patients were stabilized and optimized, facilitating subsequent therapeutic decisions.
• Three patients ultimately underwent dLVAD exchange, and one received an OHT.

Conclusions:

• The mAFP shows promise as a rescue strategy for patients with malfunctioning dLVADs, facilitating patient optimization.
• This approach may offer improved outcomes compared to immediate emergent dLVAD exchange.
• Potential for patient mobilization with mAFP use warrants further investigation.