Use of perioperative mechanical circulatory support in patients with ischemic cardiomyopathy undergoing surgical revascularization
Presented During:
Saturday, May 6, 2023: 11:00AM - 11:15AM
Los Angeles Convention Center
Posted Room Name:
515A
Abstract No:
41
Submission Type:
Abstract Submission
Authors:
Sameer Singh (1), Yuji Kaku (1), Michael Kirschner (1), Alice Vinogradsky (1), Erfan Faridmoayer (1), Jocelyn Sun (1), Paul Kurlansky, MD (1), Koji Takeda (1)
Institutions:
(1) Columbia University Medical Center, New York, NY
Submitting Author:
Sameer Singh
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Columbia University Medical Center
Columbia University Medical Center
Co-Author(s):
Yuji Kaku
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Columbia University Medical Center
Columbia University Medical Center
Michael Kirschner
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Columbia University Medical Center
Columbia University Medical Center
Alice Vinogradsky
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Columbia University Medical Center
Columbia University Medical Center
Erfan Faridmoayer
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Columbia University Medical Center
Columbia University Medical Center
Jocelyn Sun
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Columbia University Medical Center
Columbia University Medical Center
*Paul Kurlansky, MD
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Columbia University Medical Center
Columbia University Medical Center
*Koji Takeda
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Columbia University Medical Center
Columbia University Medical Center
Presenting Author:
Sameer Singh
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New York Presbyterian
New York Presbyterian
Abstract:
Objective: We aimed to explore optimal patient selection and perioperative mechanical circulatory support (MCS) in patients with reduced ejection fraction (EF) who undergo surgical revascularization.
Methods: Patients with reduced EF (<35%) undergoing isolated coronary artery bypass grafting (CABG) from 2015-2021 were identified. Requirement of preoperative MCS (pre-MCS) and postoperative MCS (post-MCS) were noted, defined as use of intra-aortic balloon pump (IABP), ECMO, or Impella. Primary outcomes of interest were in-hospital mortality and long-term survival. Logistic regression was used to identify risk factors for MCS requirement.
Results: A total of 378 patients were included. Median STS predicted risk of mortality was 2.4% (IQR 1.3-4.4%). Sixty-five percent (n=246) of patients had previous myocardial infarction, of which 75% were within 21 days of CABG. Twenty-one patients (5.5%) presented in cardiogenic shock, of which 15 were in shock at the time of CABG. Thirty-nine patients (10.3%) required pre-MCS; compared to patients that did not require pre-MCS, those that did had lower pulmonary artery saturation (57.8% vs 63%, p=0.01) and cardiac index (2.0 vs 2.5, p=0.01) on preop catheterization and lower LV end diastolic diameter (50mm vs 55mm, p=0.01) on echo. Of patients that required pre-MCS, 8 (20.5%) required post-MCS (2 IABP, 4 ECMO, 1 Impella, 1 Centrimag). Of patients that did not require pre-MCS, 22 (6.4%) required post-MCS (14 IABP, 5 ECMO, 3 Impella). Independent risk factors for requiring post-MCS were low preop EF (OR 0.91, 95%CI 0.85-0.99, p=0.02), presence of mild MR compared to no MR preop (OR 3.37, 95%CI 1.17-9.73, p=0.03), and cross-clamp time (OR 1.02, 95%CI 1.01-1.04, p=0.02). Overall, in-hospital mortality was 2.9% and 3-year survival was 95.2%. Compared to those who did not require perioperative MCS, those that required pre-MCS had similar in-hospital mortality (3.2% vs 1.6%, p=.50) and 3-year survival (96.8% vs 96.8%, p=.98). However, patients who required post-MCS had significantly worse in-hospital mortality and 3-year survival (16.7% and 76.7% respectively, p <0.001).
Conclusion: In a large series of patients with reduced EF who underwent surgical revascularization, we report favorable outcomes with selective use of MCS. Despite worse severity of illness, patients requiring pre-MCS have similar outcomes to those that do not require perioperative MCS, while patients requiring post-MCS have worse short- and long-term survival.
Methods: Patients with reduced EF (<35%) undergoing isolated coronary artery bypass grafting (CABG) from 2015-2021 were identified. Requirement of preoperative MCS (pre-MCS) and postoperative MCS (post-MCS) were noted, defined as use of intra-aortic balloon pump (IABP), ECMO, or Impella. Primary outcomes of interest were in-hospital mortality and long-term survival. Logistic regression was used to identify risk factors for MCS requirement.
Results: A total of 378 patients were included. Median STS predicted risk of mortality was 2.4% (IQR 1.3-4.4%). Sixty-five percent (n=246) of patients had previous myocardial infarction, of which 75% were within 21 days of CABG. Twenty-one patients (5.5%) presented in cardiogenic shock, of which 15 were in shock at the time of CABG. Thirty-nine patients (10.3%) required pre-MCS; compared to patients that did not require pre-MCS, those that did had lower pulmonary artery saturation (57.8% vs 63%, p=0.01) and cardiac index (2.0 vs 2.5, p=0.01) on preop catheterization and lower LV end diastolic diameter (50mm vs 55mm, p=0.01) on echo. Of patients that required pre-MCS, 8 (20.5%) required post-MCS (2 IABP, 4 ECMO, 1 Impella, 1 Centrimag). Of patients that did not require pre-MCS, 22 (6.4%) required post-MCS (14 IABP, 5 ECMO, 3 Impella). Independent risk factors for requiring post-MCS were low preop EF (OR 0.91, 95%CI 0.85-0.99, p=0.02), presence of mild MR compared to no MR preop (OR 3.37, 95%CI 1.17-9.73, p=0.03), and cross-clamp time (OR 1.02, 95%CI 1.01-1.04, p=0.02). Overall, in-hospital mortality was 2.9% and 3-year survival was 95.2%. Compared to those who did not require perioperative MCS, those that required pre-MCS had similar in-hospital mortality (3.2% vs 1.6%, p=.50) and 3-year survival (96.8% vs 96.8%, p=.98). However, patients who required post-MCS had significantly worse in-hospital mortality and 3-year survival (16.7% and 76.7% respectively, p <0.001).
Conclusion: In a large series of patients with reduced EF who underwent surgical revascularization, we report favorable outcomes with selective use of MCS. Despite worse severity of illness, patients requiring pre-MCS have similar outcomes to those that do not require perioperative MCS, while patients requiring post-MCS have worse short- and long-term survival.
ADULT CARDIAC:
Coronary Artery Disease
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