Second Generation Surgically Implanted Ventricular Assist Device Aids Renal Recovery
Penn Medicine, Department of Surgery
Philadelphia, PA
United States - Contact Me
Dr. Acker is originially from Philadelphia. His undergradute degree is in mechanical engineering from MIT where he also was a multi-year captain of MIT men's varsity basketball team. After college he played basketball professionally in Israel for a year. He received his MD from the Perelman School of Medicine at the University of Pennsylvania where he then matched into the integrated cardiothoracic surgery training program where he is a PGY-5. He is currently pursuing his MBA at The Wharton School at The University of Pennsylvania during his two years of academic enrichment. He is interested in a career in adult cardiac surgery focusing on heart failure and mechanical circulatory support. He is also interested in device development in cardiac surgery and health care administration. He is an Ironman triathlete, avid reader, and loves cooking and spending time with his family.
Description
Methods: This is a single-center retrospective cohort analysis of hospitalized adult patients. Over the period from April 2021 to June 2023, 113 patients received a second generation surgically implanted ventricular assist device via the right or left axillary artery. Both pre-implantation and post-implantation analysis was performed examining relevant laboratory values, the cause of heart failure, indication for mechanical support, 30-day outcome, The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) classification, The Society for Cardiovascular Angiography and Interventions (SCAI) stage, as well as basic demographic data.
Results: The median age of the patients was 58 years (range, 19 to 82 years), 84.1% were male (95 out of 113). The median duration of support was 16 days (range, 0 to 92 days). The device was utilized in 57 patients with non-ischemic cardiomyopathy (50.4%), 40 with ischemic cardiomyopathy (35.4%), 6 with post-cardiotomy shock (5.3%), 3 for planned post-cardiotomy (2.7%), and in 1 patient with congenital heart disease (0.9%). It was utilized in 54 patients as a bridge to decision (47.8%), 28 patients as bridge to transplant (24.8%), and 19 as bridge to recovery (16.8%). In this cohort 42 received an orthotropic heart transplant (37.2%) and 20 received a permanent durable left ventricular assist device (17.7%). The majority of the patients were INTERMACS class 2 (68), while the next most common classification was class 1 (38). The 30-day survival through device explant was 85.8% (97 out of 113). Patients' median creatinine, BUN, and urine output values before compared to after implantation, measured over a period of 3 days prior to and 3 days post-implantation, were 1.34 mg/dL vs 1.24 mg/dL (p = 0.02), 27mg/dL vs 26mg/dL (p=0.115), and 2427cc and 2850c (p<0.0001), respectively.
Conclusions: In this single-center retrospective cohort analysis of 113 hospitalized adult patients who underwent a second generation surgically implanted ventricular assist device, the 30-day survival through device explant was 85.8% (97/113). There was statistically significant renal recovery in the form of reduced creatinine (p = 0.02) and increased urine output (p <0.0001).
Authors
Andrew Acker (1), Mickel Attia (1), Jenelle Safadi (1), Joyce Wald (1), Aditya Parikh (1), Christian Bermudez (1), Marisa Cevasco (1)
Institutions
(1) Hospital of the University of Pennsylvania, Philadelphia, PA