Temporary mechanical circulatory support for refractory cardiogenic shock before left ventricular assist device surgery

Saraschandra Vallabhajosyula, Shilpkumar Arora, Sopan Lahewala, Varun Kumar, Ghanshyam P.S. Shantha, Jacob C. Jentzer, John M. Stulak, Bernard J. Gersh, Rajiv Gulati, Charanjit S. Rihal, Abhiram Prasad, Abhishek J. Deshmukh

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Background—There are limited data on the role of temporary mechanical circulatory support (MCS) devices for cardiogenic shock before left ventricular assist device (LVAD) surgery. This study sought to evaluate the trends of use and outcomes of MCS in cardiogenic shock before LVAD surgery. Methods and Results—This was a retrospective cohort study from 2005 to 2014 using the National Inpatient Sample (20% stratified sample of US hospitals). This study identified admissions undergoing LVAD surgery with preoperative cardiogenic shock. Admissions for other cardiac surgery and heart transplant were excluded. Temporary MCS was identified using administrative codes. The primary outcome was hospital mortality and secondary outcomes were hospital costs and lengths of stay in admissions with and without MCS use. In this 10‐year period, 9753 admissions were identified with 40.6% requiring pre‐LVAD MCS. There was a temporal increase in the frequency of cardiogenic shock associated with an increase in non–intra‐aortic balloon pump MCS devices. The cohort receiving MCS had greater in‐hospital myocardial infarction, ventricular arrhythmias, and use of coronary angiography. On multivariable analysis, older age, myocardial infarction, and need for MCS devices were independently predictive of higher in‐hospital mortality. In 696 propensity‐matched pairs, use of MCS was predictive of higher in‐hospital mortality (odds ratio 1.4 [95% confidence interval 1.1–1.6]; P=0.02) and higher hospital costs, but similar lengths of stay. Conclusions—In patients with cardiogenic shock bridged to LVAD therapy, there was a steady increase in preoperative MCS use. Use of MCS identified patients at higher risk for in‐hospital mortality and greater resource utilization.

Original languageEnglish (US)
Article numbere010193
JournalJournal of the American Heart Association
Issue number22
StatePublished - Nov 1 2018


  • Cardiogenic shock
  • Critical care
  • Destination therapy
  • Left ventricular assist device
  • Mechanical circulatory support

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Temporary mechanical circulatory support for refractory cardiogenic shock before left ventricular assist device surgery'. Together they form a unique fingerprint.

Cite this