Impact of Hemolysis During Microaxial Flow Pump Support on Early Outcomes After Durable Left Ventricular Assist Device Implantation
Year: 2025
Type: article
Study design: Observational Study
Abstract: 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.
Source: ASAIO Journal
Authors: Guglielmo Gallone, Daniel Lewin, Antonio Spitaleri, Sebastian Rojas Hernandez, Alexander Bernhardt, Michael Billion, Anna Meyer, Ivan Netuka, Janajade Kooij, Marina Pieri, Mariusz Szymanski, Christian Moeller, Payam Akhyari, Khalil Jawad, Ihor Krasivskyi, Bastian Schmack, Gloria Färber, Marta Medina, Assad Haneya, Daniel Zimpfer, Gaik Nersesian, Pia Lanmueller, Mehmet Oezkur, Ilija Djordjevic, Diyar Saeed, Massimo Boffini, Julia Stein, Finn Gustafsson, Anna Mara Scandroglio, Gaetano Maria De Ferrari, Bart Meyns, Steffen Hofmann, Jan Belohlavek, Jan Gummert, Mauro Rinaldi, Evgenij Potapov, Antonio Loforte
Institutions: University of Turin, Deutsches Herzzentrum der Charité, Charité - Universitätsmedizin Berlin, Heart and Diabetes Center North Rhine-Westphalia, Universität Hamburg, Schüchtermann-Klinik, Heidelberg University, University Hospital Heidelberg, Institute of Clinical and Experimental Medicine, Universitair Ziekenhuis Leuven, IRCCS Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele, University Medical Center Utrecht, Rigshospitalet, Düsseldorf University Hospital, Leipzig Heart Institute, University Hospital Cologne, Medizinische Hochschule Hannover, University of Duisburg-Essen, Jena University Hospital, Johannes Gutenberg University Mainz, University Hospital Schleswig-Holstein, Medical University of Vienna, German Centre for Cardiovascular Research, Charles University, Wroclaw Medical University
Language: English
Subfield: Biomedical Engineering
Field: Engineering
Domain: Physical Sciences
Open Access status: green
OpenAlex ID: W4410126714