{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T03:53:54Z","timestamp":1789012434732,"version":"build-2803163510"},"reference-count":24,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T00:00:00Z","timestamp":1731369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Abiomed","award":["249412-EXT"],"award-info":[{"award-number":["249412-EXT"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Patients in cardiogenic shock (CS) may be successfully bridged using intravascular micro-axial left ventricular assist devices (M-LVADs) for recovery or determination of definitive therapy. Methods: One hundred and seven CS patients implanted with M-LVADs from January 2020 to May 2024 were divided into four groups; group-1: 34 patients (transplant); group-2: 25 patients (LVAD); group-3: 42 patients (postcardiotomy CS (PCCS)); group-4: 6 patients (decision\/recovery but excluded from analysis). Multivariable logistic regression and Multivariable Coxregression models identified predictors of early -hospital and late mortality, and Odds ratios (ORs) and hazard ratios (HRs) with p &lt; 0.05, respectively, were considered statistically significant. SPSS 29.0 and Python 3.11.1. were used for analyses. Results: Complications included device-malfunction (6%), gastrointestinal bleed (9%), long-term hemodialysis (21%), axillary hematoma requiring re-exploration (10%), heparin-induced thrombocytopenia (4%) requiring heparin therapy cessation\/initiation of argatroban infusion, and non-fatal stroke (11%). Early hospital mortality included 13 patients: 2 in group-1, 1 in group-2, 10 in group-3 (p = 0.02). In the Logistic-Regression model, category of CS requiring an M-LVAD was significant (OR = 4.7, p = 0.05). Patients were followed for 4.5 years (mean follow-up was 23 \u00b1 17 months), and 23 deaths occurred; group-1: 3 patients, group-2: 5 patients, and group-3: 15 patients (p = 0.019). At 4.5 years, actuarial survival was 90.7 \u00b1 5.1% in group-1, 79.2 \u00b1 8.3% in group-2, 62.8 \u00b1 7.7% in group-3 (p = 0.01). In the Cox-Regression model, M-LVAD category (HR = 3.63, p = 0.04), and long-term postoperative dialysis (HR = 3.9, p = 0.002) emerged as predictors of long-term mortality. Conclusions: In cardiogenic shock, mid-term outcomes demonstrate good survival with M-LVADs as bridge to transplant\/durable LVADs and reasonable survival with M-LVADs as a bridge to recovery following cardiotomy, accompanied by reduced ECMO usage, and early ambulation\/rehabilitation.<\/jats:p>","DOI":"10.3390\/jcm13226804","type":"journal-article","created":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T08:12:39Z","timestamp":1731399159000},"page":"6804","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Use of Intravascular Micro-Axial Left Ventricular Assist Devices as a Bridging Strategy for Cardiogenic Shock: Mid-Term Outcomes"],"prefix":"10.3390","volume":"13","author":[{"given":"Balakrishnan","family":"Mahesh","sequence":"first","affiliation":[{"name":"Heart and Vascular Institute, Pennsylvania State Milton S Hershey Medical Center, Hershey, PA 17033, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasanth","family":"Peddaayyavarla","sequence":"additional","affiliation":[{"name":"NHS Arden & Greater East Midlands Commissioning Support Unit, St John\u2019s House, Leicester LE1 6NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenny","family":"Nguyen","sequence":"additional","affiliation":[{"name":"College of Medicine, Pennsylvania State University, University Park, PA 16802, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya","family":"Mahesh","sequence":"additional","affiliation":[{"name":"College of Medicine, Pennsylvania State University, University Park, PA 16802, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrine Corrina","family":"Hartford","sequence":"additional","affiliation":[{"name":"College of Medicine, Pennsylvania State University, University Park, PA 16802, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Devich","sequence":"additional","affiliation":[{"name":"College of Medicine, Pennsylvania State University, University Park, PA 16802, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianna","family":"Dafflisio","sequence":"additional","affiliation":[{"name":"College of Medicine, Pennsylvania State University, University Park, PA 16802, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1243-4389","authenticated-orcid":false,"given":"Nandini","family":"Nair","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Pennsylvania State Milton S Hershey Medical Center, Hershey, PA 17033, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9189-5759","authenticated-orcid":false,"given":"Miriam","family":"Freundt","sequence":"additional","affiliation":[{"name":"Christ Hospital, Cincinnati, OH 45219, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Dowling","sequence":"additional","affiliation":[{"name":"Christ Hospital, Cincinnati, OH 45219, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Behzad","family":"Soleimani","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Pennsylvania State Milton S Hershey Medical Center, Hershey, PA 17033, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Vlachakis, P.K., Theofilis, P., Leontsinis, I., Drakopoulou, M., Karakasis, P., Oikonomou, E., Chrysohoou, C., Tsioufis, K., and Tousoulis, D. (2024). Bridge to Life: Current Landscape of Temporary Mechanical Circulatory Support in Heart-Failure-Related Cardiogenic Shock. J. Clin. Med., 13.","DOI":"10.3390\/jcm13144120"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.healun.2017.09.020","article-title":"Use of a percutaneous temporary circulatory support device as a bridge to decision during acute decompensation of advanced heart failure","volume":"37","author":"Hall","year":"2018","journal-title":"J. Heart Lung Transplant."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1016\/j.jacc.2015.03.036","article-title":"2015 SCAI\/ACC\/HFSA\/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support De-vices in Cardiovascular Care: Endorsed by the American Heart Assocation, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiol-ogy-Association Canadienne de Cardiologie d\u2019intervention","volume":"65","author":"Rihal","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1097\/HCO.0b013e32834b803c","article-title":"Current status of percutaneous ventricular assist devices for cardiogenic shock","volume":"26","author":"Basra","year":"2011","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2298","DOI":"10.1002\/ehf2.14391","article-title":"Short-term outcomes of heart transplant patients bridged with Impella 5.5 ventricular assist device","volume":"10","author":"Haddad","year":"2023","journal-title":"ESC Heart Fail."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1177\/02676591221117355","article-title":"Mortality and cost of post-cardiotomy extracorporeal support in the United States","volume":"38","author":"Kakuturu","year":"2022","journal-title":"Perfusion"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1177\/02676591221111506","article-title":"The use of veno-arterial extracorporeal membrane oxygenation in the octogenarian population: A single-center experience","volume":"38","author":"Armas","year":"2022","journal-title":"Perfusion"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1177\/02676591211023304","article-title":"Novel strategy for improved outcomes of extra-corporeal membrane oxygenation as a treatment for refractory post cardiotomy cardiogenic shock in the current era: A refreshing new perspective","volume":"37","author":"Mahesh","year":"2021","journal-title":"Perfusion"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1177\/15569845211013329","article-title":"Early Outcomes of the First 200 US Patients Treated with Impella 5.5: A Novel Temporary Left Ventricular Assist Device","volume":"16","author":"Ramzy","year":"2021","journal-title":"Innov. Technol. Technol. Cardiothorac. Vasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kleinbaum, D., and Klein, M. (1996). Survival Analysis: A Self-Learning Text, Springer. [1st ed.].","DOI":"10.2307\/2532873"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s10047-020-01212-w","article-title":"Early venoarterial extracorporeal membrane oxygenation improves outcomes in post-cardiotomy shock","volume":"24","author":"Saha","year":"2021","journal-title":"J. Artif. Organs"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1016\/j.jtcvs.2020.09.045","article-title":"2020 EACTS\/ELSO\/STS\/AATS expert consensus on post-cardiotomy extracorporeal life support in adult patients","volume":"161","author":"Lorusso","year":"2021","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3403","DOI":"10.1111\/jocs.16753","article-title":"First-in-man successful use of the SPECTRUM percutaneous dual-stage right ventricle and right atrium to pulmonary artery ventricular assist device","volume":"37","author":"Usman","year":"2022","journal-title":"J. Card. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1053\/j.jvca.2021.09.045","article-title":"Echocardiography in weaning right ventricular mechanical circulatory support: Are we measuring the right stuff?","volume":"36","author":"Roscoe","year":"2022","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2549","DOI":"10.1053\/j.jvca.2021.03.006","article-title":"Invasive hemodynamic and physiologic considerations in patients undergoing extracorporeal membrane oxygenation","volume":"35","author":"Ortoleva","year":"2021","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"6993","DOI":"10.21037\/jtd.2018.11.103","article-title":"Clinical complications during veno-arterial extracorporeal membrane oxigenation in post-cardiotomy and non post-cardiotomy shock: Still the achille\u2019s heel","volume":"10","author":"Coco","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/j.jtcvs.2017.10.136","article-title":"Selective implantation of durable left ventricular assist devices as primary therapy for refractory cardiogenic shock","volume":"155","author":"Pawale","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_18","unstructured":"Soleimani, B., Brehm, C., Campbell, D.C., and Conte, J.V. (2017). A bridge to many?. J. Thorac. Cardiovasc. Surg., 1\u20132. Invited editorial commentary."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1186\/s13019-020-01251-7","article-title":"The role of the axillary Impella 5.0 device on patients with acute cardiogenic shock","volume":"15","author":"Tarabichi","year":"2020","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"ezad116","DOI":"10.1093\/ejcts\/ezad116","article-title":"Bridging with surgically placed microaxial left ventricular assist devices: A High-volume center experience","volume":"63","author":"Gill","year":"2023","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_21","first-page":"63","article-title":"Surgically implanted endovascular, micro axial left ventricular assist device: A single institution study","volume":"23","author":"Schumer","year":"2024","journal-title":"J. Thorac. Cardiovasc. Technol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2933","DOI":"10.1002\/ehf2.14865","article-title":"The intelligent Impella: Future perspectives of artificial intelligence in the setting of Impella support","volume":"11","author":"Consolo","year":"2024","journal-title":"ESC Heart Fail."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1038\/s41746-022-00640-7","article-title":"The health digital twin to tackle cardiovascular disease\u2014A review of an emerging interdisciplinary field","volume":"5","author":"Coorey","year":"2022","journal-title":"NPJ Digit. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1016\/j.jcin.2023.05.043","article-title":"Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support: A Practical Approach","volume":"16","author":"Gramegna","year":"2023","journal-title":"JACC Cardiovasc. Interv."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6804\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:30:51Z","timestamp":1760113851000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6804"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,12]]},"references-count":24,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jcm13226804"],"URL":"https:\/\/doi.org\/10.3390\/jcm13226804","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,12]]}}}