Microaxial Left Ventricular Assist Device in Cardiogenic Shock: A Systematic Review and Meta-Analysis

• Published in: Life (Basel, Switzerland) Vol. 12; no. 10; p. 1629
• Main Authors: Tan, Shien, Low, Christopher, Ng, Wei, Ling, Ryan, Tan, Chuen, Lim, Shir, Cherian, Robin, Lin, Weiqin, Shekar, Kiran, Mitra, Saikat, MacLaren, Graeme, Ramanathan, Kollengode
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 18.10.2022; MDPI
• Subjects: Aorta; Bias; cardiogenic shock; Clinical trials; Data collection; Demographics; Etiology; Extracorporeal membrane oxygenation; Heart; Heart attacks; Impella; Meta-analysis; Mortality; Observational studies; Oxygenation; Patients; Risk assessment; Sensitivity analysis; Systematic Review; Ventricle; ventricular assist device; Ventricular assist devices; South America; Asia; North America; Europe
• ISSN: 2075-1729; 2075-1729
• DOI: 10.3390/life12101629

Microaxial left ventricular assist devices (LVAD) are increasingly used to support patients with cardiogenic shock; however, outcome results are limited to single-center studies, registry data and select reviews. We conducted a systematic review and meta-analysis, searching three databases for relevant studies reporting on microaxial LVAD use in adults with cardiogenic shock. We conducted a random-effects meta-analysis (DerSimonian and Laird) based on short-term mortality (primary outcome), long-term mortality and device complications (secondary outcomes). We assessed the risk of bias and certainty of evidence using the Joanna Briggs Institute and the GRADE approaches, respectively. A total of 63 observational studies (3896 patients), 6 propensity-score matched (PSM) studies and 2 randomized controlled trials (RCTs) were included (384 patients). The pooled short-term mortality from observational studies was 46.5% (95%-CI: 42.7–50.3%); this was 48.9% (95%-CI: 43.8–54.1%) amongst PSM studies and RCTs. The pooled mortality at 90 days, 6 months and 1 year was 41.8%, 51.1% and 54.3%, respectively. Hemolysis and access-site bleeding were the most common complications, each with a pooled incidence of around 20%. The reported mortality rate of microaxial LVADs was not significantly lower than extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pumps (IABP). Current evidence does not suggest any mortality benefit when compared to ECMO or IABP.