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There is paucity of data regarding durable left ventricular assist device (LVAD) outcomes in patients with chronic kidney disease (CKD) stages 3-5 and CKD stage 5 on dialysis (end-stage renal disease [ESRD]).We conducted a retrospective study of Medicare beneficiaries with ESRD and a 5% sample of patients with CKD with an LVAD (2006-2018) to determine 1-year outcomes using the United States Renal Data System database. The LVAD implantation, comorbidities, and outcomes were identified using appropriate International Classification of Diseases, 9th and 10th edition codes. We identified 496 patients with CKD and 95 patients with ESRD who underwent LVAD implantation. The patients with ESRD were younger (59 years vs 66 years; P.001), had more Blacks (40% vs 24.6%, P = .009), compared with the CKD group. The 1-year mortality (49.5% vs 30.9%, P.001) and index mortality (27.4% vs 16.7%, P = .014) rates were higher for patients with ESRD. A subgroup analysis showed significantly higher mortality in ESRD vs CKD 3 (49.5% vs 30.2%, adjusted P = .009), but no significant difference in mortality between stage 3 vs 4/5 (30.2% vs 30.8%, adjusted P = .941). There was no significant difference in secondary outcomes (bleeding, stroke, and sepsis/infection) during follow-up between the 2 groups.Patients with ESRD undergoing LVAD implantation had significantly higher index and 1-year mortality rates compared with patients with CKD.

Background Benefits of temporary mechanical circulatory support has not been demonstrated successfully in clinical trials despite their increased widespread use in the real-world management of patients with cardiogenic shock (CS). Methods Using the Nationwide Readmissions Database from Jan 2016 to Nov 2017, we identified all patients admitted with CS requiring either only intra-aortic balloon pump (IABP) or Impella device implantation (IM) with 30-day follow up. Patients with combined devices or undergoing medical management only were excluded. Propensity matched (1:1) was performed based on demographics and comorbidities to compare the survival, complications, and use of advanced heart failure therapies. Results Out of a total of 236156 patients, 32850(13.9%) had IABP and 8389(3.5%; unweighted n= 4504) patients had IM implantation. Well-matched 4411-pairs of matched IABP vs IM patients had mean similar age (65 vs 64.9 years), women (29.2% vs 28.6%), and acute myocardial infarction (75.7% vs 75.8%). In terms of therapy, no differences in use of right heart catheterization/pulmonary catheter placement or vasopressor use(p>0.05 for all). IM group had higher mortality (45.8% vs. 28.6%, p Conclusion Significant number of CS patients undergo IM implantations with widely different survival as well as candidacy for a heart transplant. The underlying patient- and physician-related differences need to further be explored prior to widespread use of this powerful technology.

Background: The usefulness of the Right Heart Catherization/Pulmonary Artery Catheterization (RHC/PAC) has been long debated. Previous evidence has shown the lack of additive benefit of RHC/PAC use in various clinical settings. However, current evidence of RHC/PAC utility in the setting of cardiogenic shock (CS) is scarce. Methods: In the Nationwide Readmissions Database (NRD) using International Classification of Diseases, Tenth revision we identified 269,475 patient hospitalizations with cardiogenic shock between 2016-2017. We sought to evaluate the impact of RHC/PAC on in-hospital and readmission outcomes. Results: Approximately 25,840 patients received a RHC/PAC on index admission. The RHC/PAC group had significantly more comorbidities and higher AKI rates (73% vs 60.4%; p