Background

Percutaneous left ventricular assist devices (pVADs) may be used in patients with cardiogenic shock (CS) in order to stabilize patient hemodynamics and maintain sufficient end-organ perfusion. In patients with pVAD support, vascular complications such as access site bleeding or limb ischaemia are common observed complications. We aim to assess the relationship between the rate of pVAD-access site complications with the time-point of the insertion (during off-hours vs. on-hours).

Methods

All patients who received pVAD therapy for the treatment of cardiogenic shock at our university hospital between 2014 and 2021 were included in the study. The primary endpoint was the occurrence of access site bleeding events or ischemic complications.

Results

A total of 224 patients with cardiogenic shock supported by pVAD were included in this study. Depending on the time-point of pVAD insertion, the patients were assigned to the on-hours or off-hours group.

The two groups had comparable baseline characteristics and comorbidities. The vast majority of patients suffered cardiogenic shock in the context of an acute coronary syndrome (83% in the off-hours group, 75% in the on-hours group, p=0.172).

The rate of major access site bleeding was higher in the off-hours group compared to the on-hours group (12% vs. 2%, p= 0.006). There were no differences in the two groups regarding ischaemic complications. Premature discontinuation of pVAD support was required more often in the off-hours group than in the on-hours group (14% vs. 5%, p= 0.016).

The presence of interventionalists with a high level of pVAD-experience was less common in the off-hour group than in the on-hours group (68% vs. 89%, p< 0.001). In case the first interventionalist was low experienced, a second interventionalist supported more frequently the insertion of pVAD during on-hours than during off-hours (72% vs. 34%, p< 0.001). 

Conclusion

CS-Patients in which pVAD insertion occurred off-hours had higher rates of access-site bleeding and premature discontinuation of pVAD support than CS-patients in which pVAD was inserted on-hours.  The lower rate of the presence of at least one interventionalist with higher pVAD experience could have affected the higher complication rates when pVAD was inserted off-hours.