(1526) Hematopoietic Stimulation to Avoid Transfusions During Temporary LVAD Support: A Multicenter Review

Introduction: Preexisting anemia is common in advanced heart failure and cardiogenic shock. The Impella 5.5 (ABIOMED, Danvers, MA) temporary left ventricular assist device (IMP5.5) provides support in cardiogenic shock for up to several months. Blood trauma from the pump, frequent blood draws and bleeding complications due to anticoagulant use can worsen anemia to critical levels. Blood transfusions in critically ill patients are associated with worse outcomes and can lead to preformation of antibodies, which complicate matching an organ donor in bridge-to-transplant patients. Preemptive treatment with recombinant erythropoietin (rEPO) during support with IMP5.5 offers an alternative strategy. Our aim was to evaluate the effectiveness and safety of rEPO treatment for erythropoietic stimulation and prevention of critical anemia during prolonged IMP5.5 support.

Methods: A retrospective, multicenter chart review of patients (N=10) treated with IMP5.5 and rEPO was performed. Dosing and timing of rEPO and co-treatment with iron, folic acid and vitamin b12 were recorded. Red blood cell parameters, reticulocyte count and production index were assessed at baseline and during the treatment course. IMP5.5 pumps were examined on explantation. Cases were reviewed for adverse thromboembolic events.

Results: Average duration of IMP5.5 support was 17.1 days. Hemoglobin levels remained stable despite the need for frequent blood draws. Reticulocyte counts and production indices increased. No patients required transfusions while on support. All cases underwent either successful heart transplantation (N=9) or durable left ventricular assist device implantation (N=1). No deaths or thromboembolic adverse events occurred. The most common dosing of rEPO was 5,000 units sq three times per week and iron 1 gram IV total over 5 days.

Conclusions: The use of rEPO in patients on prolonged IMP5.5 support may be safe, stabilize hemoglobin levels, and allow patients to avoid RBC transfusions. Decreased RBC transfusions are known to improve operative outcomes including survival. Additionally, the risk of allosensitization may be decreased in patients awaiting heart transplantation, thereby shortening time on transplant waiting lists and improving long-term outcomes.