Résumé
Over the past decade, large observational studies and randomized controlled trials have challenged the benefit/risk balance of hemodynamic support with microaxial flow pumps (MaFP) in cardiogenic shock (CS). While recent findings demonstrate a reduction in mortality, they also highlight a significant rate of adverse events associated with this device, including moderate or severe bleeding, renal replacement therapy, limb ischemia, and stroke. Thus, the primary objectives of our study are to analyze temporal trends in the incidence of thrombotic and hemorrhagic complications associated with MaFP devices and to identify the risk factors contributing to these complications in patients supported by MaFP. Methods: we conducted a multicenter, retrospective descriptive cohort analysis, including all patients over 18 years of age who were supported by an MaFP device for CS. The primary endpoint was the occurrence of hemorrhagic or ischemic complications. Secondary endpoints included other types of complications, patient outcomes, and an analysis of associated risk factors. Results: a total of 449 patients were analyzed, the majority of whom were male (78%) with a median age of 55 years. The primary indication for MaFP use was myocardial infarction complicated by CS. The rates of hemorrhagic and ischemic complications were 64% and 12%, respectively. In-hospital mortality was 39%. Risk factors for hemorrhagic complications included duration of support (OR 1.08, 95% CI 1.04-1.13, p<0.001), ECLS associated (OR 4.2, 95% CI 2.55-7.04, p<0.001), and support by Impella 5© (OR 1.76, 95% CI 1.02-3.06, p=0.042). Risk factors for thrombotic complications were mechanical ventilation (OR 4.34, 95% CI 1.86-11.9, p<0.001) and post-myocardial infarction CS (OR 2.58, 95% CI 1.31-5.44, p=0.005). Conclusion: temporary mechanical support with MaFP is associated with a high complication rate secondary to complex hemocompatibility issues, which may offset its hemodynamic benefits. Its use should be limited to expert centers, and further studies are needed to standardize practices, particularly regarding anticoagulation management.