Management and outcome of patients supported with Impella 5.0 for refractory cardiogenic shock (original) (raw)
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Circulation. Heart failure, 2013
Acute cardiogenic shock after myocardial infarction is associated with high in-hospital mortality attributable to persisting low-cardiac output. The Impella-EUROSHOCK-registry evaluates the safety and efficacy of the Impella-2.5-percutaneous left-ventricular assist device in patients with cardiogenic shock after acute myocardial infarction. This multicenter registry retrospectively included 120 patients (63.6±12.2 years; 81.7% male) with cardiogenic shock from acute myocardial infarction receiving temporary circulatory support with the Impella-2.5-percutaneous left-ventricular assist device. The primary end point evaluated mortality at 30 days. The secondary end point analyzed the change of plasma lactate after the institution of hemodynamic support, and the rate of early major adverse cardiac and cerebrovascular events as well as long-term survival. Thirty-day mortality was 64.2% in the study population. After Impella-2.5-percutaneous left-ventricular assist device implantation, la...
The Impella Device for Acute Mechanical Circulatory Support in Patients in Cardiogenic Shock
The Annals of Thoracic Surgery, 2014
Background. Acute cardiogenic shock is associated with high mortality rates. Mechanical circulatory devices have been increasingly used in this setting for hemodynamic support. The Impella device (Abiomed Inc, Danvers, MA) is a microaxial left ventricular assist device that can be inserted using a less invasive technique. This study was conducted to determine the outcome of patients who have undergone placement of the Impella device for acute cardiogenic shock in our institution. Methods. A retrospective record review of 47 patients who underwent placement of the Impella device was performed from January 1, 2006, to December 31, 2011. Records were evaluated for demographics, operative details, and postoperative outcomes. Operative mortality was defined as death within 30 days of the operation. Results. The patients (33 male) were an average age of 60.23 ±13 years. The indication for placement of the Impella device included cardiogenic shock in 15 patients (32%) and postcardiotomy cardiogenic shock in 32 (68%). Of the 47 patients, 38 (80%) received the Impella 5.0 and the rest the 2.5 device. Ventricular function recovered in 34 of 47 patients (72%), and the device was removed, with 4 patients (8%) transitioned to long-term ventricular assist devices. The 30-day mortality was 25% (12 of 47 patients). Complications occurred in 14 patients (30%), consisting of device malfunction, high purge pressures, tube fracture, and groin hematoma. Conclusions. This is one of the largest series of patients undergoing placement of the Impella device for acute cardiogenic shock. Our outcomes showed improved results compared with historical data. Myocardial recovery was accomplished in most patients. Finally, the 30-day mortality and complication rate was acceptable in these critical patients. These benefits were all achieved with the Impella device in a less invasive method.
Journal of Interventional Cardiology, 2015
Objectives: To investigate the outcome of patients with acute myocardial infarction (AMI) complicated by refractory cardiogenic shock (CS) who underwent mechanical circulatory support with Impella 2.5. Background: AMI complicated by CS remains a highly fatal condition. A potent and minimally invasive left ventricular assist device might improve patient outcomes. Methods: We analyzed the procedural characteristics and outcomes of 22 consecutive patients who underwent, between July 2008 and December 2012, a percutaneous coronary intervention and Impella 2.5 support for AMI complicated by CS refractory to first-line therapy with inotropes and/or Intra-aortic balloon pump. Results: In this analysis, patients were relatively young with a mean age of 57.9 AE 11.6 year old and 59.1% were male. The majority of patients (77.3%) were admitted in CS and 40.9% sustained cardiac arrest prior to admission. Hemodynamics improved significantly upon initiation of support, end-organ and tissue perfusion improved subsequently demonstrated by a significant decrease in lactate levels from 6.37 AE 5.3 mmol/L to 2.41 AE 2.1 mmo/L, (P ¼ 0.008) after 2 days of support. Thirteen (59.1%) patients were successfully weaned-off Impella 2.5 and 4 (18.2%) were transitioned to another device. We observed a functional recovery of the left ventricle when compared to baseline (43 AE 10% vs. 27 AE 9%, P < 0.0001). The survival rate at 6 months and 1 year was 59.1% and 54.5%, respectively. Conclusion: Impella 2.5 was initiated as a last resort therapy to support very sick patients with refractory CS after failed conventional therapy. The use of the device yielded favorable short and mid-term survival results with recovery being the most frequently observed outcome. (J Interven Cardiol 2015;28:41-50) ST-segment elevation myocardial infarction. 1 In AMI, CS results from the loss of myocardium contractility, leading to a failure to maintain an adequate systemic perfusion. In this pathophysiologic context, patient in profound CS may not respond to increasing dose of inotropes and intra-aortic balloon pump (IABP) and, thus, requires the use of more powerful mechanical circulatory support devices to save their lives. At our institution, mechanical hemodynamic support plays a central role in the management of AMI complicated by CS. While IABP is used as the first-line
Minerva cardioangiologica, 2013
Postcardiotomy cardiogenic shock (PCCS) is associated with high mortality rates, despite full conventional treatment. Although the results of treatment with surgically implantable ventricular assist devices have been encouraging, the invasiveness of this treatment limits its applicability. Several less invasive devices have been developed, including the Impella system. The objective of this study was to describe our three-center experience with the Impella 5.0 device in the setting of PCCS. From January 2004 through December 2010, a total of 46 patients were diagnosed with treatment-refractory PCCS and treated with the Impella 5.0 percutaneous left ventricular assist device at three european heart centers. Baseline and follow-up characteristics were collected retrospectively and entered into a dedicated database. Within the study cohort of 46 patients, mean logistic and additive EuroSCORES were 24 ± 19 and 10 ± 4. The majority of patients underwent coronary artery bypass grafting (4...
The Therapeutic Use of Impella Device in Cardiogenic Shock: A Systematic Review
Cureus
Impella (Abiomed, Danvers, MA) devices nowadays have been linked to cardiogenic shock (CS) due to the importance of their use as therapeutic instruments. This study aims to review pathophysiologic mechanisms of cardiogenic shock and the implementation of Impella to overcome this condition. To investigate several different types of studies and analyze the use of Impella device in cardiogenic shock and the outcomes of heart malfunctioning and determine its positive and negative impacts as a therapeutic tool in cardiac ischemia and use as a resource in critical patients, we conducted a systematic review through different databases (PubMed, ScienceDirect, and Google Scholar) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and used the Medical Subjects Heading (MeSH) search strategy to obtain significant articles. We found 883 papers in total, and after removing duplicates, applying inclusion/exclusion criteria, and finding the most significant information, we ended up with 30 articles that were reviewed containing information about the impact of Impella device in cardiogenic shock in different locations. The study strongly concludes that Impella device in the setting of cardiogenic shock has more advantages than disadvantages in terms of outcomes and complications as a non-pharmacologic tool. Improvements in left ventricular ejection fraction and signs and symptoms of cardiogenic shock criteria were determinants. Nevertheless, complications during the implementation and use of the device were established; in this manner, the evaluation and treatment of each patient separately are imperative. Consequently, more studies on this relevant topic are needed.
Left Ventricular Support with the Impella® LP 5.0 for Cardiogenic Shock Following Cardiac Surgery
Heart, Lung and Circulation, 2008
We report the first Australian use of the Impella ® LP 5.0, a minimally invasive, high-output left ventricular assist device. The device was inserted intra-operatively for cardiac failure following coronary artery grafting. Although it facilitated a temporary post-operative recovery, the patient ultimately succumbed due to left ventricular failure more than 30 days after the original procedure. This device has several advantages over existing forms of left ventricular support, and has the potential for widespread use in Australian centres.
Revista Portuguesa de Cardiologia, 2021
Introduction and Objectives: The use of mechanical circulatory support is increasing in cases of cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR-PCI). The Impella ® is a percutaneous ventricular assist device that unloads the left ventricle by ejecting blood to the ascending aorta. We report our center's experience with the use of the Impella ® device in these two clinical settings. Methods: We performed a single-center retrospective study including all consecutive patients implanted with the Impella ® between 2007 and 2019 for CS treatment or prophylactic support of HR-PCI. Data on clinical and safety endpoints were collected and analyzed. Results: Twenty-two patients were included: 12 were treated for CS and 10 underwent an HR-PCI procedure. In the CS-treated population, the main cause of CS was acute myocardial infarction (five patients); hemolysis was the most frequent device-related complication (63.7%). In-hospital, cumulative 30-day and one-year mortality were 58.3%, 66.6% and 83.3%, respectively. In the HR-PCI group, all patients had multivessel disease (mean baseline SYNTAX I score: 44.1±13.7). In-hospital, 30-day and one-year mortality were 10.0%, 10.0% and 20.0%, respectively. There were no device-or procedure-related deaths in either group. Conclusion: The short-and long-term results of Impella ®-supported HR-PCI were comparable to those in the literature. In the CS group, in-hospital and short-term outcomes were poor, with high mortality and non-negligible complication rates.
Increasing use of the Impella®-pump in severe cardiogenic shock: a word of caution
Interactive CardioVascular and Thoracic Surgery, 2020
Impella® pumps are increasingly utilized in patients in cardiogenic shock. We report on a case series where Impella support was insufficient, and a switch to venoarterial extracorporeal membrane oxygenation (VA ECMO) became necessary. ECMO patients with previous Impella devices were identified utilizing our institutional ECMO database. Since 2014, 10 patients with a mean age of 62 ± 3 years were identified. Despite correct placement of all Impella pumps, cardiogenic shock persisted with progressive multi-organ failure (Impella type 2.5/CP n = 6/4 patients). Femoro-femoral VA ECMO was implanted percutaneously on the contralateral side with the Impella initially left on standby but retracted into the descending aorta for transport reasons after a mean support time of 20 ± 8 h. All patients were able to unload their heart by left ventricular ejection with a blood pressure amplitude of 15 ± 3 mmHg on VA ECMO support. After VA ECMO implantation haemodynamic parameters improved significan...