Author + information
- Rikin Tank1,
- Richard Cheng2,
- Danny Ramzy2,
- Fardad Esmailian2,
- Jon Kobashigawa2,
- Jaime Moriguchi2,
- Francisco Arabia2 and
- Babak Azarbal2
Outcomes with Impella (Abiomed, Danvers, MA) devices used to salvage severe shock for patients (pts) otherwise eligible for durable mechanical circulatory support (MCS) or transplant (OHT) are not well established. Percutaneously-inserted Impella CP devices have not been compared with surgically-inserted Impella 5.0 devices.
All pts who underwent Impella placement as a bridge to decision, durable MCS, or OHT were included. Survival to durable MCS or OHT and overall survival are reported. Pts initially placed on CP devices were compared with those placed on 5.0 devices.
69 Impella devices were placed in 56 pts from 11/2012 – 12/2016. Mean age at implant was 53.3±14.1 and 80.4% pts were male. 36 initial devices were Impella CP (64.3%) compared with 20 Impella 5.0 (35.7%). Mean duration of Impella-assisted support was 16.2±19.5 d, and median duration per device was 8 (IQR 5-15). 42.9% pts were in INTERMACS 1 shock at implant, 57.1% in profile 2. Recent CPR (28.6%), ventilator use (71.4%), concomitant ECMO (41.1%), and renal replacement (32.1%) were frequent. 40/56 (71.4%) pts survived to next therapy: durable MCS (58.5%), OHT (39.0%), and recovery (1.8%). Overall 30 and 60 d survival were 71.4% and 66.1%. 30 and 60 d survival conditional upon having survived to next therapy was 95.0% and 90.0%. In comparing pts initially placed on CP devices with those placed on 5.0 devices, mean age, admit source, gender, INTERMACS profile, duration of support, ventilator use, and renal replacement were not different (all p>0.1). However, pts placed on CP devices had a higher proportion with an ischemic etiology (55.6% vs. 15.0%, p=0.004), and appeared sicker with more CPR (38.9% vs. 10.0%, p=0.031) and a higher proportion on concomitant ECMO (52.8% vs. 20.0%, p=0.024). Nevertheless, survival to durable MCS or OHT (72.2% vs. 70.0%, p=1.000), 30 d survival (69.4% vs. 75.0%, p=0.763), and 60 d survival (64.9% vs. 70.0%, p=0.772) were similar.
Impella devices can be used to salvage pts in severe heart failure as a bridge to durable MCS or OHT. Initial use of percutaneously-inserted CP devices to salvage severe shock is associated with similar survival as the initial use of 5.0 devices.
CORONARY: Hemodynamic Support and Cardiogenic Shock