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Right Ventricular Failure (RVF) post myocardial infarction, post cardiotomy or post LVAD implantation increases morbidity and mortality and contributes to prolonged hospital length of stay and higher costs of care.
We present the largest prospective cohort of patients with severe RVF treated with a percutaneous right ventricular assist device (RVAD). Sixty patients with RVF refractory to medical treatment received the Impella RP device at 14 US institutions as part of the Impella RP pre and post market approval studies. The study population included two cohorts: Cohort A: patients with RVF post Left Ventricular Assist Device (LVAD) implantation (n=31) and Cohort B: patients with RVF post-cardiotomy, heart transplant or post-myocardial infarction (n=29). The primary endpoint was survival to 30 days or hospital discharge (whichever was longer).
The mean age was 59±15 years, 68% were males, 84% had a history of congestive heart failure, 44% had valvular disease and 35% had renal dysfunction. Patients were on an average of 3.4 inotropes/pressors prior to RP implant. Patients were supported for 4.0±1.5 days [0.5, 14 days]. Hemodynamics improved immediately after initiation of Impella RP support, with increase in cardiac index from 1.9±0.1 to 3.1±0.2 L/min/m2 (P<0.001), and decrease in central venous pressure from 19.0±1 to 13±1 mmHg (P<0.001). The overall survival at 30 day (or discharge) was 72%. Lower age, lower CVP, and higher cardiac output and Pulmonary Artery Pressure Index (PAPi) were associated with survival in univariate analysis.
In patients with severe RVF the use of Impella RP device resulted in immediate hemodynamic benefit with reversal of shock and favorable survival to 30 days.
CORONARY: Hemodynamic Support and Cardiogenic Shock