Initial experience covering 50 consecutive cases of large Impella implantation at a single heart centre

Abstract

Aims Pre‐operative or post‐operative heart failure (HF) and cardiogenic shock of various natures frequently remain refractory to conservative treatment and require mechanical circulatory support. We report our clinical experience with large Impella systems (5.0 or 5.5; i.e. Impella 5+) (Abiomed Inc., Boston, USA) and evaluate the parameters that determined patient outcome. Methods and results The initial 50 cases of Impella 5+ implanted for acute HF between November 2018 and August 2020 at a single centre were enrolled in this study. Data, including preoperative characteristics, perioperative clinical course information, and post‐operative outcomes, were retrospectively collected from the hospital data management and quality assurance system. Descriptive and univariate analyses were performed. Among the 49 patients in this study, 28 (56.0%) survived in the first 30 days post‐operatively, and 3 died of non‐cardiac reasons later. In‐hospital mortality was significantly higher in patients with biventricular failure [P < 0.01, odds ratio (OR) 5.63] or dilated cardiomyopathy (DCM) (P = 0.02, OR 15.8), whereas ischaemic cardiomyopathy (ICM) was associated with lower mortality (P = 0.03, OR 0.24). Interestingly, the mortality was comparable between the ‘solo’ Impella group and the veno‐arterial extracorporal membrane oxygenation (va‐ECMO) plus Impella (ECMELLA) group, despite the severity of the patients' profile in the ECMELLA group (‘solo’ vs. ECMELLA; 55.6% vs. 52.6%, P = 1.00). All patients who received an additional temporary right ventricular assist device (tRVAD) were successfully weaned from va‐ECMO. Conclusions Our results suggest that biventricular failure and DCM are predictors of higher mortality in patients with Impella. Considering the pathophysiology of HF, implantation of a large Impella system seems to be promising, especially for ICM patients. The large Impella system might be more effective for better prognosis of patients under va‐ECMO, and combination therapy with tRVAD seems to be a promising strategy for early weaning from va‐ECMO.

Microaxial Left Ventricular Assist Device in Cardiogenic Shock: A Systematic Review and Meta-Analysis

“…From 4173 articles, we reviewed 206 full-text articles. In total, we included 71 studies (63 observational, 8 PSM/RCTs) detailing 4280 adult patients that reported on the use of microaxial LVADs in CS ( Figure 1 ) [ 16 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 …”

Clinical outcomes of hundred large Impella implantations in cardiogenic shock patients based on individual clinical scenarios

“…From November 2018 to October 2021, 100 consecutive Impella 5+ ( n = 96 for Impella 5.0; n = 4 for Impella 5.5) were implanted to treat acute CS in 90 cases (i.e., episodes of care) at a single institution. We previously reported our very initial experience with Impella 5+ in the first 50 consecutive cases treated at our center between November 2018 and August 2020 9 . In this current study, we have now added more patients to clarify the stated hypothesis and the purpose of this study.…”

Outcome of Patients Supported by Large Impella Systems After Re-implantation Due to Continued or Recurrent Need of Temporary Mechanical Circulatory Support

“…Postoperative management after Impella 5+ follows as we described before ( 9 , 10 ). Briefly, all parameters displayed in Impella monitor, e.g., Impella setting, Impella flow, purge pressure, purge flow rate, and placement signal, were documented every 3 h. All patients underwent chest X-ray evaluation every day to examine the position of the Impella pump.…”