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

Frontiers in Cardiovascular Medicine

article

Yukiharu Sugimura¹  Sebastian Bauer¹  Moritz Benjamin Immohr¹  Arash Mehdiani¹  Philipp Rellecke¹  Ralf Westenfeld²  Hug Aubin¹  Udo Boeken¹  Artur Lichtenberg¹  Payam Akhyari¹ 

[1] Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Hospital;Department of Cardiology, Angiology and Pulmonology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Hospital

关键词: cardiogenic shock;    Impella;    complication;    re-implantation;    thrombosis;   

DOI  :  10.3389/fcvm.2022.926389

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Despite the growing utilization of a large microaxial pump, i. e., Impella 5.0 or 5.5 (Abiomed Inc., Danvers, MA, USA) (Impella 5+) for patients with cardiogenic shock (CS), adverse events including the necessity of re-implantation have not been well discussed. In all 67 patients, in-hospital mortality was 52.2% ( n = 35). Explantation of Impella 5+ was performed in 39 patients (58.2%), 22 of whom (32.8%) recovered under Impella 5+, and ten further patients (14.9%) survived after a successful transition to permanent mechanical circulatory support. Embolic events were considerable complications in each access. They occurred in the right arm after the removal of Impella 5+ via a subclavian artery (SA) ( n = 3, 9.1%) or in the form of leg ischemia in patients with Impella 5+ via femoral artery (FA) ( n = 2, 33.3%). Re-implantation was necessary for 10 patients (14.9%) due to 1) recurrent CS ( n = 3), 2) pump thrombosis ( n = 5), or 3) pump dislocation ( n = 2), all of which were successfully performed via the same access route. In univariate analysis, FA access was a significant risk factor for Impella dysfunction compared to SA access (FA vs. SA, 42.9% vs. 9.8%, p < 0.05, odds ratio 6.88). No statistical difference of overall mortality was observed in patients with Impella 5+ re-implantation ( n = 10) compared to patients with primary Impella 5+ support ( n = 57) (80.0% ( n = 8/10) vs. 47.4% ( n = 27/57), p = 0.09). Our results suggested the acceptable clinical outcome of Impella 5+ despite a 15% re-implantation rate. Our observational data may merit further analysis of anticoagulation strategies, including risk stratification for embolic events.

【 授权许可】

CC BY