Right Ventricular Optimization with Impella Support Prior to Left Ventricular Assist Device Implantation

• Published in: The Journal of heart and lung transplantation Vol. 41; no. 4; p. S349
• Main Authors: Alom, M., Salih, M., Bhattal, G., Kabra, N., Rawitscher, D., George, T., Afzal, A.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2022
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2022.01.1433

Limited data is available for hemodynamic optimization with Impella support prior to Left ventricular assisted device (LVAD) implantation and its impact on the right ventricle (RV) function and the need for inotropic support on discharge. In our study, we aimed to evaluate the hemodynamic outcomes and the presence of RV failure in patients who were on Impella as a bridge to LVAD therapy. Institutional IRB approval was obtained for a retrospective review was conducted on all patients who underwent LVAD from 2015 to 2020 to identify the patients who required Impella support prior to LVAD implantation. Primary outcome was the presence of RV failure on discharge. Secondary outcomes were in-hospital mortality, the need for inotropes at discharge, and disposition. 70 patients were screened. 13 of them had cardiogenic shock and are included in our study. All 13 patients required Impella prior to LVAD implantation. 9 patients (69.2 %) had RV failure prior based on echocardiogram (Echo) either at or after Impella implantation; 2 of which were severe. All included patients had an INTERMACS profile 1. 2 /13 (15.3%) died during the index hospitalization post LVAD implantation. 11 patients were discharged and none required home inotropic support. The incidence of post LVAD implantation RV failure in this cohort was 4/11 (36.3%). None of the RV failure was determined to be severe based on Echo and the need for RV tMCS. 7/11 of the discharged patients (63.6%) went home, and the rest were discharged to long term care facilities and subsequently home. Impella as a bridge to LVAD, can help improve RV hemodynamic profile prior to LVAD implantation. Given the critical clinical profile, patients carry high mortality rate but potentially Impella could potentially reduce the need for inotropes on discharge and the rate of discharge to rehab facilities.