Impella percutaneous left ventricular assist device as mechanical circulatory support for cardiogenic shock: A retrospective analysis from a tertiary academic medical center

• Published in: Catheterization and cardiovascular interventions Vol. 99; no. 1; pp. 37 - 47
• Main Authors: Nouri, Shayan Nabavi, Malick, Waqas, Masoumi, Amirali, Fried, Justin A., Topkara, Veli K., Brener, Michael I., Ahmad, Yousif, Prasad, Megha, Rabbani, LeRoy E., Takeda, Koji, Karmpaliotis, Dimitrios, Moses, Jeffrey W., Leon, Martin B., Kirtane, Ajay J., Garan, A. Reshad
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.01.2022; Wiley Subscription Services, Inc
• Subjects: Academic Medical Centers; acute myocardial infarction; Aged; cardiogenic shock; ECMO; Female; Heart; Heart-Assist Devices; Humans; Impella; Ischemia; Male; mechanical circulatory support; Middle Aged; Mortality; Myocardial infarction; Oxygenation; Patients; Retrospective Studies; Shock, Cardiogenic - diagnosis; Shock, Cardiogenic - etiology; Shock, Cardiogenic - therapy; Treatment Outcome; Vasoactive agents; Ventricle; ECMO; Impella; mechanical circulatory support; cardiogenic shock; acute myocardial infarction
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.29434

Objectives To describe hemodynamic efficacy and clinical outcomes of Impella percutaneous left ventricular assist device (pLVAD) in patients with cardiogenic shock (CS). Background Percutaneous LVADs are increasingly used in CS management. However, device‐related outcomes and optimal utilization remain active areas of investigation. Methods All CS patients receiving pLVAD as mechanical circulatory support (MCS) between 2011 and 2017 were identified. Clinical characteristics and outcomes were analyzed. A multivariable logistic regression model was created to predict MCS escalation despite pLVAD. Outcomes were compared between early and late implantation. Results A total of 115 CS patients (mean age 63.6 ± 13.8 years; 69.6% male) receiving pLVAD as MCS were identified, the majority with CS secondary to acute myocardial infarction (AMI; 67.0%). Patients experienced significant cardiac output improvement (median 3.39 L/min to 3.90 L/min, p = .002) and pharmacological support reduction (median vasoactive‐inotropic score [VIS] 25.4 to 16.4, p = .049). Placement of extracorporeal membrane oxygenation (ECMO) occurred in 48 (41.7%) of patients. Higher pre‐pLVAD VIS was associated with subsequent MCS escalation in the entire cohort and AMI subgroup (OR 1.27 [95% CI 1.02–1.58], p = .034 and OR 1.72 [95% CI 1.04–2.86], p = .035, respectively). Complications were predominantly access site related (bleeding [9.6%], vascular injury [5.2%], and limb ischemia [2.6%]). In‐hospital mortality was 57.4%, numerically greater survival was noted with earlier device implantation. Conclusions Treatment with pLVAD for CS improved hemodynamic status but did not uniformly obviate MCS escalation. Mortality in CS remains high, though earlier device placement for appropriately selected patients may be beneficial.