Outcomes of surgical Impella placement in acute cardiogenic shock

• Published in: Proceedings - Baylor University. Medical Center Vol. 36; no. 4; pp. 415 - 421
• Main Authors: George, Timothy J., Sheasby, Jenelle, DiMaio, J. Michael, Kabra, Nitin, Rawitscher, David A., Afzal, Aasim
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 2023; Taylor & Francis Ltd
• Subjects: Cardiogenic shock; Heart failure; Impella; Original Research: Cardiology; temporary mechanical circulatory support; Impella; Cardiogenic shock; temporary mechanical circulatory support
• ISSN: 0899-8280; 1525-3252
• DOI: 10.1080/08998280.2023.2205817

Although a role for percutaneous Impella devices has been established, there is a paucity of data regarding the utility and outcomes of larger surgically implanted Impella devices. We conducted a retrospective review of all surgical Impella implants at our institution. All Impella 5.0 and Impella 5.5 devices were included. The primary outcome was survival. Secondary outcomes included hemodynamic and end-organ perfusion as well as commonly encountered surgical complications. From 2012 to 2022, 90 surgical Impella devices were implanted. The median age was 63 [53-70] years, the mean creatinine was 2.07 ± 1.22 mg/dL, and the average lactate level was 3.32 ± 2.90 mmol/L. Prior to implantation, 47 patients (52%) were supported with vasoactive agents, while 43 (48%) were also supported with another device. The most common etiology of shock was acute on chronic heart failure (50, 56%), followed by acute myocardial infarction (22, 24%), and postcardiotomy (17, 19%). Overall, 69 patients (77%) survived to device removal, and 57 (65%) survived to hospital discharge. One-year survival was 54%. Neither etiology of heart failure nor device strategy was associated with 30-day or 1-year survival. On multivariable modeling, the number of vasoactive medications prior to device implantation was strongly associated with 30-day mortality (hazard ratio 1.94 [1.27-2.96], P < 0.01). Surgical Impella placement was associated with a significant decreased need for vasoactive infusions (P < 0.01) and decreased acidosis (P = 0.01). Surgical Impella support for patients in acute cardiogenic shock is associated with lower vasoactive medication use, improved hemodynamics, increased end-organ perfusion, and acceptable morbidity and mortality.