Bridging with surgically placed microaxial left ventricular assist devices: a high-volume centre experience

• Published in: European journal of cardio-thoracic surgery Vol. 63; no. 6
• Main Authors: Gill, George, Rowe, Georgina, Chen, Qiudong, Malas, Jad, Thomas, Jason, Peiris, Achille, Cole, Robert, Chikwe, Joanna, Megna, Dominick, Emerson, Dominic
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 01.06.2023
• Subjects: Brain Ischemia; Cardiomyopathies; Heart-Assist Devices - adverse effects; Humans; Retrospective Studies; Shock, Cardiogenic - etiology; Shock, Cardiogenic - surgery; Stroke; Treatment Outcome; Tx & Mcs; Heart transplant; mechanical circulatory support; heart failure
• ISSN: 1873-734X; 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezad116

Abstract OBJECTIVES The Impella 5.0 and 5.5 have largely superseded non-ambulatory temporary mechanical support devices; yet, clinical outcomes are predominantly limited to small series: this study presents the experience of a high-volume centre. METHODS An institutional clinical registry was used to identify all patients with cardiogenic shock who underwent Impella 5.0 or 5.5 implantation from January 2014 to March 2022. The primary outcome was survival to device explantation. RESULTS The study cohort comprised 221 patients, including 146 (66.1%) Impella 5.0 and 75 (33.9%) Impella 5.5 patients. The primary aetiology was non-ischaemic cardiomyopathy (50.7%, n = 112), ischaemic cardiomyopathy (23.1%, n = 51) and acute myocardial infarction (26.2%, n = 58). Patients were prospectively classified according to strategy as bridge to transplant (47.5%, n = 105), bridge to durable device (13.6%, n = 30) or bridge to recovery (38.9%, n = 86). Patients were predominantly Interagency Registry for Mechanically Assisted Circulatory Support profile 1 or 2 (95.0%, n = 210). The median bridging duration was 14 (range 0–137) days. Device exchange, Ischaemic stroke and ipsilateral arm ischaemia occurred in 8.1% (n = 18), 2.7% (n = 6) and 1.8% (n = 4) of patients, respectively. Compared to the 75 most recent Impella 5.0 patients, Impella 5.5 patients (n = 75) had lower rates of device exchange (4.0%, n = 3 vs 13.3%, n = 10, P = 0.04). Overall, 70.1% (n = 155) of patients survived to Impella explantation. CONCLUSIONS The Impella 5.0 and 5.5 provide safe and effective temporary mechanical support in appropriately selected patients with cardiogenic shock. The newer device generation may have a lower requirement for device exchange as compared to its predecessor. US and European consensus guidelines recommend the consideration of short-term mechanical circulatory support devices to improve end-organ perfusion in patients with cardiogenic shock despite optimal medical therapy [1, 2]. Graphical Abstract