Preventive Impella® Support in High-Risk Patients Undergoing Cardiac Surgery

• Published in: Journal of clinical medicine Vol. 11; no. 18; p. 5404
• Main Authors: Benke, Kálmán, Korça, Edina, Boltjes, Anniek, Stengl, Roland, Hofmann, Britt, Matin, Meradjoddin, Krohe, Katharina, Yakobus, Yuliana, Michaelsen, Jens, Khizaneishvili, Levan, Szabó, Gábor, Veres, Gábor
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 14.09.2022; MDPI
• Subjects: CABG; Clinical medicine; ECLS; Extubation; Heart failure; Heart surgery; Impella; Mortality; Patients; postcardiotomy cardiogenic shock; Postoperative period; Weaning
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm11185404

Background: Patients with severely reduced LV-EF ≤ 30% undergoing CABG have a high risk for postoperative cardiogenic shock. The optimal timing of an adequate hemodynamic support has an impact on short- and midterm mortality after CABG. This study aimed to assess the prophylactic use of the Impella pump in high-risk patients undergoing elective cardiac surgery. Methods: In this single-center retrospective study, 14 patients with LV-EF (≤30%) undergoing cardiac surgery received a prophylactic, perioperative Impella (5.0, 5.5) support between 2020 and 2022. Results: The mean age at surgery was 64.2 ± 2.6 years, the mean preoperative LV-EF was 20.7% ± 1.56%. The duration of Impella support was 4 (3–7.8) days and the 30-day survival rate was 92.85%. Acute renal failure occurred in four patients who were dialyzed on average for 1.2 ± 0.7 days. Mechanical ventilation was needed for 1.75 (0.9–2.7) days. Time to inotrope/vasopressor independence was 2 (0.97–7.25) days with a highest lactate level (24 h postoperatively) of 3.8 ± 0.6 mmol/l. Postoperative LV-EF showed a significant improvement when compared to preoperative LV-EF (29.1% ± 2.6% vs. 20.7% ± 1.56% (p = 0.022)). Conclusion: The prophylactic Impella application seems to be a safe approach to improve the outcomes of this patient population.