(210) - Outcome of the Impella Device for Mechanical Circulatory Support in Patients With Refractory Cardiogenic Shock

Abstract

Acute cardiogenic shock is associated with high mortality rates and mechanical circulatory devices have been increasingly used in this setting. We report the outcome of the Impella device for acute circulatory support in cardiogenic shock from a large-volume single institution. We performed a retrospective study of patients who underwent placement of the Impella device from December 2010 to July 2014. We analyzed patient’s demographics, hemodynamics, echocardiographic and operative details, in-hospital, 6-month and 1-year survival. Sixty consecutive patients were included in our study. The mean age was 53.4±15.4 years, 47 patients (78.3%) were men. Main indications for placement of the Impella device were post-cardiotomy cardiogenic shock in 31 (51.7%) patients, acute myocardial infarction in 14 (23.3%), acute decompensation of chronic cardiomyopathy in 9 (15.0%), myocarditis in 2 (3.3%). Sixteen Impella devices were implanted for left ventricular unloading in patients supported by Extra-Corporeal Membrane Oxygenation (ECMO). Of the 60 patients, 55(91.7%) received the Impella 5.0 and 5 (8.3%) the Impella 2.5 and 1(1.7%) the Impella CP. The mean duration of Impella support was 10.7±7.4 days (range1-37). Weaning of the Impella device was possible because of left ventricular functional recovery in 28( 46.7%) patients, bridge to long term LVAD (Left Ventricular Assist Device) in 6 (10.0%), bridge to transplantation in 6 (10.0%). Thirteen (21.7%) patients died with the Impella device in place (associated with ECMO), 8 patients were switched to double central ECMO because of severe septic shock or right ventricular failure. In hospital, 6-month and 1-year survival rates were 56.7%, 55.0% and 53.3% respectively.Five patients presented with device related complications: device malfunction, device migration, high purge pressures, axillary hematoma and axillary infection. No patient experienced new onset of acute pulmonary oedema while being supported by the Impella device. To date this is the largest series of patients undergoing placement of the Impella device for acute cardiogenic shock. In-hospital and one-year mortality rates were acceptable in these critical patients. Two third of the patients were able to be weaned from the device or bridged to other therapies. Few device-related complications were reported.