Axillary Impella 5.0 Outcomes - A Single Center Review

Abstract

Mechanical circulatory support (MCS) has been considered a "bridge to decision/therapy" alternative to ameliorate compromised hemodynamic condition in patients whom conventional medical therapy is insufficient to maintain the adequate organ perfusion and function. Outcomes of patients after temporary mechanical support depend on various factors and can range from mortality to recovery to a bridge to cardiac replacement like heart transplant or long term ventricular assist devices. We aim to retrospectively analyze medical record information and clinical outcomes from patients with axillary Impella 5.0 seen at our institution. This retrospective analysis study was designed to gather information about patients that were implanted with an axillary Impella 5.0 at The Methodist Hospital between 2010 and 2019. Subjects were identified and selected through chart review and physician referrals. Through the span of about a decade, we have placed about 48 axillary Impella 5.0 devices in a wide range of patients divided into 42 men and 6 women. 24 patients were over the age of 60, 15 patients between 41 and 60 years old, and 9 patients between 29-40 years of age. Of those patients, about 26 patients were upgraded from an Intra-aortic balloon pump, 10 patients had no previous MCS, and the rest either had ECMO or other impella devices. About 44 patients met their hemodynamic needs via the axillary impella device. The 4 remaining patient had either concurrent ECMO and/or RVAD. In regards to outcomes, 22 patients were able to be bridged to OHT or LVAD, 18 patients expired and were not candidates for advanced HF therapy, and 8 patients were able to have the impella weaned off. Our single center retrospective study shows that axillary impella 5.0 devices are a viable device for bridge to recovery and/or bridge to cardiac replacement. Over 62% of our patients were able to be bridged to heart transplant/LVAD or have the impella weaned off due to cardiac recovery. Our rate of success is largely due to the increased support provided by the Impella 5.0 devices, but also with the added benefit allowing these patients to be ambulatory to help reduced critical illness morbidity and mortality.