Axillary Impella® Improves Risk Stratification for Early, Severe Right Heart Failure Following Durable LVAD Implantation

Abstract

<h3>Purpose</h3> To evaluate the impact of axillary Impella support in the risk assessment for early right heart failure (RHF) after durable LVAD. <h3>Methods</h3> Between June 2016 and May 2020, 20 patients were bridged to LVAD with axillary Impella® 5.0/5.5. Seventeen were deemed moderate or high risk for RHF by EUROMACS-RHF score. Hemodynamic parameters of RV function were assessed pre- and post-Impella for their associations with early, severe RHF after LVAD using the INTERMACS definition. Values of continuous variables are expressed as median and interquartile range. <h3>Results</h3> Seven patients (35%) developed RHF. In all patients, measures of RV load [effective arterial elastance (E_A), pulmonary vascular resistance (PVR), and pulmonary vascular compliance (P_CA)] similarly improved after Impella insertion. The non-RHF group had greater improvements in RV adaptation parameters (RAP, RAP:PCWP, PAPi) compared to the RHF group [ΔRAP: -12 (-14 - -8) vs. -2.00 (-8 - 4) p = 0.008; ΔRAP:PCWP: -0.28 (-0.33 - -0.21) vs. -0.11 (-0.13 - 0.19), p = 0.05; ΔPAPi: 4.54 (1.20 - 8.03) vs. 0.55 (-1.58 - 1.44), p = 0.025]. Empirical cutoff values after axillary Impella insertion for changes in RAP, RAP:PCWP, and PAPi to identify early RHF after LVAD implantation are provided in Table 1. <h3>Conclusion</h3> In patients at moderate or high risk for early, severe RHF after LVAD implantation, greater improvements in RAP, RAP:PCWP, and PAPi after Impella insertion are associated with lower RHF risk.