Bridge To Decision Or Destination With Impella 5.0 And 5.5 In Cardiogenic Shock

Abstract

Introduction The Impella (ABIOMED, Danvers, MA) is a temporary left ventricular support device, intended for short-term circulatory support of an INTERMACS class 1 patient in cardiogenic shock (CS). It can be used as a bridge therapy to allow for time for decision making, as a bridge to a destination, or as a bridge to definitive therapy. Limited data from others show an improved survival rate with the use of these pumps in small cohorts. Methods We conducted a retrospective, single-center study of consecutive patients who received support with either the Impella 5.0 or 5.5 between January 2017 and December 2020. Baseline characteristics and outcomes at 30 days and 1 year were analyzed. Results A total of 61 patients were included in the study. Baseline characteristics, including comorbidities, and outcomes are presented (Table 1). The mean age was 59 years, and 85% were male. The Impella 5.0 was implanted in 40 (66%) patients, while Impella 5.5 was used in 21 (34%) patients. Patients had a mean left ventricular ejection fraction of, 22% ± 5% at the time of device implantation. CS from worsening chronic systolic heart failure occurred in 35 (57%) patients, and acute myocardial infarction was the precipitator in 26 (43%) patients. Device support was sustained for a median of 17 days (interquartile range 8 - 32). Death occurred in 32 (53%) patients while on Impella support. At 30 days, 24 (39%) patients were alive, and 16 (26%) survived to the 1-year follow-up time point. Complications occurred in 14 patients and were most commonly thromboembolic events (35%), ventricular tachycardia (28%), and need for repositioning (21%). Conclusion These hemodynamic devices are useful in supporting patients who need a bridge to decision and might be too sick to proceed with definitive therapies. At the same time, these devices offer durable support for those eligible for destination therapy. Despite adequate hemodynamic support, the overall mortality of CS in this patient population remains high. The Impella (ABIOMED, Danvers, MA) is a temporary left ventricular support device, intended for short-term circulatory support of an INTERMACS class 1 patient in cardiogenic shock (CS). It can be used as a bridge therapy to allow for time for decision making, as a bridge to a destination, or as a bridge to definitive therapy. Limited data from others show an improved survival rate with the use of these pumps in small cohorts. We conducted a retrospective, single-center study of consecutive patients who received support with either the Impella 5.0 or 5.5 between January 2017 and December 2020. Baseline characteristics and outcomes at 30 days and 1 year were analyzed. A total of 61 patients were included in the study. Baseline characteristics, including comorbidities, and outcomes are presented (Table 1). The mean age was 59 years, and 85% were male. The Impella 5.0 was implanted in 40 (66%) patients, while Impella 5.5 was used in 21 (34%) patients. Patients had a mean left ventricular ejection fraction of, 22% ± 5% at the time of device implantation. CS from worsening chronic systolic heart failure occurred in 35 (57%) patients, and acute myocardial infarction was the precipitator in 26 (43%) patients. Device support was sustained for a median of 17 days (interquartile range 8 - 32). Death occurred in 32 (53%) patients while on Impella support. At 30 days, 24 (39%) patients were alive, and 16 (26%) survived to the 1-year follow-up time point. Complications occurred in 14 patients and were most commonly thromboembolic events (35%), ventricular tachycardia (28%), and need for repositioning (21%). These hemodynamic devices are useful in supporting patients who need a bridge to decision and might be too sick to proceed with definitive therapies. At the same time, these devices offer durable support for those eligible for destination therapy. Despite adequate hemodynamic support, the overall mortality of CS in this patient population remains high.