Clinical Characteristics and Long Term Outcomes in Septuagenarians Undergoing Cardiac Transplantation

Abstract

was the primary indication for device placement (n59), followed by chronic ischemic cardiomyopathy (n53) and cardiac transplant rejection (n51). The average duration of Impella support was 1167.5 days. Within 24 hours of device placement, patients had an increase in cardiac output to 5.5L/min61.4 vs 4.4L/min61.3 (p50.005), which was associated with an improvement in GFR from 45.0613.5 to 52.0614.5 (p50.01), pulmonary artery pressures 41 613.0 to 3167.0 (p50.01), right atrial pressures 11 64 to 1066 (p50.04) and pulmonary capillary wedge pressure 326 12.0 to 2065.0 (p50.03). In 84% of cases (n511), the Impella provided adequate left ventricular support, with patients either successfully weaned off support completely (n54), or receiving permanent LVADs (n55) or cardiac transplant (n52). Only 16% of patients (n52) died while actively on the Impella .The 30 day mortality was 23% (n53), while overall mortality at 90 days stood at 54% (n57). The causes of mortality included device malfunction, fatal arrhythmia 24 hours after Impella removal and withdrawal of care in 1 patient each and multi-organ failure in 4 patients who were transitioned to permanent LVAD’s. Conclusions: The Impella 5.0 has been shown to be a safe and efficacious device for use in patients with cardiogenic shock. In our high risk population, the device was easily and quickly inserted and demonstrated consistent hemodynamic augmentation. It also established itself as a good supportive modality in our acutely ill patients as well. Though our overall results in terms of mortality have not been very encouraging, the Impella was indeed successful in bridging patients to either, a permanent LVAD, transplant or in some cases ventricular recovery as well. Therefore in these high risk patients with profound cardiogenic shock, this is indeed a suitable treatment strategy.