Hemodynamic Evaluation of Right Ventricular Function before and after Impella 5.0 Placement for Cardiogenic Shock

Abstract

Purpose Right ventricular (RV) dysfunction is a known complication following implantation of a durable left ventricular assist device (LVAD). Whether this occurs following temporary LVAD support with the Impella 5.0 is unknown. With increasing use of the Impella 5.0, knowledge of the acute hemodynamic effects on RV function after implantation are relevant for appropriate patient selection. The pulmonary artery (PA) pulsatility index or PAPi (PA systolic pressure minus PA diastolic pressure divided by right atrial pressure) is a novel hemodynamic marker associated with increased risk of RV failure after durable LVAD implantation. Whether this is true following temporary LVAD support is not known. The purpose of this study was to determine if patients with cardiogenic shock and pre-existing RV dysfunction had worsening or improvement in RV function following Impella 5.0 placement. Methods During a 5-year period ending August 2018 a total of 103 patients underwent Impella 5.0 placement for cardiogenic shock at our institution. Sixty-one of these patients had hemodynamic variables before and after implantation, 39 of which had a baseline PAPi ≤ 2, a value below which there is an increased risk for developing RV failure after durable LVAD placement. Hemodynamic variables were compared using Mann-Whitney U test. Results Median age was 56 (interquartile range (IQR) = 43 - 63) years at the time of Impella 5.0 placement. After device placement, PAPi increased to above 2 in 23 (59%) patients. Median PAPi increased from 1 (IQR = 0.75-1.34) to 2.40 (IQR = 1.28-3.20); p Conclusion In patients with biventricular dysfunction and cardiogenic shock before Impella 5.0 implantation, a majority demonstrated improvement in RV function (PAPi) as well as RAP, mPAP, and CI after temporary LVAD placement.