Improvement in Right Ventricular Stroke Work Index in Cardiogenic Shock Associated with Excellent Durable Left Ventricular Assist Implantation Results

Abstract

Purpose Cardiogenic shock results from inadequate cardiac output to satisfy organ perfusion with potential need for pharmacologic and mechanical circulatory support for survival. Impella 5.0 insertion is used as a rescue device and bridge to durable mechanical circulatory support. We sought to evaluate changes in right ventricular parameters in patients bridged with Impella 5.0 undergoing durable left ventricular device implantation (LVAD). Methods A single center retrospective review of patients presenting in cardiogenic shock requiring micro-axial circulatory support with Abiomed Impella 5.0 between 2016-2020 was performed. Patient demographics, pre- and post-implant laboratory values and right heart catheterization pressures were reviewed. Patient demographics were evaluated using chi square test, clinical value means compared with unpaired t-test, p Results A total of 24 patients presenting in cardiogenic shock receiving durable LVAD after Impella 5.0 were included for analysis. The majority of patients were male, 59.3 ± 11.1 years old, with history of ischemic heart disease. All patients received an Impella 5.0 via axillary approach. Significant improvement in serum creatinine (1.83 vs 1.42, p 0.05). No patients received right ventricular assist device support, 30-day mortality was 8.3% Conclusion Impella 5.0 insertion for cardiogenic shock significantly decreased central venous and mean pulmonary artery pressure with concomitant improvement in RV function as measured by increased right ventricular stroke work index. Total bilirubin increased, likely as a result of pump hemolysis. Excellent results can be obtained with LVAD implantation in cardiogenic shock patients utilizing Impella 5.0 as a bridge.