‘Long-Term’ Use of Impella - Safe to Do?

Abstract

<h3>Purpose</h3> Impella CP, 5.0 and RP belong to the group of short-term mechanical circulatory support (MCS) devices used for patients with severe heart failure and cardiogenic shock. The Impella is designed for short-term support up to 10 days, but our patients frequently require a longer duration of support. As our patients are often bridged to transplant and long waiting lists often result in long waiting times, we are frequently forced to prolong the use of the Impella. Therefore, we aimed to assess the safety of prolonged device duration past 10 days. <h3>Methods</h3> We present our single center data of 69 patients who underwent Impella placement between May 2017 and May 2021. We divided the patients into two groups, Group A (39 patients) with device duration <10 days and Group B (30 patients) with device duration >10 days and compared the occurrence of complications and mortality in the two groups. <h3>Results</h3> Median device duration for Group A was 6.08 (± 2.2) and 21.6 (± 11.8) days in Group B (p .001). Group A contained 6 Impella 5.0, 27 Impella CP and 6 Impella RP vs. Group B with 18 Impella 5.0, 10 Impella CP and 2 Impella RP (p 0.001). There were no significant differences between Group A and Group B regarding: haemolysis 52.4% vs. 42.6% (p 0.36), access site bleeding 24.3% vs. 30% (p 0.4), thrombocytopenia 27% vs. 23.3% (p 0.47), vascular complications 8.1% vs. 6.7% (p 0.6), device migration 5.6% vs. 6.7% (p 0.6), pump thrombosis 10.8% vs. 17.9% (p 0.3), device malfunction 0% vs. 3.3% (p 0.4), ventricular arrhythmias 29.7% vs. 23.3% (p 0.38), access site infection 0% vs. 3.3% (p 0.44), sepsis 32.4% vs. 46.7% (p 0.17), ischemic cerebrovascular accident (CVA) 0% vs. 3.3% and haemorrhagic CVA 0% vs 6.8%. (p 0.13). There were no significant differences regarding pre-implant and pre-explant bilirubin levels in both groups (p 0.35 and p 0.19) and creatinine levels (p 0.2 and 0.06). The platelet count pre-implant showed no significant difference (p 0.07). However, the pre-explant level was significantly lower in Group A (p 0.005). The mortality rate on Impella in Group A and Group B was 28.2% and 13.3% (p 0.1), respectively. <h3>Conclusion</h3> Prolonged device duration has no significant impact on the short-term outcome except on platelet levels. In cases where longer MCS is mandatory careful monitoring might allow longer Impella support.