Outcomes of Impella RP in Cardiogenic Shock

Abstract

<h3>Purpose</h3> Right ventricular dysfunction (RVD) continues to be associated with high morbidity and mortality reaching 70% in some series. The Impella RP device (RP; Abiomed; Danvers, MA) offers a percutaneous option for right ventricular support in shock patients. Here we review our single center experience with the RP for patients with RVD due to cardiogenic and post-cardiotomy shock. <h3>Methods</h3> All patients at our center implanted with the RP for RVD from January 2018 to June 2021 were retrospectively reviewed. Review included patients with acute coronary syndrome, cardiac surgery as well as cardiogenic shock from cardiomyopathy. All cases, including salvage cases were reviewed. <h3>Results</h3> Twenty-three patients were implanted with RP during the study period with a mean age of 63 years (31-79 years); 48% male; 48% with RVD complicating acute myocardial infarction. Eight patients received RP only, 12 patients received RP as part of a BiPella configuration, and 3 patients received RP and VA ECMO. A total of 11 of the 23 patients (48%) survived to hospital discharge; 3 with RP only, 7 with BiPella and 1 with RP/VA ECMO. Of the surviving patients, mean time from event to implant was 4 hours, while no patients survived if implanted greater than 24 hours after event. The primary cause of death for all patients was progressive shock and multiorgan system failure. In this series, 16 patients received RP support for cardiogenic shock: 2 RP only, 11 BiPella, 3 RP/VA ECMO and 7 of these 16 survived (44%). Of the survivors, 6 had BiPella support and 1 had RP/ECMO support. In the setting of post-cardiotomy shock, 7 patients received RP for RVD: 6 RP only and 1 with BiPella. Survival to hospital discharge was 57% (4 patients) of which 3 had RP only and 1 BiPella. <h3>Conclusion</h3> From this single-center, real-world experience of RP utilization in cardiogenic and post-cardiotomy shock we conclude that the RP is a valuable resource for RV support, with with the best outcomes when implanted early during shock and as part of a biventricular support system.