Short-term mechanical circulatory support with the Impella 5.0 device for cardiogenic shock at La Pitié-Salpêtrière.

Abstract

Cardiogenic shock carries a high mortality rate despite aggressive medical treatment. The Impella® Recover® LP 5.0 Support System is a microaxial minimally invasive ventricular assist device designed for short-term mechanical circulatory support in low cardiac output states. The aim of this study is to assess the safety of the Impella 5.0 device, using the right axillary artery approach, in cardiogenic shock managed at La Pitié-Salpêtrière Hospital. Since December 2010 and during a period of 14 months, 14 highly selected patients underwent surgical implantation of an Impella 5.0 device for cardiogenic shock. Demographics, preoperative and postoperative data were retrospectively collected from La Pitié-Salpêtrière computerized medical charts. Responders to Impella support were defined as patients with rapid improvement in haemodynamic condition and biological profile. Patients who had no signs of cardiac recovery after two weeks of mechanical support were considered for heart transplantation or long-term left ventricular assist device implantation. Patients were predominantly male (78.5%) with a mean age of 64±15. Short-term circulatory support was indicated for cardiogenic shock in the setting of acute coronary syndromes ( n=7; 50%), postcardiotomy cardiac dysfunctions ( n=6; 43%) and anthracycline-induced dilated cardiomyopathy ( n=1; 7%). After a mean support time of 8.5 days, six patients (42.8%) were successfully weaned and four (28.5%) were switched to a long-term left ventricular assist device. No major bleeding, arm ischaemia, ventricular arrhythmia or severe haemolysis was noted. We report two cases (14%) of pump thrombosis, four cases of device displacement with the need of pump repositioning and one case (7%) of infection at the insertion site. Thirty-day mortality was 35.7%. Long-term overall mortality rate at six months, one year and two years was 42.8, 42.8 and 42.8%, respectively. The Impella 5.0 device surgically inserted through the axillary artery is a valuable minimally invasive short-term circulatory support in cardiogenic shock of various aetiologies.