Impella Removal Research Articles

Techniques of Impella removal while preserving arterial access

Preservation of the arterial access site after removal of large caliber mechanical circulatory devices (MCD) can be challenging. In this paper, we describe two novel techniques and review the current literature focusing on the maintenance of arterial access after Impella removal.

A Novel Technique for Removal of Impella® Device While Maintaining Vascular Access

A Novel Technique for Removal of Impella® Device While Maintaining Vascular Access

Postoperative care of two patients with coronary artery stent implantation supported by ventricular assist device implantation

Objective To discuss the key post-procedural observation and management protocols of coronary stent implantation assisted by Impella2.5 percutaneous left ventricular assist device in cardiac insufficiency patients. Methods Hemodynamics and dynamic ECG monitoring were closely monitored after the procedure. Moderate blood volume was maintained while the electrolyte was balanced. Cardiac complication such as arrhythmia, bleeding and hemolysis were detected immediately. The waveform display on the Impella 2.5 console was monitored closely to assure the position of the Impella 2.5 catheter remains correct. Meanwhile the velocity and pressure of the axial pump was monitored to make sure that the micro axial pump works properly. Results Two patients were discharged after post-operation care without complications. Conclusions Proper management, early detection of complications and removal of Impella 2.5 percutaneous left ventricular assist device are essential to the recovery of patients with extremely low cardiac output who have received with coronary stent implantation assisted by Impella 2.5. Key words: Heart-assist device; Impella 2.5; Postoperative care

Management and outcome of patients supported with Impella 5.0 for refractory cardiogenic shock.

IntroductionCardiogenic shock refractory to standard therapy with inotropes and/or intra-aortic balloon pump is accompanied with an unacceptable high mortality. Percutaneous left ventricular assist devices may provide a survival benefit for these very sick patients. In this study, we describe our experience with the Impella 5.0 device used in the setting of refractory cardiogenic shock.MethodsIn this observational, retrospective, single-center study we included all the consecutive patients supported with Impella 5.0, between May 2008 and December 2013, for refractory cardiogenic shock. Patients’ baseline and procedural characteristics, hemodynamics and outcome to the first 48 h of support, to ICU discharge and day-28 visit were collected.ResultsA total of 40 patients were included in the study. Median age was 57 years and 87.5 % were male. Cardiogenic shock resulted from acute myocardial infarction in 17 patients (43 %), dilated cardiomyopathy in 12 (30 %) and postcardiotomy cardiac failure in 7 (18 %). In 15 patients Impella 5.0 was added to an ECMO to unload the left ventricle. The median SOFA score for the entire cohort prior to circulatory support was 12 [10–14] and the duration of Impella support was 7 [5–10] days. We observed a significant decrease of the inotrope score (10 [1–17] vs. 1 [0–9]; p = 0.04) and the lactate values (3.8 [1.7–5.9] mmol/L vs. 2.5 [1.5–3.4] mmol/L; p = 0.01) after 6 h of support with Impella 5.0. Furthermore, at Impella removal the patients’ left ventricular ejection fraction improved significantly (p < 0.001) when compared to baseline. Cardiac recovery, bridge to left ventricular assist device or heart transplantation was possible in 28 patients (70 %). Twenty-six patients (65 %) survived at day 28. A multivariate analysis showed a higher risk of mortality for patients with acute myocardial infarction (hazard ratio = 4.1 (1.2–14.2); p = 0.02).ConclusionsImpella 5.0 allowed fast weaning of inotropes and might facilitate myocardial recovery. Despite high severity scores at admission, day-28 mortality rate was better than predicated.

Clinical Characteristics and Long Term Outcomes in Septuagenarians Undergoing Cardiac Transplantation

was the primary indication for device placement (n59), followed by chronic ischemic cardiomyopathy (n53) and cardiac transplant rejection (n51). The average duration of Impella support was 1167.5 days. Within 24 hours of device placement, patients had an increase in cardiac output to 5.5L/min61.4 vs 4.4L/min61.3 (p50.005), which was associated with an improvement in GFR from 45.0613.5 to 52.0614.5 (p50.01), pulmonary artery pressures 41 613.0 to 3167.0 (p50.01), right atrial pressures 11 64 to 1066 (p50.04) and pulmonary capillary wedge pressure 326 12.0 to 2065.0 (p50.03). In 84% of cases (n511), the Impella provided adequate left ventricular support, with patients either successfully weaned off support completely (n54), or receiving permanent LVADs (n55) or cardiac transplant (n52). Only 16% of patients (n52) died while actively on the Impella .The 30 day mortality was 23% (n53), while overall mortality at 90 days stood at 54% (n57). The causes of mortality included device malfunction, fatal arrhythmia 24 hours after Impella removal and withdrawal of care in 1 patient each and multi-organ failure in 4 patients who were transitioned to permanent LVAD’s. Conclusions: The Impella 5.0 has been shown to be a safe and efficacious device for use in patients with cardiogenic shock. In our high risk population, the device was easily and quickly inserted and demonstrated consistent hemodynamic augmentation. It also established itself as a good supportive modality in our acutely ill patients as well. Though our overall results in terms of mortality have not been very encouraging, the Impella was indeed successful in bridging patients to either, a permanent LVAD, transplant or in some cases ventricular recovery as well. Therefore in these high risk patients with profound cardiogenic shock, this is indeed a suitable treatment strategy.

Does Etiology of Heart Failure Predict Orthostatic Hypotension in Patents with Left Ventricular Assist Device?

was the primary indication for device placement (n59), followed by chronic ischemic cardiomyopathy (n53) and cardiac transplant rejection (n51). The average duration of Impella support was 1167.5 days. Within 24 hours of device placement, patients had an increase in cardiac output to 5.5L/min61.4 vs 4.4L/min61.3 (p50.005), which was associated with an improvement in GFR from 45.0613.5 to 52.0614.5 (p50.01), pulmonary artery pressures 41 613.0 to 3167.0 (p50.01), right atrial pressures 11 64 to 1066 (p50.04) and pulmonary capillary wedge pressure 326 12.0 to 2065.0 (p50.03). In 84% of cases (n511), the Impella provided adequate left ventricular support, with patients either successfully weaned off support completely (n54), or receiving permanent LVADs (n55) or cardiac transplant (n52). Only 16% of patients (n52) died while actively on the Impella .The 30 day mortality was 23% (n53), while overall mortality at 90 days stood at 54% (n57). The causes of mortality included device malfunction, fatal arrhythmia 24 hours after Impella removal and withdrawal of care in 1 patient each and multi-organ failure in 4 patients who were transitioned to permanent LVAD’s. Conclusions: The Impella 5.0 has been shown to be a safe and efficacious device for use in patients with cardiogenic shock. In our high risk population, the device was easily and quickly inserted and demonstrated consistent hemodynamic augmentation. It also established itself as a good supportive modality in our acutely ill patients as well. Though our overall results in terms of mortality have not been very encouraging, the Impella was indeed successful in bridging patients to either, a permanent LVAD, transplant or in some cases ventricular recovery as well. Therefore in these high risk patients with profound cardiogenic shock, this is indeed a suitable treatment strategy.

Removal of Impella® 2.5 while maintaining vascular access: A solution to a vascular quandary

Cardiogenic shock (CS) in the setting of acute myocardial infarction is associated with high in-hospital mortality rates. Society guidelines provide a Class Ib recommendation for the use of hemodynamic support devices in patients with CS following ST-elevation myocardial infarction. Exchanging of hemodynamic support devices is often complicated by inability to maintain percutaneous vascular access upon device removal in the setting of anticoagulation. This report highlights one potential solution to the dilemma of maintaining vascular access following removal of an Impella® 2.5 mechanical support device to allow safe transition to a TandemHeart system in a patient with refractory CS.

Feasibility and long-term safety of elective Impella-assisted high-risk percutaneous coronary intervention: a pilot two-centre study

We evaluated the acute and long-term results of the use of a new intracardiac microaxial pump, the Impella Recover LP 2.5, during elective high-risk percutaneous coronary interventions in a two-centre registry. Ten consecutive patients with poor left ventricular function and multivessel or left main coronary artery disease were considered at high risk of haemodynamic compromise and underwent percutaneous coronary interventions with preintervention Impella implantation. Procedural complications, 30-day and 12-month clinical outcome were recorded. Left ventricular ejection fraction was assessed by echocardiography before procedure and after at least 6 months. The Impella was implanted before percutaneous coronary interventions by femoral approach and percutaneous coronary interventions were successfully performed (by contra lateral femoral or radial approach) in all cases. After percutaneous coronary intervention, Impella was removed in all patients, and haemostasis was obtained by prolonged manual compression or by double suture device preimplantation technique. No access-site complication was observed and no patient required transfusions. One patient died after Impella removal due to acute stent thrombosis. The other patients had an uncomplicated in-hospital course and were discharged within 5 days. At 1-year follow-up, no patient died nor suffered acute myocardial infarction, whereas two patients underwent re-percutaneous coronary intervention. Left ventricular ejection fraction at follow-up increased significantly in this study population (from 31 +/- 7% to 41% +/- 13%, P = 0.02). Our results support the feasibility and safety of Impella-assisted percutaneous coronary intervention in high-risk patients. Prospective randomized trials are needed to test the clinical impact of such an innovative approach.