Clinical Indications of IMPELLA Short-Term Mechanical Circulatory Support in a Tertiary Centre
- • The median duration of support was 5 days and the maximum duration of support with a 5.0 pump was 62 days.
- • Haemodynamic parameters improved within 24 h of Impella implantation.
- • We observed significant reductions in inotropic support and improvement in renal function, liver function and tissue perfusion.
The Impella family of devices are short-term mechanical circulatory support (MCS) pumps that hold promise in treating patients with acute cardiogenic shock, acting as bridge to recovery, transplant or durable left ventricular assist device. We assessed the clinical utility, indications and outcomes of the Impella family of devices in a tertiary centre.
In the current study we present our initial 2-year experience with different Impella types. We explored the indications for device implantation, initial hemodynamic and biochemical response and mid-term survival.
A total of 57 patients underwent Impella implantation; 36 Impella CP, 14 Impella 5.0 and 7 Impella RP. Mean age was 54.2 ± 15.2 whereas 78.9% were males. The main indications for left sided MCS included cardiogenic shock secondary to ACS, decompensated dilated or ischemic end stage cardiomyopathy and myocarditis. Mean LVEF pre-Impella implantation was 23 ± 13.7%. PCI was performed in 24 (54.5%) patients. Main indication for Impella RP was RV failure following LVAD implantation.
The median duration of support was 5 days (IQR 1 to 10.5 days). 24 h following Impella implantation, there was significant improvement in all hemodynamic parameters as well as renal and liver function. Patients presenting with INTERMACS I had a 30-day survival of 40% whereas patients with INTEMACS 2 or above had a 30-day survival of 82.4%.
The Impella short-term mechanical assist device provides immediate improvement in hemodynamic parameters and end organ function recovery. Patient outcomes are heavily influenced by the stage of shock and the timely insertion of MCS.
Cardiovascular Revascularization Medicine, 2020-05-01, Volume 21, Issue 5, Pages 629-637, Copyright © 2019 Elsevier Inc.
Read the full article: https://doi.org/10.1016/j.carrev.2019.12.010