Early Clinical Experience with Impella 5.5 at a Large Tertiary Care Center
| Autor: | Peter J. Kennel, Amirali Masoumi, Y. Naka, Ajay J. Kirtane, Koji Takeda, Gabriel Sayer, Justin Fried, Yuji Kaku, Nir Uriel, H. Lumish, Dimitrios Karmpaliotis, Hiroo Takayama |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
Inotrope Transplantation medicine.medical_specialty business.industry Cardiogenic shock medicine.medical_treatment medicine.disease Surgery Hematoma Refractory medicine.artery Ventricular assist device Ascending aorta medicine Cardiology and Cardiovascular Medicine business Stroke Impella |
| Zdroj: | The Journal of Heart and Lung Transplantation. 40:S406 |
| ISSN: | 1053-2498 |
| Popis: | Purpose The Impella 5.5 system is the newest temporary left ventricular assist device (LVAD) for the treatment of cardiogenic shock (CS). Impella 5.5 aims to improve deliverability and durability over Impella 5.0, but real-world experience with this device is limited. We aimed to report our clinical experience with Impella 5.5. Methods Clinical and outcome data of all patients treated with Impella 5.5 at our center between Feb and Oct 2020 were collected. AKI was defined as per KDIGO criteria, vascular complications as per VARC-2 criteria and severe thrombocytopenia as Results 13 patients with Impella 5.5 were managed at our center (9 (69%) male, median age 58y (IQR 52, 67). 5 patients were transitioned to Impella 5.5 from VA-ECMO, 2 from Impella CP, 2 from IABP, and 4 from inotropes. Etiology of CS was AMI in 6 cases, decompensated chronic HF in 5, suspected acute myocarditis in 1 and post-cardiotomy CS in 1 case. Median duration of Impella 5.5 support was 12 days (IQR 7-28). 2 patients required device removal due to complications: 1 with entanglement in the mitral subvalvular apparatus, 1 with migration into the ascending aorta. Device-related complications were hemolysis in 4 (30%) patients, severe thrombocytopenia in 1, axillary hematoma (minor as per VARC-2 criteria) in 3 (23%), and AKI in 2 patients (15%). No stroke, valve injury or limb complications occurred. Survival to device explant was 85%. 2 patients who were not candidates for durable LVAD or transplant died on support of refractory CS. Of the survivors, 2 required surgically implanted biventricular support for refractory ventricular arrhythmia, 4 were bridged to durable VAD, 2 were bridged to OHT, and 3 achieved ventricular recovery. At the time of analysis, 3 patients remain hospitalized (1 surgical BIVAD, 1 early post-durable LVAD, 1 recovered after device explant). Conclusion All patients supported with Impella 5.5 were critically ill in profound CS. Rates of procedural and device-related complications were favorable, and survival was high in this critically ill cohort. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|