Publication Date
7-1-2021
Journal
The Texas Heart Institute Journal
DOI
10.14503/THIJ-20-7260
PMID
34388239
Publication Date(s)
July 2021
Language
English
PMCID
PMC8367285
PubMedCentral® Posted Date
8-13-2021
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Equipment Design, Extracorporeal Membrane Oxygenation, Female, Follow-Up Studies, Heart Failure, Heart Transplantation, Heart-Assist Devices, Hemodynamics, Hospital Mortality, Humans, Male, Middle Aged, Retrospective Studies, Survival Rate, Treatment Outcome, United States
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Abstract
We studied whether sustained hemodynamic support (>7 d) with the Impella 5.0 heart pump can be used as a bridge to clinical decisions in patients who present with cardiogenic shock, and whether such support can improve their outcomes. We retrospectively reviewed cases of patients who had Impella 5.0 support at our hospital from August 2017 through May 2019. Thirty-four patients (23 with cardiogenic shock and 11 with severely decompensated heart failure) underwent sustained support for a mean duration of 11.7 ± 9.3 days (range, ≤48 d). Of 29 patients (85.3%) who survived to next therapy, 15 were weaned from the Impella, 8 underwent durable left ventricular assist device placement, 4 were escalated to venoarterial extracorporeal membrane oxygenation support, and 2 underwent heart transplantation. The 30-day survival rate was 76.5% (26 of 34 patients). Only 2 patients had a major adverse event: one each had an ischemic stroke and flail mitral leaflet. None of the devices malfunctioned. Sustained hemodynamic support with the Impella 5.0 not only improved outcomes in patients who presented with cardiogenic shock, but also provided time for multidisciplinary evaluation of potential cardiac recovery, or the need for durable left ventricular assist device implantation or heart transplantation. Our study shows the value of using the Impella 5.0 as a bridge to clinical decisions.