Use of Impella 5.0 with Axillary Approach as a Bridge to Decision in Advanced Decompensated Heart Failure

C. Kunavarapu, M. Kwan, R. Sterling, R. Tran, S. M. Rodriguez, J. Dellavolpe, P. Habib, J. Talathoti, K. Myneni, M. Ono

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE: Cardiogenic shock is a spectrum and short term mechanical circulatory support devices such as VA ECMO and Impella 5.0 have been increasingly utilized as a salvage and bridge therapy. The objective of this study is to evaluate the use of these temporary support devices in patients with refractory cardiogenic shock. METHODS: Retrospective review of all patients with an Impella 5.0 or EC-Pella between January 2018 to September 2019. RESULTS: A total of 39 patients were placed on Impella 5.0 and 17 of those received EC-Pella. Overall, patients were predominantly INTERMACS profile 1 (43%) or 2 (57%). Average age was 57 and length of stay was 28 days. Common indications included progressive decline on inotropic support, as an exit to wean from VA ECMO, and to evaluate right sided heart function to bridge to a durable LVAD. Overall survival of these patients is 74% (n= 29). Of the 39 Impella patients, 46% (n= 18) received a durable LVAD, 15% (n= 6) received OHT, 21% (n= 8) were a bridge to recovery, and 18% (n= 7) expired. The survival to discharge for patients with an LVAD was 84% (n=15), 100% for OHT (n= 6). Of the 10 total patients that expired, 3 patients died of RV failure post LVAD, and 7 died from lack of end-organ recovery..The survival to discharge rate was 90% for Impella patients that never required ECMO support during their admission. Alternatively, in the EC-Pella population, the survival to discharge was 53%. CONCLUSION: Axillary Impella 5.0 approach can be successfully used with excellent survival to discharge. With concomitant VA ECMO use the survival rate decreases, however, the patients were more acute with higher incidence of cardiac arrest, post cardiotomy shock, and increasing utilization of hemodialysis. This data needs to be validated prospectively through further data collection.

Original languageEnglish (US)
Pages (from-to)S424
JournalThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
Volume39
Issue number4
DOIs
StatePublished - Apr 1 2020
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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