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Percutaneous Mechanical Circulatory Support Using Impella® Devices for Decompensated Cardiogenic Shock: A Pediatric Heart Center Experience.

Parekh Dhaval; Jeewa, Aamir; Tume, Sebastian C; Dreyer, William J; Pignatelli, Ricardo; Horne, David; Justino, Henri; Qureshi, Athar M.
doi: 10.1097/MAT.0000000000000581
Original Article: PDF Only

Cardiogenic shock remains a significant cause of mortality and morbidity in children with heart failure. Percutaneous mechanical circulatory support may be an additional tool to augment left heart support and decompression in addition to conventional therapies. This report aims to review the clinical and hemodynamic outcomes of the Impella® device at a pediatric center. A retrospective review of all implants between October 2014 and November 2016 was conducted. Clinical outcomes, device implant techniques, complications, and hemodynamic data were collected. Statistical analysis was performed on hemodynamic and echocardiographic data. There were 10 Impella® device placements in 8 patients with a median age of 17 years (6.5 - 25) and support duration of 8 days (1-21). Implant diagnosis included 5 patients with either post-transplant rejection or allograft vasculopathy, 2 with myocarditis, and one patient with refractory ventricular tachycardia. ECMO support was required in 4 patients. Significant reduction in pulmonary capillary wedge pressures (p<0.039) and increase in near infrared spectroscopy (p=0.039) was seen pre and post Impella® implant. All patients survived to discharge from the intensive care unit with one late death. Percutaneous mechanical circulatory support is a viable option in experienced pediatric centers as a mode to augment cardiac output or to decompress the left heart in patients on ECMO or with cardiogenic shock.

Conflicts of Interest and Source of Founding: Dr. Jeewa is a consultant for HeartWare.

Dr. Justino is a consultant for St. Jude Medical, B-Braun Interventional Systems, Medtronic, and Janssen.

None of the above relationships have relevance to the subject of this manuscript. The remaining authors of this publication do not have any conflicts of interest to disclose. This research did not require any funding.

Corresponding Author: Athar M. Qureshi, MD, FSCAI, FAAP, Associate Director, CE Mullins Cardiac Catheterization Laboratories, The Lillie Frank Abercombie Section of Cardiology, Texas Children’s Hospital , Associate Professor of Pediatrics, Baylor College of Medicine , 6621 Fannin St, MC 19345C, Houston, TX 77030, Ph 832-826-5903, Email: axquresh@texaschildrens.org

Copyright © 2017 by the American Society for Artificial Internal Organs