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Clinical Outcomes of Impella Microaxial Devices Used to Salvage Cardiogenic Shock as a Bridge to Durable Circulatory Support or Cardiac Transplantation

Cheng, Richard*; Tank, Rikin; Ramzy, Danny; Azarbal, Babak*; Chung, Joshua; Esmailian, Fardad; Kobashigawa, Jon A.*; Moriguchi, Jaime D.*; Arabia, Francisco A.

doi: 10.1097/MAT.0000000000000877
Original Article: PDF Only
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Temporary mechanical circulatory support (MCS) can be a bridge to decision for patients in severe cardiogenic shock who may be eligible for durable support or transplantation. Outcomes with Impella microaxial devices for salvage of severe shock in the end-stage heart failure population are not well described. Patients who underwent Impella placement as a bridge to decision, durable MCS, or transplantation were included. Eighty Impella devices (2.5 [1.3%], CP [53.8%], and 5.0 [45.0%]) were placed in 64 patients. Implant age was 56.2 ± 12.5 years. Mean duration of assisted support was 13.2 ± 15.1 days, and median duration per device was 7 days (interquartile range: 3–14). A total of 48.4% were in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS 1) shock at implant, 51.6% in profile 2. Recent CPR (26.7%), ventilator use (67.2%), and extracorporeal membrane oxygenation (ECMO) use (26.7%) were frequent. Forty four of sixty four (68.8%) survived to next therapy: durable MCS (40.9%), OHT (36.4%), and recovery (22.7%). Overall 30 and 60 day survival were 67.2% and 65.6%, respectively. Thirty and 60 day survival conditional on having survived to next therapy were 94.1% and 91.2%, respectively. Survivors were less likely to be on ventilators (p = 0.049) or continuous renal replacement therapy (p < 0.001) but were otherwise not different from nonsurvivors by age, sex, INTERMACS profile, CPR, prevalence of ischemic cardiomyopathy, among other characteristics. Sixteen patients were directly bridged to heart transplantation, and all were alive at long-term follow-up. Impella devices can be used to salvage patients in severe heart failure as a bridge to decision, durable MCS, or transplantation. Baseline demographics are not predictive of survival. Their use for this indication is increasing and further investigations are warranted.

From the *Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California

Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California

Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California.

Submitted for consideration December 2017; accepted for publication in revised form August 2018.

Disclosures: The authors have no conflicts of interest to report.

Francisco A. Arabia reports personal fees from SynCardia, Inc. Fardad Esmailian reports personal fees from SynCardia, Inc.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Richard Cheng, Division of Cardiology, Cedars-Sinai Heart Institute, 127 S. San Vicente Boulevard, Suite A3308, Los Angeles, CA 90048. Email: rc2108@gmail.com.

Copyright © 2019 by the American Society for Artificial Internal Organs