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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
Pediatric Circulatory Support

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 posttransplant rejection or allograft vasculopathy, 2 patients with myocarditis, and 1 patient with refractory ventricular tachycardia. Extracorporeal membrane oxygenation support was required in 4 patients. Significant reduction in pulmonary capillary wedge pressures/left atrial pressures (p = 0.031) 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 extracorporeal membrane oxygenation or with cardiogenic shock.

From the *Department of Pediatrics, Division of Pediatric Cardiology and Cardiac Surgery, Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Division of Pediatric Cardiology, University of Toronto, Toronto, Ontario, Canada; and Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas.

Submitted for consideration October 2016; accepted for publication in revised form March 2017.

Disclosure: Jeewa is a consultant for HeartWare. 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 article. The remaining authors of this publication do not have any conflicts of interest to disclose. This research did not require any funding.

Correspondence: Athar M. Qureshi, CE Mullins Cardiac Catheterization Laboratories, The Lillie Frank Abercombie Section of Cardiology, Texas Children’s Hospital and Associate Professor of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, MC 19345C, Houston, TX 77030. E-mail:

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