The Use of the Impella Device in Patients with Postcardiotomy Cardiogenic Shock

Purpose The use of mechanical circulatory support is a valuable tool for patients in acute cardiogenic shock. There is a particular demand for these devices for postcardiotomy patients who develop cardiogenic shock. The Impella device is a microaxial pump that is used for short term circulatory support. We report the outcome of the Impella device for acute mechanical circulatory support in cardiogenic shock. The primary endpoints include operative mortality. Secondary endpoints include device complications. Methods and Materials We performed a retrospective chart review of 25 consecutive patients who underwent placement of the Impella device for postcardiotomy cardiogenic shock from February 6 st , 2006 to December 31 st , 2010. Charts were evaluated for data relative to patients’ demographics, hemodynamics, operative details, and 30 days outcome. Results Twenty-five consecutive patients were included in the study. The average age was 61.8 ±12 and 72% (18/25) were male. Twenty patients were implanted with the Impella 5.0 and 5 with the Impella 2.5. The indication for placement of the Impella device was postcardiotomy cardiogenic shock. The primary procedures included coronary artery bypass grafting (CABG) (N=18), valvular surgery (N=5), and other procedures such as repair of tetralogy of fallot (N=1) and Ventricular septal defect repair (N=1). The operative mortality was 16% (4/25) and 84% (21/25) recovered their native heart function. The average duration of the Impella support was 3.5±2.1 days (range [1-9]). Four complications were identified (16%), which included device malfunction (N=2), high purge pressure (N=1), and GI bleed (N=1). Conclusions The Impella device yielded very favorable outcomes in patients with postcardiotomy cardiogenic shock. The operative mortality was low compared to historical data and there were limited complications. The Impella device serves as a vital tool towards supporting critically ill patients after open heart surgery and its easy placement allows for wide applicability.