Subclavian Impella 5.5 implant for perioperative left ventricular dysfunction
0
Citation
0
Reference
10
Related Paper
Abstract:
We present the implant method and the postoperative management for an Impella 5.5 device via the right subclavian artery in a 72-year-old patient with severe left ventricular dysfunction upon weaning from cardiopulmonary bypass during a cardiac surgery procedure.Keywords:
Impella
Left subclavian artery
Impella devices have emerged as a critical tool for temporary mechanical circulatory support (TMCS) in the management of cardiogenic shock (CS) and high-risk percutaneous coronary interventions (PCI). The purpose of this review is to examine the history of the different Impella devices, their hemodynamic profiles, and how the data supports their use.This review covers the development and specifications of the Impella 2.5, Impella CP, Impella 5.0/Left Direct (LD), Impella RP, and Impella 5.5 devices. This review also covers the clinical trials that illuminate the Impella devices' use in their appropriate clinical contexts. These studies examine the effectiveness of Impella devices and have begun to yield promising results, demonstrating improved survival rates when compared to the historically high mortality rates associated with CS. It is important to weigh the benefits of Impella devices in light of their contraindications. A literature search was conducted by searching the PubMed database for reviews, meta-analyses, and clinical trials pertinent to Impella devices.Impella devices are a crucial tool for management of patients undergoing high-risk PCI and those with CS. There is evidence that early Impella implantation is beneficial in the treatment of patients presenting with CS. Further randomized controlled trials are needed to better elucidate the benefits of Impella devices in various clinical settings.
Impella
Cite
Citations (3)
Impella
Cite
Citations (0)
Right ventricular failure requiring short-term mechanical support is a relatively common complication after left ventricular assist device (LVAD) implantation. Removal of the temporary right ventricular assist device (RVAD) generally requires a reoperative sternotomy. In this report, we describe an innovative percutaneous approach for placing an RVAD at the time of LVAD implantation using the Impella RP (Abiomed Inc.) that does not require reoperation for removal, as the Impella RP can be removed at the patient's bedside.
Impella
Right ventricular failure
Cite
Citations (20)
Key Points Temporary mechanical circulatory support with Impella pLVAD has increasingly been used in the management of cardiogenic shock in recent years, despite conflicting evidence supporting improved clinical outcomes. This study shows that the use of pLVAD was associated with both an improvement in hemodynamics as well as a decrease in vasopressor and inotropic support, but the need for escalation of MCS to VA‐ECMO was not uncommon and independently associated with a need for higher vasopressor‐inotropic support on admission. Earlier pLVAD implantation was associated with a trend toward reduction in mortality, but further randomized trials are needed to assess the appropriate use and efficacy of the Impella device in treating patients with CS.
Impella
Cite
Citations (1)
We report the outcome of patients supported with the Impella device at our institution. Similar to the interim analysis of J-PVAD registry presented at the 84th Annual Scientific Meeting of the Japanese Circulation Society, we observed a worse outcome in patients with AMI cardiogenic shock who received late Impella support. It is also important to highlight that only one patient of this cohort received Impella support before reperfusion at our institute. A door to unloading strategy as opposed to one emphasizing door to balloon combined with earlier initiation of Impella support seems promising1) and it the creation of a system that embraces door to unloading which is both our institute’s challenge and opportunity to improve outcomes.
Impella
Interim
Cite
Citations (2)
Background: The Impella 5.5 (Abiomed, Danvers, MA) is a percutaneous temporary left ventricular assist device (VAD) used in cardiogenic shock. Its motor housing is thinner and shorter than that of the Impella 5.0, allowing for easier pump insertion. The device can deliver greater peak flows than the Impella 5.0, up to over 6 liters per minute. Approved by the Federal Drug Administration in September 2019, the use of the Impella 5.5 has yet to be widely adopted and there is limited data available. This is an analysis from a high-volume, single center comparing the device complications and mortality rates between the Impella 5.0 and 5.5. Methods: A retrospective analysis was conducted of all patients supported by the Impella 5.0 (n = 156) and Impella 5.5 (n = 76) from 2014 to 2021 at a high-volume medical center. Between-group differences in continuous variables were evaluated using unpaired Student t tests. Categorical variables were compared using Fisher's exact test. Results: The baseline characteristics were similar for patients implanted with the Impella 5.0 and 5.5 (Table 1). There was no difference in indication for implantation, with similar percentages of patients in the bridge to recovery, bridge to durable VAD (BTD), and bridge to transplant (BTT) groups. There were more INTERMACS 2 patients in the Impella 5.5 group and more INTERMACS 1 patients in the Impella 5.0 group. The rates of device complications did not differ between patients implanted with the Impella 5.0 and 5.5 (Table 2), except for INTERMACS-defined RV failure, with 9.3% vs 0% (p 0.006). Rates of INTERMACS-defined major hemolysis were 22.7% vs 20% (p 0.81), stroke 5.8% vs 2.6% (p 0.511), pump failure/thrombosis 6.4% vs 7.9% (p 0.783), and vascular/limb injury 3.9% vs 2.6% (p 1.0). Among patients in the intended BTT group, 73.2% vs 84.4% were transplanted in the Impella 5.0 and 5.5 groups respectively. For transplanted patients, mortality was 0% in both groups at time of discharge and 30 days post discharge. One-year mortality post-discharge was 3.33% vs 14.3% (p 0.107) with 6 patients in the 5.5 group excluded as they had not yet reached the time point. Among patients in the intended BTD group, 70% vs 23.1% of patients received the durable VAD. There was no difference in the mortality rates at all time points (Table 3). Conclusion: There is limited data on the Impella 5.5, which was recently introduced and not yet widely used. The device's design makes for easier insertion, more durability, and support with greater peak flows, allowing for full LV support. This is an analysis from a high-volume, single center that showed Impella 5.5s had fewer rates of INTERMACS-defined RV failure and had no difference in the rates of other device complications compared to Impella 5.0s. There was no difference in mortality rates between the two groups. The findings are promising as we continue to explore the utility and clinical impact of the Impella 5.5 in patients with cardiogenic shock.
Impella
Cite
Citations (0)
The Impella 5.5 ® (Abiomed, Danvers, MA, USA) is a microaxial flow pump that promotes left ventricular unloading and improves end-organ perfusion before durable left ventricular assist device (LVAD) implantation. Thrombus formation after Impella 5.5 insertion can occur and represents a significant challenge to device explantation. Durable LVAD implantation is typically performed without aortic cross-clamping, so a dislodged thrombus can potentially embolize and lead to catastrophic events. We describe our technique to safely explant an Impella 5.5 in patients who develop a thrombus on the inflow portion of the device before surgical LVAD implantation.
Impella
Cite
Citations (1)
Although left ventricular assist device (LVAD) implantation is associated with improved heart failure survival, the impact of pre-implantation Impella support on outcomes is unknown. We undertook this study to evaluate the impact of preoperative Impella support on LVAD outcomes.We conducted a retrospective review of all Heartmate 3 LVAD implants. Primary stratification was by the need for preoperative Impella support with the 5.0/5.5 device. Longitudinal survival was assessed by the Kaplan-Meier method. Multivariable Cox proportional hazards regression models were developed to evaluate mortality. Secondary outcomes included changes in laboratory values during Impella support.From 2017 to 2021, 87 patients underwent LVAD implantation. Sixteen were supported with a single inotrope, 36 with dual inotropes, 27 with Impella, and 3 with extracorporeal membrane oxygenation (ECMO). When stratified by the need for Impella, there was no difference in survival at 30-days (98.3 [88.2-99.8]% vs. 96.3 [76.5-99.5]%, p = .59), 1-year (91.0 [79.8-96.2] vs. 74.9 [51.7-88.2], p = .10), or at 2 years (87.9 [74.3-94.5] vs. 74.9 [51.7-88.2], p = .15). On multivariable modeling, the need for preoperative Impella was not associated with an increased hazard of 1-year (1.24 [0.23-6.73], p = .81) or 2-year mortality (1.05 [0.21-5.19], p = .95). After 7 (5-10) days of Impella support, recipient creatinine (p < .01), creatinine clearance (p = .02), and total bilirubin (p = .053) improved and lactic acidosis resolved (p < .01).Preoperative Impella support is not associated with increased short or long-term mortality but is associated with improved renal and hepatic function as well as total body perfusion before LVAD implantation.
Impella
Cite
Citations (5)
Impella
Cite
Citations (0)
Aims: Replacing cardiopulmonary bypass (CPB) with ECMO for isolated ventricular assist device (LVAD) implantation has significant theoretical advantages, including less systemic inflammation and bleeding disorders. We evaluate whether LVAD implantation with ECMO is feasible and safe.
Cite
Citations (0)