Utilization Of The Impella Device For Acute Cardiogenic Shock In The Perioperative Period Of Cardiac Surgery
Serge Sicouri, MD1, Vishal Shah, DO1, Jacqueline McGee, CRNP2, Elena Casanova, CRNP2, Eric Gnall, MD2, Nicholas S. Imperato, BS1, Konstadinos A. Plestis, MD3.
1Lankenau Institute for Medical Research, Wynnewood, PA, USA, 2Department of Cardiothoracic Surgery Lankenau Medical Center, Wynnewood, PA, USA, 3Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Background: Acute cardiogenic shock prior or immediately after cardiac surgery is associated with high mortality rates. The Impella device (Abiomed Inc,) is a mechanical circulatory support device that can be inserted percutaneously or directly across the aortic valve into the left ventricle. The device reduces myocardial oxygen consumption and increases cardiac output. The purpose of this study was to determine the outcomes of the Impella device in patients with acute cardiogenic shock in the perioperative period of cardiac surgery. Methods: A retrospective review of 11 consecutive patients who underwent placement of the Impella device preoperatively (Preop), intraoperatively (Intraop), or as rescue postoperatively (Postop) in cardiac surgery performed by a single surgeon from January 1st, 2016 until October 1st, 2019 was studied. Patient records were evaluated for demographics, indications of the device and postoperative outcomes including short-term (30 days) and long-term (1 year) mortality. Results: Patients (7 males, 4 females) were an average age of 60.2±14 years, (range 33 to 76). Impella device was placed Preop in 6 patients, Intraop in 4 patients and Postop in 1 patient. Indication for Impella support was cardiogenic shock in all patients (n=11) of distinct etiologies (table 1). Three patients required Preop ECMO (VV-ECMO), one patient Intraop VA-ECMO and one patient Postop VV-ECMO. and 1 patient post op Protek duo. Seven patients received Impella CP, 1 patient Impella RP, 1 patient Impella CP and RP, and two patients Impella 5.0. The device was removed in all patients in 2 to 21 days. Duration of patient ICU stay ranged from 2 to 53 days (average of 26±15 days). The 30-day and 1-year mortality were 0%. Device-related complications included various degree of hemolysis in 8 patients (73%), and device malfunction in 1 patient (11%). Conclusions: Our outcomes showed improved results compared with historical data. The Impella device allowed myocardial recovery in all patients with no deaths in the perioperative and 1-year follow up period. Larger studies are necessary to validate these results.
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