Pozzi Matteo, Quessard Astrid, Nguyen Anthony, Mastroianni Ciro, Niculescu Michaela, Pavie Alain, Leprince Pascal
Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, Pierre and Marie Curie University, Paris 6, Paris - France and Cardiovascular Surgery Unit, University of Verona Medical School, Verona - Italy.
Int J Artif Organs. 2013 Oct 3;36(9):605-11. doi: 10.5301/ijao.5000237. Epub 2013 Aug 2.
Impella 5.0 is a short-term left ventricle assist device (LVAD), inserted retrograde into the left ventricle across the aortic valve through a surgical peripheral access. Impella has been utilized for various indications but in the setting of bridge-to-bridge application there are limited reports.
We performed a retrospective observational analysis of Impella utilization at our institution as bridge to long-term LVADs. The primary end-point was survival during Impella support.
Between December 2010 and February 2012, we implanted 20 Impella in patients with cardiogenic shock and, among these, 5 were implanted as bridge to long-term LVADs. In this latter group, mean age at the time of implantation was 44 ± 15.6 (range 27-68) years and there was a prevalence of males (80%). Etiology of cardiogenic shock was: decompensated anthracycline-induced cardiomyopathy (n = 1), myocardial infarction (n = 4). There was no major bleeding requiring surgical revision or infectious complications at the right axillary access. One patient required Impella replacement due to a pump stop. After a mean period of 14.2 ± 9.0 (range 6-27) days of Impella support, patients were switched to a long-term LVAD (Jarvik 2000, n = 2; HeartMate II, n = 3). One patient died 70 days after implantation of the long-term LVAD due to multi-organ failure, while the remaining patients are still alive after a mean period of follow-up of 108.6 ± 66.2 (range 19-191) days.
Our experience shows that an Impella 5.0 implanted through the right axillary artery approach is a valid option as bridge to long-term LVADs.
Impella 5.0是一种短期左心室辅助装置（LVAD），通过外科外周通路经主动脉瓣逆行插入左心室。Impella已被用于多种适应症，但在桥接至桥接应用的情况下，相关报道有限。
我们对本机构将Impella用作长期LVAD桥接的情况进行了回顾性观察分析。主要终点是Impella支持期间的生存率。
2010年12月至2012年2月期间，我们为20例心源性休克患者植入了Impella，其中5例被用作长期LVAD的桥接。在后一组中，植入时的平均年龄为44±15.6（范围27 - 68）岁，男性占比80%。心源性休克的病因包括：蒽环类药物诱导的失代偿性心肌病（n = 1）、心肌梗死（n = 4）。右腋窝通路未发生需要手术修复的大出血或感染并发症。1例患者因泵停止工作需要更换Impella。在Impella平均支持14.2±9.0（范围6 - 27）天后，患者转为长期LVAD（Jarvik 2000，n = 2；HeartMate II，n = 3）。1例患者在植入长期LVAD 70天后因多器官衰竭死亡，其余患者在平均随访108.6±66.2（范围19 - 191）天后仍存活。
我们的经验表明，通过右腋动脉途径植入的Impella 5.0作为长期LVAD的桥接是一种有效的选择。
