Department of Cardiothoracic Surgery, Robert Wood Johnson University Hospital, The University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey; and Abiomed, Inc, Danvers, Massachusetts.
Department of Cardiothoracic Surgery, Robert Wood Johnson University Hospital, The University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey; and Abiomed, Inc, Danvers, Massachusetts.
Ann Thorac Surg. 2014 Jan;97(1):133-8. doi: 10.1016/j.athoracsur.2013.07.053. Epub 2013 Oct 1.
Acute cardiogenic shock is associated with high mortality rates. Mechanical circulatory devices have been increasingly used in this setting for hemodynamic support. The Impella device (Abiomed Inc, Danvers, MA) is a microaxial left ventricular assist device that can be inserted using a less invasive technique. This study was conducted to determine the outcome of patients who have undergone placement of the Impella device for acute cardiogenic shock in our institution.
A retrospective record review of 47 patients who underwent placement of the Impella device was performed from January 1, 2006, to December 31, 2011. Records were evaluated for demographics, operative details, and postoperative outcomes. Operative mortality was defined as death within 30 days of the operation.
The patients (33 male) were an average age of 60.23 ± 13 years. The indication for placement of the Impella device included cardiogenic shock in 15 patients (32%) and postcardiotomy cardiogenic shock in 32 (68%). Of the 47 patients, 38 (80%) received the Impella 5.0 and the rest the 2.5 device. Ventricular function recovered in 34 of 47 patients (72%), and the device was removed, with 4 patients (8%) transitioned to long-term ventricular assist devices. The 30-day mortality was 25% (12 of 47 patients). Complications occurred in 14 patients (30%), consisting of device malfunction, high purge pressures, tube fracture, and groin hematoma.
This is one of the largest series of patients undergoing placement of the Impella device for acute cardiogenic shock. Our outcomes showed improved results compared with historical data. Myocardial recovery was accomplished in most patients. Finally, the 30-day mortality and complication rate was acceptable in these critical patients. These benefits were all achieved with the Impella device in a less invasive method.
急性心源性休克与高死亡率相关。在这种情况下，机械循环装置已越来越多地用于提供血液动力学支持。Impella 装置（Abiomed Inc，Danvers，MA）是一种微轴左心室辅助装置，可通过创伤较小的技术插入。本研究旨在确定在我院接受 Impella 装置治疗急性心源性休克的患者的结局。
回顾性记录了 2006 年 1 月 1 日至 2011 年 12 月 31 日期间接受 Impella 装置植入的 47 例患者的资料。评估了患者的人口统计学、手术细节和术后结局。手术死亡率定义为术后 30 天内死亡。
患者（33 名男性）的平均年龄为 60.23 ± 13 岁。植入 Impella 装置的指征包括心源性休克 15 例（32%）和心脏手术后心源性休克 32 例（68%）。47 例患者中，38 例（80%）接受了 Impella 5.0 装置，其余接受了 2.5 装置。47 例患者中有 34 例（72%）心功能恢复，装置被移除，其中 4 例（8%）过渡到长期心室辅助装置。30 天死亡率为 25%（47 例患者中有 12 例）。14 例患者（30%）出现并发症，包括装置故障、高冲洗压力、管腔断裂和腹股沟血肿。
这是接受 Impella 装置治疗急性心源性休克的最大系列之一。我们的结果与历史数据相比显示出改善的结果。大多数患者实现了心肌恢复。最后，这些危重患者的 30 天死亡率和并发症发生率是可以接受的。这些益处都是通过 Impella 装置以微创的方法实现的。
