Abaunza Miriam, Kabbani Loay S, Nypaver Timothy, Greenbaum Adam, Balraj Praveen, Qureshi Sherazuddin, Alqarqaz Mohammed A, Shepard Alexander D
Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich.
Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich.
J Vasc Surg. 2015 Aug;62(2):417-23. doi: 10.1016/j.jvs.2015.03.040. Epub 2015 Jun 6.
Mechanical assist devices have found an increasingly important role in high-risk interventional cardiac procedures. The Impella (Abiomed Inc, Danvers, Mass) is a percutaneous left ventricular assist device inserted through the femoral artery under fluoroscopic guidance and positioned in the left ventricular cavity. This study was undertaken to assess the incidence of vascular complications and associated morbidity and mortality that can occur with Impella placement.
We used a prospective database to review patients who underwent placement of an Impella left ventricular assist device in our tertiary referral center from July 2010 to December 2013. Patient demographics, comorbidities, interventional complications, and 30-day mortality were recorded.
The study included 90 patients (60% male). Mean age was 66 years (range, 17-97 years). Hypertension was found in 69% of the patients, 37% were diabetic, 57% had a history of tobacco abuse, and 65% had chronic renal insufficiency. The median preprocedure cardiac ejection fraction was 30%. Most (87%) had undergone coronary artery intervention. Cardiogenic shock was documented in 67 patients (74%). The Impella was placed for an average of 1 day (range, 0-5 days). At least one vascular complication occurred in 15 patients (17%). Acute limb ischemia occurred in 12 patients; of whom four required an amputation and six required open or endovascular surgery. Other complications included groin hematomas and one pseudoaneurysm. All-patient 30-day mortality was 50%, which was not significantly associated with vascular complications. Female sex and cardiogenic shock at the time of insertion were associated with vascular complications (P = .043 and P = .018, respectfully).
Vascular complications are common with placement of the Impella percutaneous left ventricular assist device (17%) and are related to emergency procedures. Vascular complications in this high-risk patient population frequently lead to withdrawal of care. These data provide quality improvement targets for left ventricular assist device programs.
机械辅助装置在高风险心脏介入手术中发挥着越来越重要的作用。Impella（美国马萨诸塞州丹弗斯市的Abiomed公司）是一种经皮左心室辅助装置，在透视引导下经股动脉插入并置于左心室腔。本研究旨在评估Impella植入后可能发生的血管并发症及相关的发病率和死亡率。
我们使用前瞻性数据库回顾了2010年7月至2013年12月在我们三级转诊中心接受Impella左心室辅助装置植入的患者。记录患者的人口统计学资料、合并症、介入并发症和30天死亡率。
该研究纳入了90例患者（60%为男性）。平均年龄为66岁（范围17 - 97岁）。69%的患者患有高血压，37%为糖尿病患者，57%有吸烟史，65%有慢性肾功能不全。术前心脏射血分数中位数为30%。大多数患者（87%）接受过冠状动脉介入治疗。67例患者（74%）记录有心源性休克。Impella平均放置1天（范围0 - 5天）。15例患者（17%）发生至少一种血管并发症。12例患者发生急性肢体缺血；其中4例需要截肢，6例需要开放手术或血管腔内手术。其他并发症包括腹股沟血肿和1例假性动脉瘤。所有患者30天死亡率为50%，与血管并发症无显著相关性。女性和植入时的心源性休克与血管并发症相关（分别为P = 0. = 043和P = 0.018）。
Impella经皮左心室辅助装置植入时血管并发症常见（17%），且与急诊手术有关。在这一高风险患者群体中，血管并发症常导致治疗中断。这些数据为左心室辅助装置项目提供了质量改进目标。
