Monteagudo-Vela María, Simon Andre, Panoulas Vasileios
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
Artif Organs. 2020 May;44(5):473-477. doi: 10.1111/aor.13610. Epub 2020 Jan 10.
Right ventricular failure is one of the most common complications encountered after left ventricular assist device implantation and heart transplantation. It has been reported to have an incidence up to 30%. It increases morbidity and short-term mortality. Impella RP is a small pump that can provide up to 4L/min of flow. We analyzed all the patients with right ventricular failure that were treated with Impella RP in our institution. The Impella RP was implanted percutaneously in the catheterization laboratory guided by fluoroscopy. Overall, 7 patients required the implantation of an Impella RP due to right ventricular failure: 2 after long-term LVAD, 3 presented with acute right ventricular failure immediately after LVAD implantation, and 2 needed it after heart transplantation. Regarding complications, we report 2 patients with hemolysis. Hemodynamic parameters as well as end-organ perfusion and inotropic requirements improved after the insertion of the Impella. Overall, 30-day survival is 58%. Median time of support was 9 (5-19) days. RV failure is one of the most challenging complications after LVAD implantation and heart transplantation. The major challenge is the timing of implantation. The minimally invasive nature of the Impella RP facilitates de-escalation of treatment and paves the road to recovery. Impella RP proved useful in facilitating ECMO wean. Used in a prompt manner alongside the ease of implantation and the minimal rate of complications, Impella RP seems to be an appropriate device to tackle RV failure providing enough flow to allow for recovery or escalation decision-making.
右心室衰竭是左心室辅助装置植入和心脏移植后最常见的并发症之一。据报道，其发生率高达30%。它会增加发病率和短期死亡率。Impella RP是一种小型泵，可提供高达4升/分钟的血流量。我们分析了在我们机构接受Impella RP治疗的所有右心室衰竭患者。Impella RP在荧光透视引导下于导管实验室经皮植入。总体而言，7例患者因右心室衰竭需要植入Impella RP：2例在长期左心室辅助装置植入后，3例在左心室辅助装置植入后立即出现急性右心室衰竭，2例在心脏移植后需要植入。关于并发症，我们报告了2例溶血患者。插入Impella后，血流动力学参数以及终末器官灌注和强心药物需求均有所改善。总体而言，30天生存率为58%。中位支持时间为9（5-19）天。右心室衰竭是左心室辅助装置植入和心脏移植后最具挑战性的并发症之一。主要挑战在于植入时机。Impella RP的微创特性有助于降低治疗强度，并为康复铺平道路。Impella RP被证明有助于体外膜肺氧合的撤离。由于其易于植入且并发症发生率低，Impella RP似乎是一种合适的设备，可用于应对右心室衰竭，提供足够的血流量以实现恢复或升级决策。
