Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Catheter Cardiovasc Interv. 2021 Jan 1;97(1):E161-E167. doi: 10.1002/ccd.28986. Epub 2020 Jun 22.
To understand the predictors of survival and indications for Impella RP in a single healthcare experience.
The Impella RP can be used to temporarily support patients with right ventricular (RV) dysfunction after left ventricular assist device (LVAD) placement or myocardial infarction (MI). However, recent postmarket approval data have raised concerns of higher than expected mortality with this device.
A retrospective chart review and analysis of all patients that underwent Impella RP placement in the Emory Healthcare system between January 2016 and December 2018 were performed. Patients were classified according to the indication.
A total of 39 patients underwent Impella RP placement. Six patients were post-LVAD, 9 were implanted for massive pulmonary embolism with persistent shock, 8 for postcardiac surgery RV failure (non-LVAD), 11 for RV failure post-MI, and 5 for new or worsening nonischemic cardiomyopathy. The worst survival was noted in MI-related cardiogenic shock group and in patients who presented with cardiac arrest (3/12). All observed deaths were due to persistent refractory shock. There was no device related death. Survival improved during the last year of experience compared to the first 2 years.
This study supports the selective use of the Impella RP, with a higher than national reported survival rate (49% vs. 28.6%). Indication appears to be an important factor determining survival.
在单一医疗经验中了解 Impella RP 生存的预测因素和适应证。
Impella RP 可用于在左心室辅助装置 (LVAD) 放置或心肌梗死 (MI) 后临时支持右心室 (RV) 功能障碍的患者。然而，最近的上市后批准数据对该设备的死亡率高于预期表示担忧。
对 2016 年 1 月至 2018 年 12 月期间在埃默里医疗保健系统中接受 Impella RP 放置的所有患者进行回顾性图表审查和分析。根据适应证对患者进行分类。
共有 39 例患者接受了 Impella RP 放置。6 例为 LVAD 后，9 例为巨块性肺栓塞伴持续休克，8 例为心脏手术后 RV 衰竭（非 LVAD），11 例为 MI 后 RV 衰竭，5 例为新发或恶化的非缺血性心肌病。MI 相关心源性休克组和出现心脏骤停的患者（3/12）的生存最差。所有观察到的死亡均由于持续性难治性休克。没有与设备相关的死亡。与前 2 年相比，在最后 1 年的经验中，生存率有所提高。
本研究支持选择性使用 Impella RP，生存率高于全国报告的生存率（49%比 28.6%）。适应证似乎是决定生存的重要因素。
