Zaiser Anna S, Fahrni Gregor, Hollinger Alexa, Knobel Demian T, Bovey Yann, Zellweger Núria M, Buser Andreas, Santer David, Pargger Hans, Gebhard Caroline E, Siegemund Martin
Intensive Care Unit, University Hospital Basel, 4031 Basel, Switzerland.
Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland.
J Clin Med. 2021 Aug 20;10(16):3710. doi: 10.3390/jcm10163710.
Worldwide, the left ventricular assist device Impella (Abiomed, Danvers, MA, USA) is increasingly implanted in patients with acute cardiogenic shock or undergoing high-risk cardiac interventions. Despite its long history of use, few studies have assessed its safety and possible complications associated with its use. All patients treated with a left-sided Impella device at the University Hospital of Basel from 1 January 2011 to 31 December 2019 were enrolled. The primary endpoint was the composite rate of mortality and adverse events (bleeding, acute kidney injury, and limb ischemia). Out of 281 included patients, at least one adverse event was present in 262 patients (93%). Rates of in-hospital, 90-day, and one-year mortality were 48%, 47%, and 50%, respectively. BARC type 3 bleeding (62%) and hemolysis (41.6%) were the most common complications. AKI was observed in 50% of all patients. Renal replacement therapy was required in 97 (35%) of all patients. Limb ischemia occurred in 13% of cases. Bleeding and hemolysis are common Impella-associated complications. Additionally, we found a high rate of AKI. A careful selection of patients receiving microaxial LV support and defining the indication for its use are essential measures to be taken for the benefits to outweigh potential complications.
在全球范围内，左心室辅助装置Impella（美国马萨诸塞州丹弗斯市的Abiomed公司生产）越来越多地被植入急性心源性休克患者或接受高风险心脏介入治疗的患者体内。尽管其使用历史悠久，但很少有研究评估其安全性以及与使用相关的可能并发症。纳入了2011年1月1日至2019年12月31日在巴塞尔大学医院接受左侧Impella装置治疗的所有患者。主要终点是死亡率和不良事件（出血、急性肾损伤和肢体缺血）的综合发生率。在纳入的281例患者中，262例患者（93%）至少出现了一种不良事件。住院死亡率、90天死亡率和一年死亡率分别为48%、47%和50%。3型出血（62%）和溶血（41.6%）是最常见的并发症。50%的患者观察到急性肾损伤。所有患者中有97例（35%）需要进行肾脏替代治疗。13%的病例发生肢体缺血。出血和溶血是与Impella相关的常见并发症。此外，我们发现急性肾损伤的发生率很高。仔细选择接受微轴左心室支持的患者并明确其使用指征是使益处超过潜在并发症的必要措施。
