Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany.
Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.
Artif Organs. 2022 Aug;46(8):1689-1694. doi: 10.1111/aor.14245. Epub 2022 Apr 8.
With the rapid development of mechanical circulatory support technologies, patients presenting with cardiogenic shock have gained access to various treatment opportunities which were not until recently available. The Impella® pump (Abiomed, Danvers, USA) is a minimally invasive device which provides excellent left ventricular unloading and full circulatory support. The aim of the study was to review our center's experience with Impella® and to analyze the major adverse events associated with the device.
From January 2020 to January 2022, a total of 32 patients underwent Impella® implantation at our center for various indications.
The mean age at surgery was 60.3 ± 12.4 years and 9.4% were female. All patients presented with acute cardiogenic shock in INTERMACS Class I (53.1%) and INTERMACS Class II (46.9%). Twenty-six patients (81.25%) out of the whole cohort have been mobilized on Impella® support. Seventeen patients (53.1%) have been weaned from the Impella® support and 10 patients (31.3%) have been bridged to durable LVAD. The median time on Impella® was 7 days (IQR 5.0-11.0). 30-day mortality was 37.5%, with 56.25% survival until hospital discharge. Only one patient developed vascular complications consisting of arm hypoperfusion. There were no cases of stroke on Impella® support.
The Impella® axial-flow pump seems an appropriate therapeutic option for patients with acute cardiogenic shock requiring partial or full hemodynamic support. It also provides sufficient left ventricular unloading to allow full mobilization and neurological assessment of the patients. Furthermore, Impella® offers a high rate of myocardial recovery.
随着机械循环支持技术的快速发展，出现心源性休克的患者获得了各种治疗机会，而这些机会在不久前是无法获得的。Impella®泵（美国雅培公司）是一种微创设备，可提供出色的左心室卸载和完全循环支持。本研究旨在回顾我们中心使用 Impella®的经验，并分析与该设备相关的主要不良事件。
从 2020 年 1 月至 2022 年 1 月，共有 32 名患者因各种适应症在我们中心接受 Impella®植入术。
手术时的平均年龄为 60.3±12.4 岁，9.4%为女性。所有患者均因急性心源性休克处于 INTERMACS 分级 I 级（53.1%）和 INTERMACS 分级 II 级（46.9%）。整个队列中有 26 名患者（81.25%）在 Impella®支持下被移动。17 名患者（53.1%）从 Impella®支持中撤机，10 名患者（31.3%）桥接到耐用型 LVAD。Impella®的中位使用时间为 7 天（IQR 5.0-11.0）。30 天死亡率为 37.5%，出院时存活率为 56.25%。只有 1 名患者发生血管并发症，表现为手臂灌注不足。在 Impella®支持下没有发生卒中的病例。
Impella®轴流泵似乎是需要部分或完全血液动力学支持的急性心源性休克患者的合适治疗选择。它还可提供足够的左心室卸载，以允许患者充分移动和进行神经学评估。此外，Impella®可提供较高的心肌恢复率。
