Lankenau Institute for Medical Research, Wynnewood, PA, USA.
Department of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
Braz J Cardiovasc Surg. 2023 Feb 10;38(1):71-78. doi: 10.21470/1678-9741-2021-0398.
The Impella ventricular support system is a device that can be inserted percutaneously or directly across the aortic valve to unload the left ventricle. The purpose of this study is to determine the role of Impella devices in patients with acute cardiogenic shock in the perioperative period of cardiac surgery.
A retrospective single-surgeon review of 11 consecutive patients who underwent placement of Impella devices in the perioperative period of cardiac surgery was performed. Patient records were evaluated for demographics, indications for placement, and postoperative outcomes.
Impella devices were placed for refractory cardiogenic shock preoperatively in 6 patients, intraoperatively in 4 patients, and postoperatively as a rescue in 1 patient. Seven patients received Impella CP, 1 Impella RP, 1 Impella CP and RP, and 2 Impella 5.0. Additionally, 3 patients required preoperative venovenous extracorporeal membrane oxygenation (VV-ECMO), and 1 patient required intraoperative venoarterial extracorporeal membrane oxygenation (VA-ECMO). All Impella devices were removed 1 to 28 days after implantation. Length of stay in the intensive care unit stay ranged from 2 to 53 days (average 23.9±14.6). The 30-day and 1-year mortality were 0%. Ten of 11 patients were alive at 2 years. Also, 1 patient died 18 months after surgery from complications of coronavirus disease (Covid-19). Device-related complications included varying degrees> of hemolysis in 8 patients (73%) and device malfunction in 1 patient (9%).
The Impella ventricular support system can be combined with other mechanical support devices for additional hemodynamic support. All patients demonstrated myocardial recovery with no deaths in the perioperative period and in 1-year of follow-up. Larger studies are necessary to validate these findings.
Impella 心室辅助系统是一种可经皮或直接穿过主动脉瓣插入以减轻左心室负荷的装置。本研究旨在确定 Impella 装置在心外科围手术期急性心源性休克患者中的作用。
对 11 例连续接受 Impella 装置在心外科围手术期置入的患者进行回顾性单外科医生回顾。评估患者的人口统计学、置入适应证和术后结果。
6 例患者术前因难治性心源性休克置入 Impella CP，4 例患者术中置入，1 例患者术后作为抢救置入。7 例患者接受 Impella CP，1 例患者接受 Impella RP，1 例患者接受 Impella CP 和 RP，2 例患者接受 Impella 5.0。此外，3 例患者需要术前静脉-静脉体外膜肺氧合（VV-ECMO），1 例患者需要术中静脉-动脉体外膜氧合（VA-ECMO）。所有 Impella 装置在植入后 1 至 28 天内取出。重症监护病房（ICU）的住院时间为 2 至 53 天（平均 23.9±14.6）。30 天和 1 年死亡率均为 0%。11 例患者中有 10 例在 2 年内存活。此外，1 例患者在手术后 18 个月因冠状病毒病（COVID-19）并发症死亡。与器械相关的并发症包括 8 例患者（73%）不同程度的>溶血和 1 例患者（9%）的器械故障。
Impella 心室辅助系统可与其他机械支持装置联合使用以提供额外的血液动力学支持。所有患者在围手术期和 1 年随访期间均表现出心肌恢复，无死亡。需要更大的研究来验证这些发现。
