From the Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
ASAIO J. 2023 Jul 1;69(7):642-648. doi: 10.1097/MAT.0000000000001931. Epub 2023 Apr 10.
We report midterm results of Impella 5.5 use with focus placed on bridge-outcomes, venoarterial extracorporeal membrane oxygenation (VA-ECMO) transition, complications, and risk factors for mortality. A retrospective review of patients implanted with the Impella 5.5 at our medical center was conducted. Forty patients were included with varying bridge strategies. Sixteen (40%) patients were supported for <14 days, 13 (32.5%) for 14-30 days, and 11 (27.5%) for >30 days. Thirty day mortality was 22.5% (9/40). Twenty-five (62.5%) were successfully bridged to transplant or durable left ventricular assist device (LVAD), while four (10.0%) recovered without the need for any further cardiac support. Five of 11 (60%) patients initially supported with VA-ECMO were either transitioned to durable left ventricular assist device (dLVAD; n = 3, 27.3%), transplanted (n = 1, 9.1%), or recovered (n = 1, 9.1%). Of nine patients with >moderate right ventricle (RV) dysfunction, five (55.6%) were successfully bridged to transplant or LVAD. Five (12.5%) patients required interval cannulation to VA-ECMO, often in the setting of RV dysfunction, and all (100%) were successfully transplanted. Lower pulmonary artery (PA) systolic pressure ( P = 0.029), among other factors, was associated with mortality. In summary, the Impella 5.5 may be able to effectively stabilize patients in refractory left ventricular predominant cardiogenic shock for extended durations, allowing time for mechanical circulatory support (MCS) and transplant evaluations.
我们报告了 Impella 5.5 的中期使用结果，重点关注桥接结局、静脉-动脉体外膜肺氧合（VA-ECMO）转换、并发症以及死亡的危险因素。对我们医疗中心植入 Impella 5.5 的患者进行了回顾性研究。共纳入 40 例患者，采用不同的桥接策略。16 例（40%）患者的支持时间<14 天，13 例（32.5%）为 14-30 天，11 例（27.5%）>30 天。30 天死亡率为 22.5%（9/40）。25 例（62.5%）成功桥接到移植或持久左心室辅助装置（LVAD），而 4 例（10.0%）无需任何进一步的心脏支持即可恢复。最初接受 VA-ECMO 支持的 11 例患者中有 5 例（60%）转为持久左心室辅助装置（dLVAD；n=3，27.3%）、移植（n=1，9.1%）或恢复（n=1，9.1%）。在 9 例存在中度以上右心室（RV）功能障碍的患者中，5 例（55.6%）成功桥接到移植或 LVAD。5 例（12.5%）患者需要间隔插管至 VA-ECMO，通常在 RV 功能障碍的情况下，所有患者（100%）均成功移植。较低的肺动脉（PA）收缩压（P=0.029）等因素与死亡率相关。总之，Impella 5.5 可有效稳定长时间处于难治性左心室为主型心源性休克的患者，为机械循环支持（MCS）和移植评估提供时间。
