George Timothy J, Sheasby Jenelle, DiMaio J Michael, Kabra Nitin, Rawitscher David A, Afzal Aasim
Department of Advanced Heart Failure and Mechanical Circulatory Support, Baylor Scott & White The Heart Hospital - Plano, Plano, Texas.
Proc (Bayl Univ Med Cent). 2023 May 8;36(4):415-421. doi: 10.1080/08998280.2023.2205817. eCollection 2023.
Although a role for percutaneous Impella devices has been established, there is a paucity of data regarding the utility and outcomes of larger surgically implanted Impella devices.
We conducted a retrospective review of all surgical Impella implants at our institution. All Impella 5.0 and Impella 5.5 devices were included. The primary outcome was survival. Secondary outcomes included hemodynamic and end-organ perfusion as well as commonly encountered surgical complications.
From 2012 to 2022, 90 surgical Impella devices were implanted. The median age was 63 [53-70] years, the mean creatinine was 2.07 ± 1.22 mg/dL, and the average lactate level was 3.32 ± 2.90 mmol/L. Prior to implantation, 47 patients (52%) were supported with vasoactive agents, while 43 (48%) were also supported with another device. The most common etiology of shock was acute on chronic heart failure (50, 56%), followed by acute myocardial infarction (22, 24%), and postcardiotomy (17, 19%). Overall, 69 patients (77%) survived to device removal, and 57 (65%) survived to hospital discharge. One-year survival was 54%. Neither etiology of heart failure nor device strategy was associated with 30-day or 1-year survival. On multivariable modeling, the number of vasoactive medications prior to device implantation was strongly associated with 30-day mortality (hazard ratio 1.94 [1.27-2.96], < 0.01). Surgical Impella placement was associated with a significant decreased need for vasoactive infusions ( < 0.01) and decreased acidosis ( = 0.01).
Surgical Impella support for patients in acute cardiogenic shock is associated with lower vasoactive medication use, improved hemodynamics, increased end-organ perfusion, and acceptable morbidity and mortality.
尽管经皮置入Impella装置的作用已得到确立，但关于更大尺寸的外科植入式Impella装置的效用和结果的数据却很少。
我们对本机构所有外科植入Impella装置的情况进行了回顾性研究。纳入了所有Impella 5.0和Impella 5.5装置。主要结局是生存率。次要结局包括血流动力学和终末器官灌注以及常见的手术并发症。
2012年至2022年期间，共植入了90个外科Impella装置。中位年龄为63[53 - 70]岁，平均肌酐为2.07±1.22mg/dL，平均乳酸水平为3.32±2.90mmol/L。植入前，47例患者（52%）接受了血管活性药物支持，43例（48%）还接受了另一种装置的支持。休克最常见的病因是慢性心力衰竭急性发作（50例，56%），其次是急性心肌梗死（22例，24%）和心脏手术后（17例，19%）。总体而言，69例患者（77%）存活至装置移除，57例（65%）存活至出院。1年生存率为54%。心力衰竭的病因和装置策略均与30天或1年生存率无关。在多变量模型中，装置植入前血管活性药物的数量与30天死亡率密切相关（风险比1.94[1.27 - 2.96]，P<0.01）。外科植入Impella装置与血管活性药物输注需求显著减少（P<0.01）和酸中毒减轻（P = 0.01）相关。
外科植入Impella装置对急性心源性休克患者的支持与血管活性药物使用减少、血流动力学改善、终末器官灌注增加以及可接受的发病率和死亡率相关。
