Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy.
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Int J Cardiol. 2024 Feb 1;396:131418. doi: 10.1016/j.ijcard.2023.131418. Epub 2023 Oct 7.
Perioperative cardiogenic shock (CS) in cardiac surgery is still burdened by a high mortality risk. The introduction of Impella pumps in the therapeutic armory of temporary mechanical circulatory support (tMCS) has potential implications to improve the management of complex cases, although it has never been systematically addressed. We performed a systematic review of the reported use of tMCS with Impella in cardiac surgery.
We searched PubMed for all original studies on the Impella use in adult patients in cardiac surgery.
Nineteen studies (out of 151 identified by search string) were included. All studies were observational and all but one (95%) were retrospective. Seven studies focused on the implantation of Impella in the pre-operative setting (coronary or valvular surgery), either as a prophylactic device in high-risk cases (3 studies) or in patients with CS as stabilization tool prior to cardiac surgery procedure (4 studies). Three studies reported the use of Impella as periprocedural support for percutaneous valvular procedure, three as bridge to heart replacement, and six for postcardiotomy CS. Impella support had a low complication rate and was successful in supporting hemodynamics pre-, intra- and postoperatively. Most consistently reported data were left-ventricular ejection fraction at implant, short-term survival and weaning rate.
tMCS with Impella in cardiac surgery patients is feasible and successful. It can be applied in selected cardiac surgery patients and presents advantages over other types of support. Systematic prospective studies are needed to standardize indications for implant and management of surgical issues, and to identify which patients may benefit.
心脏手术中的围手术期心源性休克（CS）仍然存在高死亡率风险。Impella 泵在临时机械循环支持（tMCS）的治疗武器库中的引入有可能改善复杂病例的管理，尽管它从未得到系统的解决。我们对心脏手术中使用 tMCS 和 Impella 的报道进行了系统评价。
我们在 PubMed 上搜索了所有关于成人心脏手术中 Impella 使用的原始研究。
19 项研究（从搜索字符串中确定的 151 项研究中）被纳入。所有研究均为观察性研究，除 1 项（95%）外均为回顾性研究。7 项研究侧重于 Impella 在术前环境中的植入，要么作为高危病例的预防性设备（3 项研究），要么作为心脏手术前 CS 的稳定工具（4 项研究）。3 项研究报告了 Impella 在经皮瓣膜手术中的围手术期支持作用，3 项研究作为心脏置换的桥接，6 项研究用于心脏手术后 CS。Impella 支持的并发症发生率低，在术前、术中和术后支持血液动力学方面均取得成功。最一致报告的数据是植入时的左心室射血分数、短期生存率和脱机率。
心脏手术患者的 tMCS 和 Impella 是可行且成功的。它可应用于选定的心脏手术患者，并具有优于其他类型支持的优势。需要进行系统的前瞻性研究，以规范植入的适应症和手术问题的管理，并确定哪些患者可能受益。
