Parker Lauren E, Overbey Douglas M, Kang Lillian, Medina Cathlyn K, Kurzlechner Leonie M, Beckerman Ziv, Andersen Nicholas D, Schroder Jacob N, Turek Joseph
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
JTCVS Tech. 2023 Aug 7;21:188-194. doi: 10.1016/j.xjtc.2023.07.021. eCollection 2023 Oct.
The Impella 5.5 has been successfully used in the adult population; however, safety and efficacy data in patients aged less than 18 years are limited.
Six pediatric patients, aged 13 to 16 years and weighing 45 to 113 kg, underwent axillary artery graft placement and attempted placement of the Impella 5.5 device at our institution between August 2020 and March 2023.
Indications for implantation were heart failure secondary to myocarditis (2), rejection of prior orthotopic heart transplant, idiopathic dilated cardiomyopathy (2), and heart failure after transposition of the great arteries repair. Placement was unsuccessful in a 13.8-year-old female patient due to prohibitively acute angulation of the right subclavian artery, and venoarterial extracorporeal membrane oxygenation cannulation was performed via the axillary graft. In 5 patients with successful Impella 5.5 placement, median duration of support was 13.5 days (range, 7-42 days). One experienced cardiac arrest secondary to coagulation-associated device failure, requiring temporary HeartMate3 implantation. Four patients were bridged to transplant; 3 patients received a transplant directly from Impella 5.5, and 1 patient received a transplant after HeartMate3. The final patient received the HeartMate3 on Impella day 42 and is awaiting transplant.
Although exact size cutoffs and anatomy are still being determined, our experience provides a framework for use of the Impella 5.5 in adolescents.
Impella 5.5已成功应用于成人；然而，18岁以下患者的安全性和有效性数据有限。
2020年8月至2023年3月期间，6名年龄在13至16岁、体重45至113公斤的儿科患者在我院接受了腋动脉移植，并尝试植入Impella 5.5装置。
植入的适应症包括心肌炎继发的心力衰竭（2例）、先前原位心脏移植排斥反应、特发性扩张型心肌病（2例）以及大动脉转位修复术后心力衰竭。一名13.8岁女性患者因右锁骨下动脉角度过锐而植入失败，通过腋动脉移植进行了静脉-动脉体外膜肺氧合插管。在5例成功植入Impella 5.5的患者中，中位支持时间为13.5天（范围7-42天）。1例因凝血相关装置故障继发心脏骤停，需要临时植入HeartMate3。4例患者过渡到移植；3例患者直接从Impella 5.5过渡到移植，1例患者在植入HeartMate3后接受移植。最后一名患者在Impella植入第42天接受了HeartMate3，正在等待移植。
尽管确切的尺寸界限和解剖结构仍在确定中，但我们的经验为Impella 5.5在青少年中的应用提供了一个框架。
