Pieri Marina, Ortalda Alessandro, Altizio Savino, Bertoglio Luca, Nardelli Pasquale, Fominskiy Evgeny, Lapenna Elisabetta, Ajello Silvia, Scandroglio Anna Mara
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Front Cardiovasc Med. 2024 Jul 2;11:1379199. doi: 10.3389/fcvm.2024.1379199. eCollection 2024.
Impella 5.0 and 5.5 are promising low-invasive left ventricle (LV) temporary mechanical circulatory supports (tMCS) for cardiogenic shock due to LV mechanical unloading and are paired with powerful hemodynamic support. This study aimed to analyze data and destinies of patients supported with Impella 5.0/5.5 at a national referral center for cardiogenic shock and to assess the parameters associated with myocardial recovery and successful weaning.
A single-center observational study was conducted on all patients treated with Impella 5.0 or 5.5 from March 2018 to July 2023.
A total of 59 patients underwent Impella 5.0/5.5 implantation due to profound cardiogenic shock, with acute myocardial infarction being the most frequent cause of shock (42 patients, 71%). The median duration of Impella support was 13 days (maximum duration of 52 days). Axillary cannulation was feasible in almost all patients, and 36% were mobilized during support. A total of 44 patients (75%) survived to the next therapy/recovery: 21 patients experienced recovery and 15 and 8 were bridged to long-term LVAD and heart transplantation, respectively. The global survival rate was 66%. The predictors of native heart recovery at multivariate analysis were the number of days on tMCS before upgrade to Impella 5.0/5.5 [hazard ratio (HR) 0.68 (0.51-9) = 0.0068] and improvement of LVEF within the first 7-10 days of support [HR 4.72 (1.34-16.7), = 0.016].
Transcatheter systems such as Impella 5.0/5.5 revolutionized the field of tMCS. Myocardial recovery is the primary clinical target. Its prognostication and promotion are key to ensure the most proficuous course for each patient from cardiogenic shock to long-term event-free survival.
Impella 5.0和5.5是很有前景的低侵入性左心室（LV）临时机械循环支持（tMCS）装置，用于因左心室机械卸载导致的心源性休克，并伴有强大的血流动力学支持。本研究旨在分析在一家全国性的心源性休克转诊中心接受Impella 5.0/5.5支持的患者的数据和转归，并评估与心肌恢复和成功撤机相关的参数。
对2018年3月至2023年7月期间所有接受Impella 5.0或5.5治疗的患者进行了一项单中心观察性研究。
共有59例患者因严重心源性休克接受了Impella 5.0/5.5植入，急性心肌梗死是最常见的休克原因（42例患者，占71%）。Impella支持的中位持续时间为13天（最长持续时间为52天）。几乎所有患者都可行腋动脉插管，36%的患者在支持期间能够活动。共有44例患者（75%）存活至接受下一步治疗/恢复：21例患者实现恢复，15例和8例分别过渡到长期左心室辅助装置（LVAD）和心脏移植。总体生存率为66%。多因素分析中，自身心脏恢复的预测因素是升级至Impella 5.0/5.5前接受tMCS的天数[风险比（HR）0.68（0.51 - 0.9）= 0.0068]以及支持的前7 - 10天内左心室射血分数（LVEF）的改善[HR
