Eisenga John, McCullough Kyle, Moubarak Ghadi, Dimaio J Michael, George Timothy
Department of Cardiovascular Research, Baylor Scott and White Research Institute, Dallas, TX, USA.
Department of Cardiac Surgery, Baylor Scott and White The Heart Hospital Plano, Plano, TX, USA.
J Thorac Dis. 2024 Sep 30;16(9):6045-6051. doi: 10.21037/jtd-24-194. Epub 2024 Sep 26.
Although the Impella device has an established role in high-risk percutaneous intervention and cardiogenic shock, its role in open cardiac surgery remains unclear. We undertook this study to better understand the role of Impella support in cardiac surgical intervention.
This is a retrospective cohort study of consecutive patients who underwent cardiac surgery with surgically placed Impella 5.5 device support from October 2020 through June 2023. Patient charts were identified and systematically reviewed for relevant information. The primary outcome for this study was patient survival to discharge. Secondary outcomes included intraoperative survival, 30-day survival and 1-year survival.
From 2020-2023, ten patients underwent open cardiac surgery with Impella 5.5 support. Five patients were male and the median age was 56.5 years [interquartile range (IQR), 52-63.8 years]. Three patients (30%) presented for isolated revascularization, 3 patients (30%) presented for single valve surgical intervention, 3 patients (30%) presented for revascularization and valve intervention, and 1 patient (10%) presented for multivalve intervention. The median ejection fraction (EF) of patients was 25% (IQR, 21.25-32.5%), the median Society of Thoracic Surgeons risk score was 4.32% (IQR, 1.73-11.06%). Of the patients, 40% underwent axillary cannulation while 60% had central cannulation. Intraoperative survival was 100%, survival to discharge was 90% and 30-day survival was 80%.
Our study suggests the use of surgical Impella in high-risk cardiac surgical patients is associated with acceptable survival regardless of site or timing of cannulation. However, Impella usage is associated with significant morbidity. Further investigation is warranted to better understand which patients benefit perioperative Impella support.
尽管Impella装置在高危经皮介入治疗和心源性休克中已确立其作用，但其在心脏直视手术中的作用仍不明确。我们开展这项研究以更好地了解Impella支持在心脏外科手术干预中的作用。
这是一项回顾性队列研究，研究对象为2020年10月至2023年6月期间接受心脏手术并通过手术植入Impella 5.5装置支持的连续患者。识别患者病历并系统审查相关信息。本研究的主要结局是患者出院生存。次要结局包括术中生存、30天生存和1年生存。
2020年至2023年期间，10例患者在Impella 5.5支持下接受了心脏直视手术。5例患者为男性，中位年龄为56.5岁[四分位间距（IQR），52 - 63.8岁]。3例患者（30%）因单纯血运重建就诊，3例患者（30%）因单瓣膜手术干预就诊，3例患者（30%）因血运重建和瓣膜干预就诊，1例患者（10%）因多瓣膜干预就诊。患者的中位射血分数（EF）为25%（IQR，21.25 - 32.5%），胸外科医师协会风险评分中位数为4.32%（IQR，1.73 - 11.06%）。其中，40%的患者采用腋动脉插管，60%的患者采用中心插管。术中生存率为100%，出院生存率为90%，30天生存率为80%。
我们的研究表明，在高危心脏手术患者中使用外科Impella装置，无论插管部位或时间如何，其生存率均可接受。然而，使用Impella装置会导致显著的发病率。有必要进一步研究以更好地了解哪些患者能从围手术期Impella支持中获益。
