Schmack Leonie, Ali-Hasan-Al-Saegh Sadeq, Weymann Alexander, Pizanis Nikolaus, Akhyari Payam, Zubarevich Alina, Hanke Jasmin Sarah, Popov Aron-Frederik, Ruhparwar Arjang, Rassaf Tienush, Kamler Markus, Luedike Peter, Schmack Bastian
Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, University Duisburg-Essen, 45141 Essen, Germany.
Klinikum Region Hannover, Klinikum Siloah, Klinik für Kardiologie, Rhythmologie und Internistische Intensivmedizin, Stadionbrücke 4, 30459 Hannover, Germany.
Medicina (Kaunas). 2024 Nov 28;60(12):1960. doi: 10.3390/medicina60121960.
The use of temporary left ventricular assist devices (tLVADs) for patients suffering from cardiogenic shock (CS) is becoming more common. This study examines the indications and outcomes of microaxial flow pumps (Impella, Abiomed Inc., Danvers, MA, USA) when cannulated through the axillary artery in patients with severe CS, with a particular focus on acute phase reactions and hemolytic responses. This single-center, retrospective cohort involved patients who received microaxial Impella implantation via the axillary artery from 2020 to 2022 ( = 47). Among the patients, 66% (N = 31 cases) were treated with the Impella 5.5, 25.5% (N = 12 cases) with the Impella 5.0, and 8.5% (N = 4 cases) with the Impella CP. Additionally, 28% were managed using the ECMELLA concept. The mean length of time for Impella support was 8 days. The overall 30-day survival rate was 78%, with no significant differences observed between the ECMELLA group and the various Impella types. At 30 days post-therapy, 47% of survivors no longer required mechanical support, while 26% were upgraded to a durable LVAD. Interleukin-6 (IL-6) levels were significantly lower in patients receiving Impella 5.5 ( = 17 vs. 12) immediately following implantation ( = 0.03) compared with those with smaller devices. Haptoglobin levels were significantly higher in the Impella 5.5 group ( = 17 vs. 11, = 0.02), with overall lower rates of hemolysis (45.1%, < 0.01). The mortality rate in critical CS appears reduced with axillary artery implantation of Impella devices relative to existing literature. A full-flow microaxial pump (Impella 5.5) seems advantageous regarding systemic inflammatory response syndrome (SIRS) and acute hemolysis, indicated by lower IL-6 and higher haptoglobin levels, compared with smaller Impella devices. A tailored escalation/de-escalation concept using axillary access for different mAFP types appears feasible and safe.
对于心源性休克（CS）患者使用临时左心室辅助装置（tLVADs）正变得越来越普遍。本研究探讨了微轴流泵（美国马萨诸塞州丹弗斯市Abiomed公司的Impella）经腋动脉插管用于重症CS患者的适应证和结局，特别关注急性期反应和溶血反应。这项单中心回顾性队列研究纳入了2020年至2022年期间经腋动脉接受微轴流Impella植入的患者（n = 47）。在这些患者中，66%（n = 31例）接受了Impella 5.5治疗，25.5%（n = 12例）接受了Impella 5.0治疗，8.5%（n = 4例）接受了Impella CP治疗。此外，28%的患者采用了ECMELLA概念进行治疗。Impella支持的平均时长为8天。总体30天生存率为78%，ECMELLA组与不同类型的Impella之间未观察到显著差异。治疗后30天时，47%的幸存者不再需要机械支持，而26%的患者升级为永久性左心室辅助装置。与使用较小装置的患者相比，接受Impella 5.5治疗的患者（n = 17 vs. 12）植入后即刻白细胞介素-6（IL-6）水平显著更低（P = 0.03）。Impella 5.5组的触珠蛋白水平显著更高（n = 17 vs. 11，P = 0.02），总体溶血发生率更低（45.1%，P < 0.01）。相对于现有文献，经腋动脉植入Impella装置似乎可降低重症CS的死亡率。与较小的Impella装置相比，全流量微轴流泵（Impella 5.5）在全身炎症反应综合征（SIRS）和急性溶血方面似乎具有优势，表现为IL-6水平更低和触珠蛋白水平更高。对于不同类型的微轴流泵采用经腋入路进行量身定制的升级/降级概念似乎是可行且安全的。
