心力衰竭相关心源性休克中手术植入的Impella微轴流泵的治疗效果。

Outcomes of Surgically Implanted Impella Microaxial Flow Pumps in Heart Failure-Related Cardiogenic Shock.

作者信息

Abraham Jacob, Anderson Mark, Silvestry Scott, Soltesz Edward G, Ono Masahiro, Mody Kanika, Esmailian Fardad, Kilic Arman, Bharmi Rupinder, Chhim Rothy, Bogaev-Chapman Roberta, Katlaps Gundars J, Armas Ismael Salas DE, Daneshmand Mani A, Kaczorowski David J, Pham Duc Thinh, Ramzy Danny, D'Alessandro David

机构信息

Center for Cardiovascular Analytics, Research, & Data Science (CARDS), Providence St. Joseph Research Network, Portland, OR.

Hackensack University Medical Center, Hackensack, NJ.

出版信息

J Card Fail. 2025 Mar 30. doi: 10.1016/j.cardfail.2025.03.008.

DOI:10.1016/j.cardfail.2025.03.008

PMID:40164407

Abstract

BACKGROUND

Patients with cardiogenic shock (CS) are increasingly treated with high-profile microaxial flow pumps (Impella 5.5), but little is known about the indications and outcomes of this support strategy in patients with CS due to heart failure (HF-CS).

OBJECTIVES

We sought to describe the clinical features and outcomes of patients with HF-CS treated with Impella 5.5.

METHODS

We analyzed data from a prospective, multicenter observational study of patients with CS who had been implanted with an Impella 5.5. Adverse events, in-hospital survival rates and 6- and 12-month survival rates were analyzed in the total cohort and between patients treated with Impella 5.5 alone or with multiple temporary mechanical circulatory support (tMCS) devices. Outcomes were stratified based on native heart survival (NHS) and heart-replacement therapy (HRT).

RESULTS

Of the 804 patients with CS who received Impella 5.5, 444 had HF-CS. Prior to Impella 5.5 placement, 214 (48.1%) had received other tMCS devices. The duration of Impella support was 21.1 ± 20.1 days (median: 15; IQR: 8, 26 days). Survival to discharge was 75.0% for the total cohort, 86.5% for those receiving Impella 5.5 alone, and 65.0% for those receiving multiple tMCS devices. The need for renal-replacement therapy and thrombocytopenia requiring transfusions was more common in those receiving multiple tMCS devices. Among patients with NHS, 6- and 12-month survival rates were 71.3% and 64.4%, respectively, while patients receiving HRT had survival rates > 93%.

CONCLUSIONS

Patients with HF-CS treated with Impella 5.5 had overall favorable in-hospital, 6-month and 12-month survival, both as a bridge to NHS as HRT.

摘要

背景

心源性休克（CS）患者越来越多地接受高调的微轴流泵（Impella 5.5）治疗，但对于因心力衰竭导致的心源性休克（HF-CS）患者采用这种支持策略的适应症和结局知之甚少。

目的

我们试图描述接受Impella 5.5治疗的HF-CS患者的临床特征和结局。

方法

我们分析了一项对植入Impella 5.5的CS患者进行的前瞻性、多中心观察性研究的数据。分析了整个队列以及单独接受Impella 5.5治疗或接受多种临时机械循环支持（tMCS）设备治疗的患者之间的不良事件、住院生存率以及6个月和12个月生存率。结局根据自体心脏生存（NHS）和心脏置换治疗（HRT）进行分层。

结果

在804例接受Impella 5.5治疗的CS患者中，444例为HF-CS。在植入Impella 5.5之前，214例（48.1%）曾接受过其他tMCS设备治疗。Impella支持的持续时间为21.1±20.1天（中位数：15天；四分位间距：8，26天）。整个队列的出院生存率为75.0%，单独接受Impella 5.5治疗的患者为86.5%，接受多种tMCS设备治疗的患者为65.0%。在接受多种tMCS设备治疗的患者中，需要肾脏替代治疗和因血小板减少需要输血的情况更为常见。在NHS患者中，6个月和12个月生存率分别为71.3%和64.4%，而接受HRT的患者生存率>93%。