Dumitru Ioana, DeWolf Jonathan, Sevillano Maria, Schnell Leeandra, Bezerra Hiram, Rinde-Hoffman Debbie
Division of Advanced Heart Failure and Cardiac Transplant, Tampa General Hospital, University of South Florida, Tampa, Florida, USA.
Alabama College of Osteopathic Medicine, Dothan, Alabama, USA.
Catheter Cardiovasc Interv. 2025 Sep;106(3):1593-1599. doi: 10.1002/ccd.31726. Epub 2025 Jun 29.
Right ventricular failure (RVF) in patients with cardiogenic shock (CS) is associated with increased mortality. Mechanical circulatory support with Impella RP Flex may improve survival, but expert opinion is inconsistent due to lack of established best practices. We explore the impact of Impella RP Flex in treating patients with RVF.
In this single-center, retrospective study, patients with RVF or biventricular failure treated with Impella RP Flex from December 2022 to March 2024 were reviewed. Clinical data included CS etiology, diagnostic laboratory values, and hemodynamics. Patient-oriented outcomes were duration of Impella RP Flex support, survival rate, and 30-day heart failure (HF) readmission rate. Secondary outcomes included incidence of complications.
Twenty-two SCAI stage D (72.7%) and E (27.3%) patients with RVF were implanted with Impella RP Flex, either alone or in combination with a left ventricular assist device (LVAD). The average duration of Impella RP Flex support was 6.6 (1, 14) days, and the overall mortality rate was 31.8% (n = 7/22). Among survivors, four received orthotopic heart transplant, one received durable LVAD support, and 10 recovered to discharge. Vasopressors (n = 17) and inotropes (n = 17) were initiated in most patients before device support. Incidence of 30-day HF readmission was 20% (n = 3/15), and 68.2% (n = 15/22) of patients required inpatient hemodialysis. Hemodynamics improved post-Impella RP Flex implant, though hemolysis occurred in 86.4% (n = 19/22) of patients, and bleeding requiring transfusion occurred in 63.6% (n = 14/22).
Impella RP Flex may provide a treatment option for patients with CS and RVF who require inotropic or vasopressor support when used with careful attention to procedural technique and individualized risk assessment.
心源性休克（CS）患者的右心室衰竭（RVF）与死亡率增加相关。使用Impella RP Flex进行机械循环支持可能会提高生存率，但由于缺乏既定的最佳实践，专家意见并不一致。我们探讨了Impella RP Flex对RVF患者治疗的影响。
在这项单中心回顾性研究中，对2022年12月至2024年3月期间接受Impella RP Flex治疗的RVF或双心室衰竭患者进行了回顾。临床数据包括CS病因、诊断实验室值和血流动力学。以患者为导向的结局包括Impella RP Flex支持的持续时间、生存率和30天心力衰竭（HF）再入院率。次要结局包括并发症的发生率。
22例SCAI D期（72.7%）和E期（27.3%）的RVF患者单独或联合左心室辅助装置（LVAD）植入了Impella RP Flex。Impella RP Flex的平均支持时间为6.6（1，14）天，总死亡率为31.8%（n = 7/22）。在幸存者中，4例接受了原位心脏移植，1例接受了持久的LVAD支持，10例康复出院。大多数患者在装置支持前开始使用血管升压药（n = 17）和正性肌力药（n = 17）。30天HF再入院率为20%（n = 3/出15），68.2%（n = 15/22）的患者需要住院血液透析。Impella RP Flex植入后血流动力学得到改善，尽管86.4%（n = 19/22）的患者发生了溶血，63.6%（n = 14/22）的患者发生了需要输血的出血。
当仔细关注操作技术和个体化风险评估时，Impella RP Flex可为需要正性肌力或血管升压支持的CS和RVF患者提供一种治疗选择。
