Abstract
Cardiogenic shock results from inadequate cardiac output to satisfy organ perfusion with potential need for pharmacologic and mechanical circulatory support for survival. Impella 5.0 insertion is used as a rescue device and bridge to durable mechanical circulatory support. We sought to evaluate changes in right ventricular parameters in patients bridged with Impella 5.0 undergoing durable left ventricular device implantation (LVAD).
A single center retrospective review of patients presenting in cardiogenic shock requiring micro-axial circulatory support with Abiomed Impella 5.0 between 2016-2020 was performed. Patient demographics, pre- and post-implant laboratory values and right heart catheterization pressures were reviewed. Patient demographics were evaluated using chi square test, clinical value means compared with unpaired t-test, p<0.05 was considered significant.
A total of 24 patients presenting in cardiogenic shock receiving durable LVAD after Impella 5.0 were included for analysis. The majority of patients were male, 59.3 ± 11.1 years old, with history of ischemic heart disease. All patients received an Impella 5.0 via axillary approach. Significant improvement in serum creatinine (1.83 vs 1.42, p<0.05), cardiac index (1.79 vs 3.34 L/min/m2, p<0.05), central venous pressure (17.5 vs 8.88 mmHg, p<0.05), mean pulmonary artery pressure (38.3 vs 29.4 mmHg, p<0.05), and right ventricular stroke work index (397.5 vs 750.3 mmHg*ml/m2, p<0.001) was observed. Improvements in liver transaminases were also observed, while total bilirubin increased after Impella 5.0 implantation, but was not significant (1.68 vs 2.26 mg/dL, p>0.05). No patients received right ventricular assist device support, 30-day mortality was 8.3%
Impella 5.0 insertion for cardiogenic shock significantly decreased central venous and mean pulmonary artery pressure with concomitant improvement in RV function as measured by increased right ventricular stroke work index. Total bilirubin increased, likely as a result of pump hemolysis. Excellent results can be obtained with LVAD implantation in cardiogenic shock patients utilizing Impella 5.0 as a bridge.