Initial experience with miniature axial flow ventricular assist devices for postcardiotomy heart failure

Abstract

Background: The recently introduced Impella Recover (Impella CardioSystems AG, Aachen, Germany) microaxial flow left and right ventricular assist devices (LVAD/RVAD) were evaluated as they provide circulatory support in the setting of postcardiotomy heart failure refractory to high-dose inotropic and intra-aortic balloon pump (IABP) support.

Methods: Between May 2002 and November 2002, the Recover LVAD was implanted in six patients (64 +/- 11 years) with acute left heart failure following coronary artery bypass procedures. Preoperative left ventricular (LV) ejection fraction was compromised (28% +/- 12%, 12% to 45%). Three patients presented with unstable circulation or cardiogenic shock following acute myocardial infarction, with a predicted mortality rate of 44% +/- 11% (EuroSCORE). Intraoperatively, severe heart failure was present with a more than 70% mortality rate predicted by the IABP score. The Recover RVAD and LVAD were combined to provide biventricular assist device (BVAD) support in one case of post-transplant graft failure.

Results: The Recover LVAD delivered blood flows of up to 5 L/min. A moderate degree of hemolysis and a reduction in platelet count were noted. Four patients were weaned from the LVAD after 169 +/- 34 hours, two of whom remain long-term survivors. Full recovery of graft function allowed weaning of the patient from BVAD support after six days.

Conclusions: The initial experience with the Impella Recover VADs proved the new systems to be advantageous regarding the ease of implantation and device removal, low anticoagulation requirements, and advanced weaning features. In cases of severe heart failure, survival was improved by using LVADs when compared to that predicted by solely continuing IABP and drug support.