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. 2024 Sep 30;16(9):6045-6051.
doi: 10.21037/jtd-24-194. Epub 2024 Sep 26.

The use of perioperative Impella 5.5 support in high-risk cardiac surgery: a retrospective cohort study

John Eisenga  1 , Kyle McCullough  1 , Ghadi Moubarak  1 , J Michael Dimaio  2 , Timothy George  2
Affiliations

The use of perioperative Impella 5.5 support in high-risk cardiac surgery: a retrospective cohort study

John Eisenga et al. J Thorac Dis. .

Abstract

Background: Although the Impella device has an established role in high-risk percutaneous intervention and cardiogenic shock, its role in open cardiac surgery remains unclear. We undertook this study to better understand the role of Impella support in cardiac surgical intervention.

Methods: This is a retrospective cohort study of consecutive patients who underwent cardiac surgery with surgically placed Impella 5.5 device support from October 2020 through June 2023. Patient charts were identified and systematically reviewed for relevant information. The primary outcome for this study was patient survival to discharge. Secondary outcomes included intraoperative survival, 30-day survival and 1-year survival.

Results: From 2020-2023, ten patients underwent open cardiac surgery with Impella 5.5 support. Five patients were male and the median age was 56.5 years [interquartile range (IQR), 52-63.8 years]. Three patients (30%) presented for isolated revascularization, 3 patients (30%) presented for single valve surgical intervention, 3 patients (30%) presented for revascularization and valve intervention, and 1 patient (10%) presented for multivalve intervention. The median ejection fraction (EF) of patients was 25% (IQR, 21.25-32.5%), the median Society of Thoracic Surgeons risk score was 4.32% (IQR, 1.73-11.06%). Of the patients, 40% underwent axillary cannulation while 60% had central cannulation. Intraoperative survival was 100%, survival to discharge was 90% and 30-day survival was 80%.

Conclusions: Our study suggests the use of surgical Impella in high-risk cardiac surgical patients is associated with acceptable survival regardless of site or timing of cannulation. However, Impella usage is associated with significant morbidity. Further investigation is warranted to better understand which patients benefit perioperative Impella support.

Keywords: Impella; adult cardiac; perioperative care; temporary mechanical support.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-194/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart with patient outcomes and cause of mortality if known.
Figure 2
Figure 2
Discharge disposition in patients successfully discharged from the hospital following surgically placed Impella 5.5 supported cardiac surgery.
See this image and copyright information in PMC

References

    1. Peura JL, Colvin-Adams M, Francis GS, et al. Recommendations for the use of mechanical circulatory support: device strategies and patient selection: a scientific statement from the American Heart Association. Circulation 2012;126:2648-67. 10.1161/CIR.0b013e3182769a54 - DOI - PubMed
    1. Atti V, Narayanan MA, Patel B, et al. A Comprehensive Review of Mechanical Circulatory Support Devices. Heart Int 2022;16:37-48. 10.17925/HI.2022.16.1.37 - DOI - PMC - PubMed
    1. Hernandez-Montfort J, Sinha SS, Thayer KL, et al. Clinical Outcomes Associated With Acute Mechanical Circulatory Support Utilization in Heart Failure Related Cardiogenic Shock. Circ Heart Fail 2021;14:e007924. 10.1161/CIRCHEARTFAILURE.120.007924 - DOI - PubMed
    1. Thiele H, Zeymer U, Neumann FJ, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012;367:1287-96. 10.1056/NEJMoa1208410 - DOI - PubMed
    1. Bellumkonda L, Gul B, Masri SC. Evolving Concepts in Diagnosis and Management of Cardiogenic Shock. Am J Cardiol 2018;122:1104-10. 10.1016/j.amjcard.2018.05.040 - DOI - PubMed

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