P2626Outcome of patients in cardiogenic shock supported with a micro-axial blood pump providing 5 l/min blood flow

Introduction

Percutaneous mechanical circulatory support devices are increasingly used in acute cardiogenic shock (CS), despite limited evidence for their effectiveness. The aim of this study was to evaluate outcomes associated with use of the full support Impella 5 and 5.5 as a short- term left ventricular device (LVAD) and to identify preoperative predictors of short -term mortality.

Methods

Data of patients in CS (n=51) treated with the Impella 5 (n=48) and 5.5 (n=3) devices at our institution were collected retrospectively. The primary endpoint was 30-day all-cause mortality. Clinical follow up including adverse events was analyzed.

Results

Mean age was 58.2±12.1 years; 80.4% were male. 13 patients had BMI >30 kg/m2. CS was caused by acute myocardial infarction (n=14), decompensated chronic heart failure (n=29), postcardiotomy syndrom and acute myocarditis (n=4 each). Before implantation, median Intermacs profile was 1 (range 1–3) and 31 patients (61%) were on respiratory support. In 49 patients the axillary artery was used for vascular access (n=4 left and n=45 right) employing a 10mm dacron graft tunneled through the skin, in one patient left femoral artery and ascending aorta, respectively. Median support time was 14 days.

In 12 cases the pump was removed for myocardial recovery. In 15 patients a continuous flow permanent LVAD was implanted. Bleeding (n=9), thromboembolic event (n=5), pump dislodgement (n=7) requiring revision occurred during support. Seven patients developed ventricular arrhythmia requiring flow reduction. In 5 cases the pump was explanted for hemolysis, in 2 other patients pump exchange was performed. The overall 30-day survival was 53% (95% CI: 38.8–67.1%). Penalized multivariable logistic regression analysis identified preoperative elevated lactate (p=0.027) and CK-MB (p=0.022) as predictors for 30- day mortality. On the basis of these data, a nomogram to estimate 30d-mortality after Impella implantation was created.

Conclusion

Stabilization of patients suffering from CS employing temporary full support Impella LVAD is feasible and results in acceptable survival. Preoperative degree of shock and myocardial damage predict the short-term mortality. Effect of full support Impella LVAD in earlier stages of shock may prevent irreversible end organ damage.