Original Clinical Science
Use of a percutaneous temporary circulatory support device as a bridge to decision during acute decompensation of advanced heart failure

https://doi.org/10.1016/j.healun.2017.09.020Get rights and content

Background

Prognosis is poor for patients with decompensated advanced heart failure (HF) refractory to medical therapy. Evaluating candidacy for durable mechanical circulatory support (MCS), cardiac transplantation, or palliative care is complex, and time is often needed to stabilize the patient hemodynamically. The Impella 5.0 (Abiomed, Danvers, MA) is a minimally invasive axial-flow catheter capable of providing full temporary hemodynamic support. We report a multicenter series on the use of this device for bridge to decision (BTD) in decompensated advanced HF patients.

Methods

In a retrospective evaluation at 3 centers of patients with advanced HF who acutely decompensated and received the Impella 5.0 for BTD, we analyzed demographics, procedural characteristics, in-hospital and intermediate-term outcomes, and in-hospital complications.

Results

There were 58 patients who met inclusion criteria from 2010 to 2015. All were inotrope dependent. The mean ejection fraction was 13%, and median age was 59 years (interquartile range, 48–64 years). Mean duration of support was 7 days (range, 0–22 days). Thirty-nine patients survived to next therapy (67%), with most receiving durable MCS (n = 20) or heart transplantation (n = 15). In-hospital complications included bleeding (n = 9) and hemolysis (n = 4). Of patients who survived to the next therapy, 1-year survival was 65% for those who received durable MCS, 87% for those who received a transplant, and 75% for those who were stabilized and weaned.

Conclusions

The Impella 5.0 may provide a BTD strategy for patients with advanced HF and acute hemodynamic instability. Prospective studies are needed to evaluate the safety and effectiveness of this device in this patient population.

Section snippets

Methods

This was a 3-center, retrospective, observational study conducted at Baylor University Medical Center, Tufts Medical Center, and the University of Chicago Medical Center. Data were collected retrospectively by record review. The study was approved by the Institutional Review Board at each center.

Results

Between January 2010 and December 2015, 73 patients received the Impella 5.0 device for hemodynamic support at our 3 centers (Figure 1). The analysis excluded 19 patients due to the absence of pre-existing advanced HF (myocarditis in 7, cardiogenic shock secondary to acute myocardial infarction in 5, and post-cardiotomy cardiogenic shock in 5) or due to inability to implant the device (n = 2). The remaining 58 patients received Impella 5.0 support for acutely decompensated advanced HF and were

Discussion

In this large series of patients with advanced HF and acute hemodynamic instability, the Impella 5.0 stabilized these patients so that candidacy for advanced therapies, such as OHTx, durable LVAD, or palliative care, could be evaluated in a timely manner. This study expands an earlier report to a multicenter setting, including follow-up of all patients to 1 year after explant of the Impella device, and provides an analysis of predictors of survival to next therapy. Specifically, we identified

Disclosure statement

S.A.H. is a consultant for Abiomed Inc. N.K.K. receives research funding from Abiomed Inc., Maquet Inc., and Cardiac Assist Inc. None of the other authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.

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