Abstract 20874: Left Ventricular Unloading With Percutaneous Ventricular Assist Device is Comparable to Direct Left Ventricular Vent During Extracorporeal Life Support
Introduction: Patients supported with extracorporeal life support (ECLS) can experience severe complications from increased left ventricular afterload. The Impella percutaneous ventricular assist device is an attractive option for unloading the left ventricle, but there are no comprehensive studies about its use with ECLS. This study describes the outcomes of Impella use during ECLS compared to direct LV venting.
Methods: In this retrospective, observational, single-center study, we reviewed patients supported on ECLS with Impella or direct LV vent for cardiogenic shock between April 2010 and May 2016. Twenty-three patients supported on ECLS with Impella devices retained or placed for LV unloading were compared to 19 patients with direct LV vents merged into venous drainage of ECLS. Patients’ baseline characteristics, hemodynamic data, and outcomes were collected at the time of combined support initiation and at 48 hours of support, ICU discharge, and 28 days.
Results: The indication for circulatory support was postcardiotomy shock in 13 patients (31%), myocardial infarction in 11 (26%), decompensated non-ischemic cardiomyopathy in 9 (21%). Seven patients (30%) in the Impella group were supported with Impella 2.5, 7 (30%) with Impella CP, and 9 (39%) with Impella 5.0. After 48 hours, radiographic evidence of pulmonary edema was reduced or unchanged in 18 (90%) of the 20 surviving Impella patients and 15 (83%) of the 18 surviving direct vent patients. In patients with PA pressure monitoring, PA diastolic pressure was significantly decreased after 48 hours in both Impella (23±8 mmHg vs. 15±4 mmHg, p=0.02) and direct vent patients. 13 patients (57%) with Impella devices were weaned from ECLS following cardiac recovery or transition to durable LVAD, compared to 9 (47%) patients with direct LV venting. Eleven patients (48%) in the Impella group and 5 (26%) in the direct vent group were alive at day 28.
Conclusions: The use of Impella devices in patients supported with ECLS is an effective means of unloading the left ventricle and reducing or preventing worsened pulmonary edema and is comparable to direct LV venting. Further study is desired to determine the efficacy and safety of this multi-device approach in these critically ill patients.
Author Disclosures: S. Tepper: None. M. Baltazar Garcia: None. M. Pisani: None. G. Ewald: None. J. Singh: None. M. Masood: None. K. Balsara: None. A. Itoh: None.
- © 2016 by American Heart Association, Inc.