Microaxial devices for ventricular failure: a multicentre, population-based experience

Background

Impella microaxial devices provide circulatory assistance for patients with acute decompensated heart failure. This study reviews the population-based provincial experience in British Columbia.

Methods

We performed a retrospective review of the prospectively maintained database. Impella devices were inserted for acute cardiogenic shock refractory to maximal therapy, as a bridge to decision or to long-term mechanical support.

Results

Between August 2007 and September 2009, 35 patients received 37 Impella devices (Impella LP 2,5, n = 2; Impella LP 5,0, n = 29; and Impella RD 5.0, n = 6) (Abiomed Inc, Danvers, MA). Devices were inserted in the setting of dilated cardiomyopathy (n = 13), acute myocardial infarction (n = 6), postcardiotomy shock (n = 6), and other etiologies (n = 12). Mean age was 53.0 ± 13.7 years. Mean left ventricular ejection fraction was 19 ± 9% at the time of insertion. Nineteen patients required aggressive resuscitation, all patients were on inotropic support, 97% of patients were intubated, and 46% of patients received mechanical circulatory support prior to insertion of the Impella devices. Mean duration of support was 3.7 ± 3.0 days. In all, 49% were successfully weaned, and 22% were transferred to long-term mechanical support. Four patients have subsequently undergone successful cardiac transplantation. The 30-day mortality was 40%, and 6-month mortality was 49%. Complications included gastrointestinal bleeding (n = 1), hemoptysis (n = 1), and thrombocytopenia (n = 4). There were no cardiovascular or cerebrovascular events.

Conclusion

Temporary support with Impella microaxial ventricular assist devices adds a valuable therapeutic option in selected patients with acute decompensated heart failure.