Impella Mechanical Circulatory Support for Takotsubo Syndrome With Shock: A Retrospective Multicenter Analysis |
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| Institution: | 1. Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany;2. Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany;3. Department of Cardiology, Odense University Hospital, Odense, Denmark;4. Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele University, Milan, Italy;5. Department of CardioThoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy;6. Technische Universität Dresden, Campus Chemnitz, Klinikum Chemnitz gGmbH, Chemnitz, Germany;7. Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France;8. Farmington, NM, United States;9. Banner University Medicine Cardiology Clinic, Phoenix, AZ, United States;10. Wellstar, GA, United States;11. Ascension, Warren, MI, United States;12. University Cardiology Associates, Augusta, GA, United States;13. Division of Cardiology, Abiomed Inc., Danvers, MA, United States;14. Department of Cardiovascular Medicine, Northside Cardiovascular Institute, Atlanta, GA, United States;15. Cardiovascular Research Foundation, New York, NY, United States;p. Columbia University Medical Center, New York, NY, United States;q. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States;r. Henry Ford Medical Center, Department of Interventional Cardiology and Structural Heart, Detroit, MI, United States;s. The Cardiovascular Center, Tufts Medical Center, Boston, MA, United States;t. St Francis Heart Center, Roslyn, New York, NY, United States;1. Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California Los Angeles, Los Angeles, California;2. Advanced Heart Failure and Transplantation Center, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio;3. University of Texas Health Science Center at Houston, Department of Medicine, Division of Cardiology, Houston, TX.;4. Center for Advanced Heart Failure, Memorial Hermann Hospital, Houston, Texas;1. Section of Interventional Cardiology, St. Francis Medical Center, Monroe, LA, United States of America;2. Section of Cardiothoracic Surgery, St. Francis Medical Center, Monroe, LA, United States of America;1. Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA;2. Center for Research in Indigenous Health, Wuqu'' Kawoq|Maya Health Alliance, 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango, Guatemala;3. Division of Cardiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA |
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| Abstract: | ObjectivesTo analyze the characteristics and outcome of Impella mechanical circulatory support (MCS) for Takotsubo syndrome (TS) with cardiogenic shock.BackgroundTS is an acute heart failure syndrome characterized by transient severe reduction of left ventricular (LV) systolic function, with cardiogenic shock occurring in around 10% of patients. Since inotropes should be avoided due to their role in TS pathogenesis and aggravation of LV outflow tract obstruction, the use of MCS as treatment is a viable treatment option, however, studies are lacking.MethodsThe catheter-based ventricular assist device (cVAD) registry and local MCS databases were screened for TS patients with cardiogenic shock (TS-CS) supported with an Impella percutaneous ventricular assist device (pVAD). Patient and treatment characteristics and in-hospital outcomes were retrospectively analyzed.ResultsAt 10 US and European centers, 16 TS-CS patients supported with an Impella pVAD were identified between December 2013 and May 2018 (mean age, 61.8 ± 15.5 years; 87.5% women). LV ejection fraction (LVEF) at presentation was severely reduced (mean, 19.4 ± 8.3%). Prior to MCS, 13 patients (81.3%) were mechanically ventilated, 4 patients (25.0%) had been resuscitated, and mean serum lactate was 4.7 ± 3.5 mmol/L. Mean duration of Impella support was 1.9 ± 1.0 days (range, 1–4 days). Thirteen patients (81.3%) survived to discharge, and all survivors experienced cardiac recovery with significant improvement of LVEF at discharge compared to baseline (20.4 ± 8.8 vs. 52.9 ± 12.0, P < 0.001).ConclusionsThis is the first series of TS-CS patients supported with an Impella pVAD. Mortality was low, and LV systolic function recovered in all survivors. Prospective studies of Impella support in this special condition are warranted. |
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