Impella support as a bridge to heart surgery in patients with cardiogenic shock

Abstract

OBJECTIVES In patients with cardiogenic shock, delayed surgery after stabilization of haemodynamics and improvement in end-organ function by mechanical circulatory support is known to yield better outcomes than emergency surgery. We aimed to investigate the effectiveness of Impella (Abiomed, Danvers, MA, USA) as a bridge to cardiac surgery in patients with cardiogenic shock. METHODS We reviewed 7 patients with cardiogenic shock who underwent Impella support as a bridge to cardiac surgery using cardiopulmonary bypass at our institution between April 2018 and August 2021. RESULTS Cardiogenic shock was caused by ventricular septal rupture in 3 patients, papillary muscle rupture in 1 and acute myocardial infarction in 3. Cardiac surgery was delayed by 1–7 (3.9 ± 2.5) days with Impella support after the diagnosis of cardiogenic shock, during which the hepatic and renal function of the patients improved significantly. Device-related or operation-related adverse events included re-exploration for bleeding in 3 patients, acute limb ischaemia due to thromboembolism in 1 and intraoperative aortic dissection in 1. Thirty-day mortality was 14.3%, and the cumulative survival was 71.4% at 1 year. The survival tended to be better than that in historical control group in which extracorporeal membrane oxygenation was used as a bridge to surgery (P = 0.0992). CONCLUSIONS Impella is an effective tool for bridging patients with cardiogenic shock to surgery. This strategy may improve surgical outcomes in patients with cardiogenic shock. However, prolonged Impella support may increase significant adverse events, and further investigation is required to determine the optimal duration of support before surgery.

Single center experience and early outcomes of Impella 5.5

“…To date, studies for Impella protected cardiac surgery have been limited to small case series, with the majority reporting no to minimal mortality or morbidity (27)(28)(29). Collectively, these studies concluded that prophylactic use of the Impella 5.5 is safe and effective in patients with severe LV dysfunction.…”

Impella Implantation as a Bridge to Surgery for Repair of Aorto-Right Ventricular Fistula Following Prosthetic Valve Endocarditis: A Case Report

“…Thus, axial-flow in "tunnel channel" ensures increased blood flow without a strain to the aortic valve annulus. In patients with fragile annuli, such as The optimal duration of mechanical circulatory support before surgery in patients with cardiogenic shock remains under debate [1]. Prolonged Impella support may increase device-related adverse events and complicate perioperative management.…”

“…Several studies have reported the application of Impella (Aboimed, Danvers, MA, USA) as a bridge to cardiac surgery in patients with cardiogenic shock [1][2][3]. In such patients, delayed surgery after hemodynamic stabilization by mechanical circulatory support is known to yield better outcomes than emergency surgery.…”

Temporary mechanical circulatory support & enhancing recovery after cardiac surgery

“…The spectrum of tMCS use in adult cardiac surgery commonly includes bridge to surgery, proactive support for patients with high risk of postcardiotomy cardiogenic shock (PCCS), which ranges from 2% to 14% of procedures and the associated 12–25 times increased mortality [29,30 ▪ ,31,32], and reactive assistance for failure to separate from cardiopulmonary bypass (CPB) [33] or rescuing patients suffering from PCCS [34 ▪▪ ,35].…”