Percutaneous biventricular Impella support in therapy-refractory cardiogenic shock

Chiu, Cheng-Ying; Hättasch, Robert; Praeger, Damaris; Knebel, Fabian; Stangl, Karl; Ramirez, Ivan Diaz; Dreger, Henryk

doi:10.1016/j.hrtlng.2018.03.009

Cited by 16 publications

(9 citation statements)

References 6 publications

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“…Impella RP became more widely used in the adult population following the RECOVER RIGHT study, which showed the safety and efficacy of the device for acute RV failure . Bilateral Impella use has been described in few case reports and one larger series in adults after acute myocardial infarction, acute cardiac failure, or myocarditis, which showed a 50% mortality rate and improved outcomes in patients that were younger, on fewer inotropes, and who had simultaneous deployment of left and right Impellas . When compared to ECMO, bilateral Impella devices allow for biventricular support while avoiding the known negative side effects of ECMO, namely increased LV afterload leading to insufficient myocardial rest, and bleeding and stroke due to increased anticoagulation needs.…”

Section: Discussionmentioning

confidence: 99%

“…Impella RP, a device designed for right ventricular (RV) support, is FDA approved for pediatric patients with a body surface area (BSA) ≥1.5 m 2 with RV failure after left VAD implantation, heart transplant, or open heart surgery. Few adult studies and case reports have described the use of bilateral Impella devices, or BiPella, in the management of patients with severe biventricular dysfunction . These reports largely represent patients after acute myocardial infarction, sudden decompensated heart failure, or myocarditis: populations that can be very different from the pediatric population .…”

Section: Introductionmentioning

confidence: 99%

“…Few adult studies and case reports have described the use of bilateral Impella devices, or BiPella, in the management of patients with severe biventricular dysfunction. [1][2][3] These reports largely represent patients after acute myocardial infarction, sudden decompensated heart failure, or myocarditis: populations that can be very different from the pediatric population. 4 The use of BiPella has only been reported once in the pediatric population as a two patient case series and clearly warrants more investigation.…”

Section: Introductionmentioning

confidence: 99%

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Biventricular Impella use in pediatric patients with severe graft dysfunction from acute rejection after heart transplantation

et al. 2019

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Rejection with severe hemodynamic compromise is a significant source of morbidity and mortality for pediatric heart transplant patients. Traditionally, treatment for these patients includes inotropes and escalation to extracorporeal membrane oxygenation (ECMO) when necessary. There is increasing interest in using percutaneous ventricular assistive devices in the pediatric population as a less invasive alternative to ECMO. We report the largest case series to date of biventricular support using percutaneous Impella devices. Retrospective case series was performed by chart review. Hemodynamics, left ventricular ejection fraction (LVEF), and indices of end organ function were collected before and after Impella placement. A 14‐year‐old male, 18‐year‐old male, and 19‐year‐old female, all status post heart transplant, presented with severely decreased biventricular function due to presumed clinical rejection, requiring maximal inotropic support without improvement. In all the three cases, simultaneous Impella CP and RP devices were placed percutaneously. Prior to implantation, LVEFs were 40%, 23%, and 25%, respectively. Hemodynamics measured invasively prior to device placement showed elevated filling pressures. Adverse events while on support included bleeding, hemolysis, and right femoral arterial dissection during implantation. All patients were successfully weaned from the devices and survived to discharge. The average time of right‐sided support and total support was 11 days and 13 days, respectively. After device removal, right‐sided pressures and echocardiographic measurements showed improvement in all patients. Bilateral Impella configuration (BiPella) is a viable option for temporary mechanical circulatory support in pediatric patients with significant graft dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Biventricular Impella use in pediatric patients with severe graft dysfunction from acute rejection after heart transplantation

et al. 2019

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“…1 Treating patients with cardiogenic shock secondary to biventricular heart failure is challenging because of limited options for mechanical circulatory support that can serve as a bridge to cardiac transplantation. [3][4][5][6][7] Case report A 67-year-old female presented with chest discomfort and was diagnosed with complete heart block. 2 The treatment of choice remains OHT, but a significant number do not survive to transplantation.…”

Section: Introductionmentioning

confidence: 99%

“…The use of biventricular Impella devices in cardiogenic shock as a bridge to recovery and LV assist device has been previously reported. [3][4][5][6][7]…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive biventricular mechanical circulatory support with Impella pumps as a bridge to heart transplantation: a first‐in‐the‐world case report

Varian

Lin

et al. 2019

ESC Heart Failure

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Cardiogenic shock from biventricular failure that requires acute mechanical circulatory support carries high 30 day mortality. Acute mechanical circulatory support can serve as bridge to orthotopic heart transplant (OHT) in selected patients. We report a patient with biventricular failure secondary to rapidly progressive cardiac sarcoidosis refractory to medical management who was bridged to OHT with Impella 5.0 and Impella RP—temporary left and right ventricular assist devices, respectively. This is the first successful bridge to transplantation using these devices in biventricular heart failure and cardiogenic shock. We discuss considerations for using this strategy over veno‐arterial extracorporeal membrane oxygenation or surgically implanted assist devices in patients with cardiogenic shock and biventricular failure as a bridge to OHT.

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Pediatric Mechanical Circulatory Support

Thangappan,

Ashfaq,

Villa

et al. 2023

Textbook of Transplantation and Mechanical Support for End‐Stage Heart and Lung Disease

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Percutaneous biventricular Impella support in therapy-refractory cardiogenic shock

Cited by 16 publications

References 6 publications

Biventricular Impella use in pediatric patients with severe graft dysfunction from acute rejection after heart transplantation

Biventricular Impella use in pediatric patients with severe graft dysfunction from acute rejection after heart transplantation

Minimally invasive biventricular mechanical circulatory support with Impella pumps as a bridge to heart transplantation: a first‐in‐the‐world case report

Pediatric Mechanical Circulatory Support

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