Percutaneous Left Ventricular Assist Device in Cardiogenic Shock: A Five-Year Single Canadian Center Initial Experience

Abstract

Background Mechanical circulatory support in cardiogenic shock (CS) with percutaneous left ventricular assist devices (PVADs) has expanded rapidly, but there is a paucity of Canadian data. Conflicting observational reports have emerged regarding the benefit of PVADs in CS. We describe a 5-year experience with Impella CP for CS at a single Canadian tertiary care centre. Methods Consecutive adult patients with CS supported with Impella CP were included. Comprehensive clinical data and outcomes were retrospectively assessed. We evaluated patient characteristics, patterns of care, in-hospital outcomes, 6-month survival, and predictors of survival. Results Thirty-four patients were supported with Impella CP for CS over 5 years. A majority had acute myocardial infarction (94%) with advanced CS (68% Society for Cardiovascular Angiography and Intervention [SCAI] stage D or E). Survival to discharge was 58%. In patients who survived to discharge, 6-month survival was 100% with excellent functional status. SCAI CS stage and initial serum lactate showed significant associations with survival. There was also a trend towards improved survival with shorter door-to-PVAD time. Clinically significant bleeding was common (26%), and 3 patients had device-related vascular complications. Conclusion Impella CP may have a role in carefully selected patients with CS. The SCAI shock classification and serum lactate may facilitate patient selection, and minimizing door-to-support time as well as bleeding complications are important considerations. Further clinical investigations, particularly in a Canadian setting, will be necessary to establish the role of this new technology in CS.

Microaxial Left Ventricular Assist Device in Cardiogenic Shock: A Systematic Review and Meta-Analysis

“…From 4173 articles, we reviewed 206 full-text articles. In total, we included 71 studies (63 observational, 8 PSM/RCTs) detailing 4280 adult patients that reported on the use of microaxial LVADs in CS ( Figure 1 ) [ 16 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 …”

Clinical presentation, shock severity and mortality in patients with de novo versus acute‐on‐chronic heart failure‐related cardiogenic shock

“…Some studies indicate that patients in SCAI stage C or D tend to experience the greatest advantages with an earlier use of a percutaneous LVAD (pLVAD). 33 Others studies suggest to wait until there is evidence of deterioration to avoid subjecting patients prematurely to the potential complications associated with MCS. 34 Hence, optimal timing of MCS remains elusive, which may explain the similar usage rates of MCS across SCAI shock stages C, D, and E in this study (which importantly enrolled patients treated before publication of the ECLS-SHOCK results).…”

Intervention in Cardiogenic Shock

“…While studies have shown the benefits of MCS in such patients, the optimum timing of intervention remains controversial, with recent studies indicating that early initiation of MCS is warranted and delays lead to higher chances of mortality. [6,7] e commonly used MCS in cardiogenic shock (summarized in Table 1) include-IABP IABP was the first MCS device designed and used, and it is also the most used device. It is deployed using common femoral artery access, and placed in the descending aorta, 2 cm below the left subclavian artery.…”