Response to Letter Regarding Article, “Percutaneous Left-Ventricular Support With the Impella-2.5-Assist Device in Acute Cardiogenic Shock Results of the Impella-EUROSHOCK-Registry”

Abstract

CorrespondenceWe appreciate the comments by Dr Maini regarding our recent article on outcome of percutaneous left-ventricular support with the Impella-2.5 assist device in acute cardiogenic shock.1 In this article, we summarize the results of real-world Impella-2.5 use in Europe outside of randomized trials, where the device is frequently used as last resort option in patients unresponsive to vasopressors, revascularization, and intra-aortic balloon pump support.We agree with Dr Maini in emphasizing the fact that the disappointing data of the EUROSHOCK Registry likely reflects the selection of the most severely ill patients who have failed first-line treatment of cardiogenic shock. The lack of a control group in this registry hampers definite conclusions on efficacy of Impella-2.5 support at this point. However, decrease in plasma lactate after the beginning of Impella support suggests at least partial reversal of hypoperfusion and supports the hemodynamic efficacy of the device. As suggested in the article, earlier institution of support and rapid escalation to more powerful assist devices could be a recommended strategy in patients failing to improve, which, however, is currently rather based on experience than actual data. 1,2 DisclosuresDr Henriques has received an unrestricted research grant from Abiomed Europe GmbH, Aachen, Germany. The other authors report no conflict. Alexander Lauten, MD

Support with intra-aortic balloon pump vs. Impella2.5® and blood flow to the heart, brain and kidneys — An experimental porcine model of ischaemic heart failure

“…Acute kidney injury occurs in 30-50% of the patients, of these 10-25% requires dialysis [4,17,18]. Although improving blood flow to the kidneys, the use of mechanical support with the Impella® is known to cause haemolysis, which theoretically might impair renal function, but until now we do not have any clinical trials confirming or deferring this issue [19][20][21]. Furthermore in the present study, although non-significant, there was a trend towards a lower renal blood flow on combined support, indicating that the IABP in fact counteracted the effect from the Impella®.…”

Incidence of Hemolysis in Patients with Cardiogenic Shock Treated with Impella Percutaneous Left Ventricular Assist Device

“…The safety and efficacy of the Impella devices have been described elsewhere. [3][4][5] Although, bleeding is the most common complication, 6 increased rates of hemolysis have been noted with the prolonged use of the Impella. 7,8 The purpose of this study is to determine the incidence of hemolysis when Impella is used longer than 6 hours in patients with CS.…”

Use of Left Ventricular Support Devices During Acute Coronary Syndrome and Percutaneous Coronary Intervention

“…The Impella-Euro SHOCK registry [29] explored the clinical safety and outcomes of Impella 2.5 in patients with AMI complicated by refractory CS. One-hundred twenty patients from 14 European centres were included.…”