Objective: To assess the outcomes of the use of the percutaneous Impella RP device (Abiomed, Danvers, MA) in adolescents and young adults.
Background: Results of the Impella RP device have been reported in adults, but a multicenter experience in adolescents and young adults has yet to be reported.
Methods: Patients ≤21 years of age who underwent implantation of an Impella RP device for refractory right heart failure from June, 2016 to April, 2018 at nine U.S. Centers were included.
Results: A total of 12 adolescents, median age of 18 (14-21) years and median weight 74.4 (49-112.4) kg underwent Impella RP implantation (INTERMACS Profile 1 in nine and Profile 2 in three patients. The central venous pressure decreased from 20 (16-35) to 12 (7-17) mmHg, (p = .001). One patient was concomitantly supported with an intra-aortic balloon pump (IABP) and the rest with a percutaneous/surgically placed left ventricular assist device. There was one adverse event related to the Impella RP device (thrombosis requiring explant). The support duration was 6.5 days (4.8 hr-18.4 days) and survival to hospital discharge was 83%. At a median follow-up of 11 months (5 days-2.5 years), 8 of 12 (67%) patients are alive.
Conclusions: In this multicenter experience, the Impella RP device was found to be efficacious and safe when used in adolescents and young adults. Further studies are warranted to identify suitable young/pediatric candidates for Impella RP therapy for right heart failure.
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http://dx.doi.org/10.1002/ccd.28830 | DOI Listing |
J Cardiothorac Vasc Anesth
December 2024
Department of Cardiovascular Surgery, Mayo Clinic, Scottsdale, AZ.
Objective: Right ventricular failure is a leading cause of mortality among patients with various etiologies of cardiogenic shock. This case series outlines an innovative approach to directly unloading the right ventricle with the Impella LD or 5.5 without crossing the tricuspid valve in cases requiring tricuspid valve repair or replacement.
View Article and Find Full Text PDFIntroduction: Impella CP is a percutaneous left ventricle assist device used in selected patients undergoing high-risk percutaneous coronary interventions (HR-PCI). To improve outcomes after Impella-supported HR-PCI, institutional Impella programs have been developed.
Objectives: We evaluated the association between the standardized periprocedural management algorithm and outcomes of patients undergoing HR-PCI in the national IMPELLA-PL Registry.
J Cardiothorac Vasc Anesth
December 2024
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA.
Cardiogenic shock (CS) in acute myocardial infarction (AMI) is a life-threatening syndrome characterized by systemic hypoperfusion that can quickly progress to multiorgan failure and death. Various devices and configurations of mechanical circulatory support (MCS) exist to support patients, each with unique pathophysiological characteristics. The Intra-aortic balloon pump can improve coronary perfusion, decrease afterload, and indirectly augment cardiac output.
View Article and Find Full Text PDFJ Cardiothorac Surg
December 2024
Department of Cardiovascular Surgery, Kanazawa University, Takaramachi 13-1, Kanazawa, 920-8641, Japan.
Background: Acute type A aortic dissection (A-AAD) with severe acute aortic regurgitation (AR) and coronary involvement is a potentially fatal condition that causes left ventricular volume overload and catastrophic acute myocardial infarction. We present the successful management of a patient using Impella 5.5 following cardiopulmonary arrest caused by A-AAD with severe acute AR and left main trunk (LMT) obstruction.
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