ABSTRACT
Introduction: The Impella ventricular support system is a
device that can be inserted percutaneously or directly across the
aortic valve to unload the
left ventricle . The purpose of this study is to determine the
role of Impella
devices in
patients with acute
cardiogenic shock in the
perioperative period of
cardiac surgery .
Methods: A retrospective single-surgeon
review of 11 consecutive
patients who underwent placement of Impella
devices in the
perioperative period of
cardiac surgery was performed.
Patient records were evaluated for demographics, indications for placement, and postoperative outcomes.
Results: Impella
devices were placed for refractory
cardiogenic shock preoperatively in 6
patients , intraoperatively in 4
patients , and postoperatively as a rescue in 1
patient . Seven
patients received Impella CP, 1 Impella RP, 1 Impella CP and RP, and 2 Impella 5.0. Additionally, 3
patients required preoperative
venovenous extracorporeal membrane oxygenation (VV-ECMO), and 1
patient required intraoperative
venoarterial extracorporeal membrane oxygenation (VA-ECMO). All Impella
devices were removed 1 to 28 days after implantation.
Length of stay in the
intensive care unit stay ranged from 2 to 53 days (average 23.9±14.6). The 30-day and 1-year
mortality were 0%. Ten of 11
patients were alive at 2 years. Also, 1
patient died 18 months after
surgery from
complications of
coronavirus disease (Covid-19).
Device -related
complications included varying degrees> of
hemolysis in 8
patients (73%) and
device malfunction in 1
patient (9%).
Conclusions: The Impella ventricular support system can be combined with other mechanical support
devices for additional
hemodynamic support. All
patients demonstrated myocardial recovery with no deaths in the
perioperative period and in 1-year of follow-up. Larger studies are necessary to validate these findings.