Multi-Institutional Clinical and Hemodynamic Effects of Impella 5.5 Therapy in Patients with Cardiogenic Shock

10118 

Abstract Submission 

Gabriel Dardik (1), John DePaolo (2), Marisa Cevasco (2), Yuji Kaku (1), Christine Yang (1), Mauer Biscotti (2), Joyce Wald (2), Nir Uriel (1), Gabriel Sayer (1), Koji Takeda (1), Justin Fried (1)

(1) Columbia University Irving Medical Center, New York, NY, (2) Hospital of the University of Pennsylvania, Philadelphia, PA

Gabriel Dardik    -  Contact Me
Columbia University Irving Medical Center

John DePaolo    -  Contact Me
Hospital of the University of Pennsylvania

*Marisa Cevasco    -  Contact Me
Hospital of the University of Pennsylvania

Yuji Kaku    -  Contact Me
Columbia University Irving Medical Center

Christine Yang    -  Contact Me
Columbia University Irving Medical Center

Mauer Biscotti    -  Contact Me
Hospital of the University of Pennsylvania

Joyce Wald    -  Contact Me
Hospital of the University of Pennsylvania

Nir Uriel    -  Contact Me
Columbia University Irving Medical Center

Gabriel Sayer    -  Contact Me
Columbia University Irving Medical Center

*Koji Takeda    -  Contact Me
Columbia University Irving Medical Center

Justin Fried    -  Contact Me
Columbia University Irving Medical Center

Gabriel Dardik    -  Contact Me
Columbia University Irving Medical Center

Objective: The Impella 5.5 is a novel temporary mechanical circulatory support device used in the treatment of cardiogenic shock as a bridge to recovery or heart replacement therapy. We sought to assess the hemodynamic and clinical response to Impella 5.5 in patients with cardiogenic shock and identify predictors of response to this device.

Methods: We retrospectively reviewed 265 patients undergoing Impella 5.5 implantation from 2020-2024 at two institutions to identify patients in cardiogenic shock. Patients with preoperative extracorporeal life support (ECLS) were excluded. Clinical deterioration on Impella 5.5 was defined as failure to bridge to either recovery with discharge on medical therapy or to heart replacement therapy (HRT; durable left ventricular assist device or heart transplant) with Impella 5.5 alone.

Results: We identified 177 patients who met the criteria. Fifty patients (28%) deteriorated while on support and needed escalation to ECLS and/or died in-hospital, while 127 (72%) were successfully bridged to HRT or discharged without need for escalation of device support. Creatinine (1.54 vs. 1.27, p=0.041), lactate (1.4 vs. 1.0, p=0.001), white blood cell count (9.13 vs. 7.60, p=0.016), central venous pressure (CVP) (11 vs. 9, p= 0.029), and tricuspid regurgitation (TR) severity (moderate vs. mild, p=0.016) prior to implantation were all significantly higher in those that deteriorated, while pulmonary artery pulsatility index (PAPi) was lower (2.08 vs. 2.94, p=0.033). Rates of stroke (14% vs. 3% p= 0.019), AKI requiring CRRT (30% vs. 6%, p<0.001) and tracheostomy (14% vs. 3% p=0.019) were significantly higher in those who deteriorated. After adjusting for age, sex and CVP, TR was identified as a predictor of clinical deterioration on Impella 5.5 (OR 1.72, 95% CI 1.07-2.86, p=0.03). Similarly, PAPi <2.5 was significantly associated with clinical deterioration after adjusting for age and sex (OR 2.99, 95% CI 1.38 - 6.72; p= 0.006).

Conclusions: Overall outcomes with Impella 5.5 in cardiogenic shock patients are encouraging, and Impella 5.5 is a reasonable first-line device for stabilizing these patients. Baseline right ventricular function as measured by PAPi and TR severity were identified as predictors of worse outcomes with Impella 5.5 in this population.

ECMO/Mechanical Support