Percutaneous Left Ventricular Unloading with the Impella Pump in Adolescents on Veno-Arterial Extracorporeal Membrane Oxygenation
Presented During: Welcome Reception and Poster Competition | Sponsored by: TransMedics
Bambino Gesù Children's Hospital
Rome, Rome
Italy - Contact Me
Gianluca Brancaccio, MD, PhD
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, Rome, Italy
Dr. Brancaccio is currently appointed as member staff in the Pediatric Cardiac Surgery Department at Bambino Gesù Children’s Hospital of Rome, qualified as Associate Professor, Adjunt Professor of Surgery at University “La Sapienza” of Rome.
His area of interests includes repair of congenital heart defects in neonates and children and adults, with particular interest of mitral and tricuspid valve anomalies repair, neonatal correction of heart diseases, heart transplantation and mechanical assist device.
He has published over 60 papers in international papers and he is authors of books in Pediatric Cardiac Surgery.
Friday, September 20, 2024: 5:00 PM - 6:30 PM
Omni King Edward Hotel
Description
Objectives
The combination of Impella devices (Abiomed, Inc., Danvers, MA) and ECMO support has been suggested to counteract the LV afterload seen with ECMO, prevent complications during VA ECMO, and facilitate weaning from VA-ECMO. While this technique has been successfully utilized in adults, efficacy data in patients under 18 are limited.
Methods
Eight pediatric patients, aged 13 to 18 years and weighing 40 to 59 kg, underwent VA-ECMO support with Impella 2.5 or 3.5 implantation at our institution between July 2016 and April 2024. All patients were hemodynamically unstable at the presentation time (INTERMACS 1). Our policy is to wean the patient off ECMO first while ensuring support in the early stages of ECMO removal (~ 2 days) with the Impella device still in place for those achieving myocardial recovery.
Results
Indications for implantation were heart failure secondary to myocarditis (4), rejection of prior orthotopic heart transplant (1), heart failure after transposition of the great arteries repair (1), metabolic cardiomyopathy (1), and arrhythmia-induced cardiomyopathy (1). VA-ECMO cannulation was performed first via neck vessels in six patients and groin vessels in two. Impella device was implanted in femoral vessels in seven patients and the carotid artery (through a chimney graft) in one. The median duration of Impella support was eight days (range, 2-20 days). The median duration of ECMO support was 11 days (4-14 days). One patient was bridged to transplant; one patient received a HeartMate3; five patients recovered myocardial function and were weaned off mechanical support; and one patient died on support. Impella removal was performed by compression of the arterial femoral access.
Conclusions
Given the high rate of ventricular recovery in pediatric acute heart failure, the ideal support strategy would be temporary and with a favorable risk profile. A short ECMO run in combination with LV unloading provided by the Impella device seems the treatment of choice. Impella percutaneous pump support should be considered in adolescents supported with peripheral VA-ECMO as a means of left heart decompression and a strategy to come off ECMO to achieve endpoints of myocardial recovery, transition to a durable ventricular assist device, or transplantation.
Authors
Matteo Trezzi (1), Gianluca Brancaccio (2), micol rebonato (3), Silvia Teresa Scalera (4), francesco lodoli (5), Gianluigi Perri (6), Sergio Filippelli (2), Rachele Adorisio (7), Lorenzo Galletti (8), Antonio Amodeo (9)
Institutions
(1) Bambino Gesù Children's Hospital, Rome, Rome, (2) Bambino Gesù Children's Hospital, Rome, NA, (3) Bambino Gesù Children's Hospital, roma, Italy, (4) Bambino Gesù Childrens' Hospital, Roma, NA, (5) Bambino Gesù Childrens' Hospital, ROMA, NA, (6) N/A, Rome, Italy, (7) Bambino Gesu' Childrens' Hospital, rome, NA, (8) Hospital Bambino Gesù, Roma, Italy, (9) Bambino Gesù Children's Hospital, Roma, Italy
The combination of Impella devices (Abiomed, Inc., Danvers, MA) and ECMO support has been suggested to counteract the LV afterload seen with ECMO, prevent complications during VA ECMO, and facilitate weaning from VA-ECMO. While this technique has been successfully utilized in adults, efficacy data in patients under 18 are limited.
Methods
Eight pediatric patients, aged 13 to 18 years and weighing 40 to 59 kg, underwent VA-ECMO support with Impella 2.5 or 3.5 implantation at our institution between July 2016 and April 2024. All patients were hemodynamically unstable at the presentation time (INTERMACS 1). Our policy is to wean the patient off ECMO first while ensuring support in the early stages of ECMO removal (~ 2 days) with the Impella device still in place for those achieving myocardial recovery.
Results
Indications for implantation were heart failure secondary to myocarditis (4), rejection of prior orthotopic heart transplant (1), heart failure after transposition of the great arteries repair (1), metabolic cardiomyopathy (1), and arrhythmia-induced cardiomyopathy (1). VA-ECMO cannulation was performed first via neck vessels in six patients and groin vessels in two. Impella device was implanted in femoral vessels in seven patients and the carotid artery (through a chimney graft) in one. The median duration of Impella support was eight days (range, 2-20 days). The median duration of ECMO support was 11 days (4-14 days). One patient was bridged to transplant; one patient received a HeartMate3; five patients recovered myocardial function and were weaned off mechanical support; and one patient died on support. Impella removal was performed by compression of the arterial femoral access.
Conclusions
Given the high rate of ventricular recovery in pediatric acute heart failure, the ideal support strategy would be temporary and with a favorable risk profile. A short ECMO run in combination with LV unloading provided by the Impella device seems the treatment of choice. Impella percutaneous pump support should be considered in adolescents supported with peripheral VA-ECMO as a means of left heart decompression and a strategy to come off ECMO to achieve endpoints of myocardial recovery, transition to a durable ventricular assist device, or transplantation.
Authors
Matteo Trezzi (1), Gianluca Brancaccio (2), micol rebonato (3), Silvia Teresa Scalera (4), francesco lodoli (5), Gianluigi Perri (6), Sergio Filippelli (2), Rachele Adorisio (7), Lorenzo Galletti (8), Antonio Amodeo (9)
Institutions
(1) Bambino Gesù Children's Hospital, Rome, Rome, (2) Bambino Gesù Children's Hospital, Rome, NA, (3) Bambino Gesù Children's Hospital, roma, Italy, (4) Bambino Gesù Childrens' Hospital, Roma, NA, (5) Bambino Gesù Childrens' Hospital, ROMA, NA, (6) N/A, Rome, Italy, (7) Bambino Gesu' Childrens' Hospital, rome, NA, (8) Hospital Bambino Gesù, Roma, Italy, (9) Bambino Gesù Children's Hospital, Roma, Italy