Multi-Institutional Clinical and Hemodynamic Effects of Impella 5.5 Therapy in Patients with Cardiogenic Shock
Presented During: Welcome Reception and Poster Competition | Sponsored by: TransMedics
Columbia University Irving Medical Center
LIVINGSTON, NJ
United States - Contact Me
Gabriel Dardik graduated from Harvard University in 2021 with bachelor’s and master’s degrees in Chemistry. He is currently a second-year medical student at the Vagelos College of Physicians and Surgeons at Columbia University. His research background includes wet lab work in the fields of organic chemistry and regenerative biology, as well as clinical outcomes research in cardiothoracic transplantation and mechanical circulatory support under the mentorship of Dr. Koji Takeda.
Friday, September 20, 2024: 5:00 PM - 6:30 PM
Omni King Edward Hotel
Description
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.
Authors
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)
Institutions
(1) Columbia University Irving Medical Center, New York, NY, (2) Hospital of the University of Pennsylvania, Philadelphia, PA
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.
Authors
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)
Institutions
(1) Columbia University Irving Medical Center, New York, NY, (2) Hospital of the University of Pennsylvania, Philadelphia, PA