Durability of the Impella 5.0 Micro-Axial Flow Device as a Bridge to Long Term Therapy in Patients with Refractory Cardiogenic Shock

Abstract

Introduction The Impella 5.0 micro-axial flow device has been increasingly used in refractory cardiogenic shock as a bridge to; long-term therapy or recovery. However, the durability of the device in this population has not been studied. Methods A retrospective study of all consecutive Impella 5.0 devices implanted at Baylor St Luke s Medical Center between 8/2013 - 12/2018. Results Sixty-eight patients received an Impella 5.0 for refractory cardiogenic shock at our institution. The cohort was divided, based on duration of support, into group 1 (≤ 1 week of support), group 2 (> 1 and ≤ 2 weeks of support), group 3 (> 2 and ≤ 3 weeks of support), and group 4 (> 3 weeks of support, up to 83 days). Group 1 (25 patients) had a 40% survival rate, of which 3 patients recovered and 7 patients were bridged to durable LVAD or transplant. Group 2 (17 patients) had 41% survival rate, of which 7 patients were bridged to durable LVAD or transplant. Group 3 (14 patients) had 64% survival rate, of which 2 patients recovered and 7 patients were bridged to durable LVAD or transplant. Group 4 (12 patients) had 58% survival rate, of which 1 patient recovered and 6 patients were bridged to durable LVAD/transplant. The survival difference was not statistically significant with a 2 tailed p-value of 0.39. Conclusion In our single-center experience, the Impella 5.0 device provided durable temporary mechanical circulatory support and was a reliable bridge to decision in patients with refractory cardiogenic shock.