Use of the Impella 5.0 Micro-Axial Flow Device in Refractory Cardiogenic Shock - A Single Center Experience

Abstract

Introduction Patients with refractory cardiogenic shock have a mortality in excess of 80%. The use of percutaneous mechanical circulatory support devices to bridge patients with refractory cardiogenic shock to definitive therapy has steadily increased, although the benefit remains poorly defined. This study describes the Baylor St Luke s Medical Center - Texas Heart Institute institutional experience using the Impella 5.0 micro-axial flow device to treat patients with refractory cardiogenic shock. Methods A retrospective study of all consecutive Impella 5.0 devices implanted at our institution between 8/2013 - 12/2018. Results Sixty-eight patients with refractory cardiogenic shock received an Impella 5.0 as a bridge to decision or definitive therapy. The cohort mean age was 60.2±12.7 years, 85.3% were male, 51.5% were Caucasian and 50.0% had coronary artery disease. The etiology of cardiogenic shock was primarily acute on chronic decompensated systolic heart failure (89.7%). After a median of 10 days on support (range 1-83 days), thirty-five patients (51.5%) had significant improvement while on Impella 5.0 support and were successfully bridged; twenty-six patients received a durable left ventricular assist device, one received a heart transplantation and eight recovered. Thirty-three patients (48.5%) had failed to recover end-organ function and either expired or care was withdrawn. Conclusions In our single center experience, Impella 5.0 implantation allowed discrimination of a patient sub-population suitable for definitive long-term therapy and was associated with better than expected survival to hospital discharge in patients with refractory cardiogenic shock.