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• W4283008545 abstract "Background: The Impella 5.0 and 5.5 devices (Abiomed, Danvers, MA) offer an important treatment option for cardiogenic shock (CS) since they deliver complete left ventricular support. Their use has expanded recently to include support during high-risk procedures. However, the lack of large studies makes it difficult to determine who most benefits from them. The purpose of our study is to assess the outcomes associated with Impella 5.0 and 5.5 use, and the variables associated with mortality. Methods: This is a single center, retrospective study evaluating patients receiving Impella 5.0 or 5.5 devices from 2014 to 2021. Patients were categorized into 1 of 5 intention-to-treat cohorts: bridge to transplant (BTT), bridge to durable device (BTD), bridge to recovery (BTR), CABG support, and PCI support. The Vasoactive-Inotropic Score (VIS) was used to quantify pre-implant support. Multivariable models were used to evaluate the predictors associated with mortality and to determine an optimal VIS cutoff. Results: A total of 232 devices were implanted (156 Impella 5.0 vs 76 Impella 5.5). The study population had a mean age of 56.3 ± 13.3 years, was majority male (86%), had a mean EF of 17.6 ± 10.4%, and was majority INTERMACS 1 (51%) or 2 (22%). Of the 5 cohorts the majority were BTT (49%), BTR (29%) and BTD (14%). A total of 163 (70%) survived to discharge. Of the BTT group 77% were transplanted, 3% received a LVAD, 3% were exchanged, and 17% expired. Of the BTD cohort, 52% received a LVAD, 1% were transplanted, 15% recovered, and 32% expired. Of the BTR cohort, 42% recovered, 3% were transplanted, and 55% expired. The majority (94%) of CABG and PCI support patients survived to discharge. Adverse event rates included INTERMACS major hemolysis 21%, INTERMACS RV failure 6%, stroke 5%, Impella motor failure 6%, and vascular injury 3%. Variables associated with mortality included INTERMACS 1 status (OR 2.76-14.17; p<.001), a BTR designation (OR 1.72-8.09; p.001), and a VIS ≥ 13.5 (OR 1.32-6.24; p.008). Patients with a VIS ≥ 13.5 had a significantly lower survival compared to those with a lower score (41% vs 79%). Conclusion: This study offers insight into the safety and efficacy of Impella 5.0 and 5.5 devices. Of those being treated for CS, the BTT cohort had the best survival with BTR having the worst. A majority of BTT patients survived to both transplant and to discharge, thus supporting the use of these devices as an effective bridge to transplantation. The higher mortality in the BTR group is likely due to the fact that this cohort was comprised of patients too ill to qualify for advanced therapies. This is supported by the fact that the BTR group had the highest mean VIS of all groups along with a high percentage of INTERMACS 1 patients. Interestingly, both an INTERMACS 1 classification and a VIS ≥ 13.5 were associated with mortality. These may be important prognostic indicators that can be used in the future to determine who will benefit most from these devices." @default.
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• W4283008545 date "2022-06-01" @default.
• W4283008545 modified "2023-09-27" @default.
• W4283008545 title "CARC1: Outcomes and Complications of the Impella 5.0 and 5.5: A Single Center Experience" @default.
• W4283008545 doi "https://doi.org/10.1097/01.mat.0000840868.78999.d2" @default.
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