Perioperative Temporary Mechanical Circulatory Support with Impella in Patients Undergoing Cardiac Surgery

Objectives: Experience with Impella in cardiac surgery patients is still limited. It has been associated with high complication rates. Hence, the benefits of Impella in this specific group of patients are uncertain. This study aims to review early outcomes of perioperative temporary Impella support in cardiac surgery patients presenting cardiogenic shock.

Methods: Retrospective, single-center, observational study involving 33 consecutive cardiac surgery adult patients presenting with cardiogenic shock (CS) in whom Impella was used for perioperative temporary mechanical circulatory support (MCS), whether as isolated therapy or as left ventricular (LV) venting strategy for concomitant extra corporeal membrane oxygenation (ECMO). Study outcomes were: 30-day mortality and complication composite outcome (occurrence of any of the following: bleeding requiring surgical reexploration, active bleeding at the Impella insertion site, limb ischemia, Impella thrombosis, stroke, arteriovenous fistula, arterial pseudoaneurysm, groin/axillary hematoma).

Result: A total of 33 patients [Impella alone 19 (57.6%) patients and Impella + ECMO 14 (42.4%) patients] were included in the analysis. Female gender: 8 (24.2%) patients, mean age: 62.4 (±14.5) years, mean LVEF: 27.5% (± 14.4%), peripheral artery disease: 4 (12.2%) patients, and emergent implantation: 22 (66.6%) patients. Mortality of Impella-alone group versus Impella + ECMO group was 15.8 versus 50% (p = 0.03), respectively. Mortality rates according to pre-, intra-, and postoperative Impella implantation were 12.5, 60.0, and 28.6% (p = 0.04), respectively. Complication composite outcome occurred in 6 (75%) patients with axillary Impella and in 9 (36%) patients with femoral Impella (p = 0.05). This is explained through high stroke rates in patients with axillary Impella [stroke: axillary Impella: 3 (37.5%) patients vs. femoral Impella: 1 (4.0%) patient (p = 0.03)]. Mortality according to operation was: LVAD 0.0%, CABG 45.4%, and valve surgery 60.0% (p < 0.01). Age >65 years was found to be a predictor of early mortality (OR: 1.1, 95% CI: 1.0–1.2, p = 0.03). No predictors of complication composite outcome could be identified.

Conclusion: Intra- and postoperative implantation of Impella, both as LV venting and as single-device temporary MCS, is associated with high complication and mortality rates. Preoperative use of Impella as single-device temporary MCS is a reasonable alternative as bridge-to-bridge strategy (e.g., bridge-to-LVAD) for acutely decompensated patients with decreased LV function presenting with CS.

Publication History

Article published online:
19 February 2021