Use of Impella Devices for Acute Cardiogenic Shock in the Perioperative Period of Cardiac Surgery
ABSTRACT Introduction: The Impella ventricular support system is a device that can be inserted percutaneously or directly across the aortic valve to unload the left ventricle. The purpose of this study is to determine the role of Impella devices in patients with acute cardiogenic shock in the perio...
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Cirurgia Cardiovascular
2022-08-01
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| Series: | Brazilian Journal of Cardiovascular Surgery |
| Subjects: | |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382023000100071&tlng=en |
| _version_ | 1797871180396363776 |
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| author | Serge Sicouri Vishal N. Shah Meghan Buckley Nicholas Imperato Jacqueline McGee Elena Casanova Eric Gnall Konstadinos A. Plestis |
| author_facet | Serge Sicouri Vishal N. Shah Meghan Buckley Nicholas Imperato Jacqueline McGee Elena Casanova Eric Gnall Konstadinos A. Plestis |
| author_sort | Serge Sicouri |
| collection | DOAJ |
| description | ABSTRACT Introduction: The Impella ventricular support system is a device that can be inserted percutaneously or directly across the aortic valve to unload the left ventricle. The purpose of this study is to determine the role of Impella devices in patients with acute cardiogenic shock in the perioperative period of cardiac surgery. Methods: A retrospective single-surgeon review of 11 consecutive patients who underwent placement of Impella devices in the perioperative period of cardiac surgery was performed. Patient records were evaluated for demographics, indications for placement, and postoperative outcomes. Results: Impella devices were placed for refractory cardiogenic shock preoperatively in 6 patients, intraoperatively in 4 patients, and postoperatively as a rescue in 1 patient. Seven patients received Impella CP, 1 Impella RP, 1 Impella CP and RP, and 2 Impella 5.0. Additionally, 3 patients required preoperative venovenous extracorporeal membrane oxygenation (VV-ECMO), and 1 patient required intraoperative venoarterial extracorporeal membrane oxygenation (VA-ECMO). All Impella devices were removed 1 to 28 days after implantation. Length of stay in the intensive care unit stay ranged from 2 to 53 days (average 23.9±14.6). The 30-day and 1-year mortality were 0%. Ten of 11 patients were alive at 2 years. Also, 1 patient died 18 months after surgery from complications of coronavirus disease (Covid-19). Device-related complications included varying degrees> of hemolysis in 8 patients (73%) and device malfunction in 1 patient (9%). Conclusions: The Impella ventricular support system can be combined with other mechanical support devices for additional hemodynamic support. All patients demonstrated myocardial recovery with no deaths in the perioperative period and in 1-year of follow-up. Larger studies are necessary to validate these findings. |
| first_indexed | 2024-04-10T00:39:01Z |
| format | Article |
| id | doaj.art-e60cd9686d134d08bdece8d19946cd74 |
| institution | Directory Open Access Journal |
| issn | 1678-9741 |
| language | English |
| last_indexed | 2024-04-10T00:39:01Z |
| publishDate | 2022-08-01 |
| publisher | Sociedade Brasileira de Cirurgia Cardiovascular |
| record_format | Article |
| series | Brazilian Journal of Cardiovascular Surgery |
| spelling | doaj.art-e60cd9686d134d08bdece8d19946cd742023-03-14T07:34:35ZengSociedade Brasileira de Cirurgia CardiovascularBrazilian Journal of Cardiovascular Surgery1678-97412022-08-01381717810.21470/1678-9741-2021-0398Use of Impella Devices for Acute Cardiogenic Shock in the Perioperative Period of Cardiac SurgerySerge Sicourihttps://orcid.org/0000-0002-1822-768XVishal N. ShahMeghan BuckleyNicholas ImperatoJacqueline McGeeElena CasanovaEric GnallKonstadinos A. PlestisABSTRACT Introduction: The Impella ventricular support system is a device that can be inserted percutaneously or directly across the aortic valve to unload the left ventricle. The purpose of this study is to determine the role of Impella devices in patients with acute cardiogenic shock in the perioperative period of cardiac surgery. Methods: A retrospective single-surgeon review of 11 consecutive patients who underwent placement of Impella devices in the perioperative period of cardiac surgery was performed. Patient records were evaluated for demographics, indications for placement, and postoperative outcomes. Results: Impella devices were placed for refractory cardiogenic shock preoperatively in 6 patients, intraoperatively in 4 patients, and postoperatively as a rescue in 1 patient. Seven patients received Impella CP, 1 Impella RP, 1 Impella CP and RP, and 2 Impella 5.0. Additionally, 3 patients required preoperative venovenous extracorporeal membrane oxygenation (VV-ECMO), and 1 patient required intraoperative venoarterial extracorporeal membrane oxygenation (VA-ECMO). All Impella devices were removed 1 to 28 days after implantation. Length of stay in the intensive care unit stay ranged from 2 to 53 days (average 23.9±14.6). The 30-day and 1-year mortality were 0%. Ten of 11 patients were alive at 2 years. Also, 1 patient died 18 months after surgery from complications of coronavirus disease (Covid-19). Device-related complications included varying degrees> of hemolysis in 8 patients (73%) and device malfunction in 1 patient (9%). Conclusions: The Impella ventricular support system can be combined with other mechanical support devices for additional hemodynamic support. All patients demonstrated myocardial recovery with no deaths in the perioperative period and in 1-year of follow-up. Larger studies are necessary to validate these findings.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382023000100071&tlng=enExtracorporeal Membrane OxygenationShockCardiogenicHeart VentriclesAortic ValveHemodynamicsCardiac Surgical ProceduresPerioperative Period. |
| spellingShingle | Serge Sicouri Vishal N. Shah Meghan Buckley Nicholas Imperato Jacqueline McGee Elena Casanova Eric Gnall Konstadinos A. Plestis Use of Impella Devices for Acute Cardiogenic Shock in the Perioperative Period of Cardiac Surgery Brazilian Journal of Cardiovascular Surgery Extracorporeal Membrane Oxygenation Shock Cardiogenic Heart Ventricles Aortic Valve Hemodynamics Cardiac Surgical Procedures Perioperative Period. |
| title | Use of Impella Devices for Acute Cardiogenic Shock in the Perioperative Period of Cardiac Surgery |
| title_full | Use of Impella Devices for Acute Cardiogenic Shock in the Perioperative Period of Cardiac Surgery |
| title_fullStr | Use of Impella Devices for Acute Cardiogenic Shock in the Perioperative Period of Cardiac Surgery |
| title_full_unstemmed | Use of Impella Devices for Acute Cardiogenic Shock in the Perioperative Period of Cardiac Surgery |
| title_short | Use of Impella Devices for Acute Cardiogenic Shock in the Perioperative Period of Cardiac Surgery |
| title_sort | use of impella devices for acute cardiogenic shock in the perioperative period of cardiac surgery |
| topic | Extracorporeal Membrane Oxygenation Shock Cardiogenic Heart Ventricles Aortic Valve Hemodynamics Cardiac Surgical Procedures Perioperative Period. |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382023000100071&tlng=en |
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