Professor, Moscow Sechenov Medical University, Russia
*Corresponding Author: Alexey Koroteev, Professor, Moscow Sechenov Medical University, Russia.
Received: June 06, 2023; Published: July 05, 2023
Objective: The aim of this study was to assess the efficiency of Impella® 5.0 microaxial catheter-mounted heart pump implementation in prevention of postcardiotomy cardiogenic shock in patients, operated for dilated cardiomyopathy, heart failure, NYHA class III-IV. The AKOR® extracardiac mesh implantation and mitral valve replacement were performed to all of them.
Background: Postcardiotomy cardiogenic shock (PCCS) is associated with high mortality rates of 50-80%. The results of mechanical circulatory support (MCS) in PCCS depend on proper choice of the MCS device and optimal timing of its initiation. The effectiveness of preventive use of Impella® 5.0 microaxial heart pumps after the AKOR® extracardiac mesh implantation and mitral valve replacement in patients with dilated cardiomyopathy, NYHA III-IV was tested.
Patients and Methods: The Impella® 5.0 (Abiomed, Inc.; Danvers, Mass) is a percutaneous ventricle assist device that is positioned across the aortic valve with inflow in the left ventricle (LV) and outflow in the ascending aorta. This configuration augments forward flow and directly decompresses the LV. MCS with the Impella® 5.0 microaxial heart pumps was used preventively in 9 patients (mean age was 61 ± 6 years, all males). Preoperatively all of them were evaluated as high risk of PCCS development. They had idiopathic dilated cardiomyopathy (DCM), mitral valve regurgitation: grade 3,0 ± 0,6, mean NYHA class of 3,0 ± 0,7. Mean LV ejection fraction (EF) was 31,6 ± 6,1%. LV end diastolic volume (LV EDV) was 234 ± 52 ml. Mean pulmonary artery wedge pressure was 27 ± 8 mmHg. Preoperatively cardiac index was a mean of 2,2 ± 0.1 l/min. Mitral valve replacement and the AKOR® extracardiac mesh implantation were performed in all cases. The AKOR® extracardiac mesh was implanted to prevent further dilation of heart chambers. The Impella® 5,0 catheter was inserted and initiated intraoperatively, in post bypass period, to prevent PCCS development.
Results: Cardiac index increased from 2,2 ± 0,1 l/min to 2,5 ± 0.2 l/min/m² (p = 0.003). Mean pulmonary wedge pressure decreased from 27 ± 8 mmHg to 17 ± 4 mmHg (p = 0.003). LV EF increased to 39,2 ± 5,2%. The mean duration of Impella® 5.0 support was 3 ± 1days. There was one case of device-related complications: hemolysis indicated by increase in plasma free hemoglobin developed at the 2d postoperative day in one patient; it was caused by suctioning of the pump and was corrected by its repositioning. No patient suffered from PCCS. All patients survived.
Conclusions: The preventive application of Impella 5.0 is a suitable treatment modality to avoid postcardiotomy cardiogenic shock in patients with compromised myocardium.
Keywords: Postcardiotomy Cardiogenic Shock; Dilated Cardiomyopathy; AKOR® Extracardiac Mesh; Impella®; Timing of Initiation
Citation: Alexey Koroteev. “Impella® 5.0 Microaxial Heart Pump Implementation for Prevention of Postcardiotomy Cardiogenic Shock”.Acta Scientific Medical Sciences 7.8 (2023): 29-32.
Copyright: © 2023 Alexey Koroteev. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.