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Circulatory support using the impella device in fontan patients with systemic ventricular dysfunction: A multicenter
Brian H Morray1, Vivian V Dimas2, Scott Lim3
1Division of Cardiology, Seattle Children's Hospital, Seattle, Washington.
Insights
Mechanical circulatory support with the Impella pump offers a favorable safety profile for single ventricle patients with Fontan circulation. This temporary support can bridge patients to recovery or further interventions.
Area of Science:
- Cardiology
- Medical Devices
- Pediatric Cardiology
Background:
- Limited mechanical circulatory support options exist for single ventricle (SV) patients.
- The Impella pump was evaluated for systemic ventricle support in SV patients with Fontan circulation.
Purpose of the Study:
- To assess the safety and efficacy of Impella pump support in single ventricle patients with Fontan circulation.
Main Methods:
- A multicenter, retrospective study included 10 SV patients with Fontan circulation supported by an Impella device between 2012 and 2015.
- Data collected included demographics, indications for support, adverse events, and short-term outcomes.
Main Results:
- The median age was 26 years; indications included systemic ventricular failure (n=8) and high-risk electrophysiology procedures (n=2).
- Median support duration was 49 hours. Survival to hospital discharge was 80%.
- Adverse events occurred in 4 patients (hemolysis, aortic valve insufficiency, access site thrombus), with no bleeding or thromboembolic events.
Conclusions:
- Impella devices provide temporary systemic ventricle support in SV patients, serving as a bridge to recovery or other devices.
- The Impella pump demonstrates favorable procedural survival and an acceptable adverse event profile in this cohort.
Background:
There are limited mechanical circulatory support options for patients with single ventricle (SV) anatomy. This is a multicenter, retrospective study of the Impella pump to support the systemic ventricle in a cohort of SV patients with Fontan circulation.
Methods:
Patients with SV anatomy supported with an Impella device from 2012 to 2015 were included. Demographic information, indication for support, adverse events and short-term outcome data were collected.
Results:
Ten patients were included. The median age and weight at implant was 26 years (4-38 years) and 64 kg (15-102 kg). Indications for support were systemic ventricular failure with cardiogenic shock (n = 8) or high-risk electrophysiology (EP) procedures (n = 2). The median duration of support was 49 hr (2.7-264 hr). Support was discontinued for ventricular recovery in five patients, transition to another device in two patients, completion of EP procedure in two patients and death in one patient. Survival to hospital discharge was 80%. Adverse events occurred in 4 patients. There were two cases of hemolysis, one case of increasing aortic valve insufficiency with implant and one asymptomatic access site thrombus. There were no bleeding or thromboembolic events.
Conclusions:
Impella devices can provide temporary support for the systemic ventricle in SV patients as a bridge to recovery or additional device. Procedural survival and adverse event profiles are favorable. © 2017 Wiley Periodicals, Inc.
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