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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
A multicenter study of the impella device for mechanical support of the systemic circulation in pediatric and
V Vivian Dimas1, Brian H Morray2, Dennis W Kim3
1Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX.
Insights
Temporary circulatory support using Impella devices is feasible for pediatric and adolescent patients. This study found acceptable risk profiles, though further research is needed for optimal use.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Pediatric Critical Care
Background:
- Limited options exist for minimally invasive circulatory support in children.
- Published data are scarce, primarily consisting of case reports and small series.
Purpose of the Study:
- To review the use of Impella devices for temporary circulatory support in patients aged 21 years or younger.
- To assess the feasibility and risk profile of Impella device use in this pediatric and adolescent population.
Main Methods:
- A retrospective, multicenter review of Impella implants in pediatric and adolescent patients (≤21 years) from 2009-2015.
- Utilized standardized data collection and INTERMACS definitions for analysis.
Main Results:
- 39 implants were performed in 38 patients; 72% were for cardiogenic shock.
- Median support duration was 45 hours, with survival rates of 85% at 7 days and 68% at 30 days.
- Major adverse events occurred in 8 patients, including hemolysis, bleeding, stroke, sepsis, and leg ischemia.
Conclusions:
- Temporary circulatory support with Impella devices is feasible in pediatric and adolescent patients.
- The risk profile appears acceptable, but more experience and follow-up are required.
- Further research is needed to enhance technical performance and patient selection for Impella use.
Objectives:
The objective was to review the use of Impella devices (Abiomed Inc, Danvers, MA) for temporary circulatory support in pediatric and adolescent patients (age ≤ 21 yrs).
Background:
Options for minimally invasive circulatory support in children are limited, and published data are confined to case reports and small case series.
Methods:
This was a retrospective, multicenter review of Impella implants in pediatric and adolescent patients from 2009-15, using standardized data collection and INTERMACS definitions.
Results:
A total of 39 implants were performed in 38 patients from 16 centers. Median age and weight were 16 yrs (4-21 yrs) and 62 kg (15-134 kg). The primary indication for implant was cardiogenic shock in 28 patients (72%). Cardiac allograft rejection, myocarditis, or cardiomyopathy were the underlying diagnosis in 23 patients (59%); 11 patients had congenital heart disease. The median duration of support was 45 hr (1-1224 hr). Indications for explant included ventricular recovery in 16 patients, transition to another device in 12, death in 5, and transplant in 1. Survival was 85% at 7 days and 68% at 30 days. Major adverse events occurred in 8 patients: hemolysis in 3, bleeding in 2, stroke in 1 (unclear if related to Impella), sepsis in 1, and critical leg ischemia in 1. An increase in aortic regurgitation was noted in three patients, with no evidence of valve injury.
Conclusion:
Temporary circulatory support with Impella devices is feasible in pediatric and adolescent patients, with acceptable risk profiles. More experience and follow up is needed to improve technical performance and patient selection. © 2017 Wiley Periodicals, Inc.
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