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Percutaneous Left Ventricular Assist Device in Cardiogenic Shock: A Five-Year Single Canadian Center Initial
Cvetan Trpkov1, Jordan D Gibson2, Robert J H Miller1
1Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
Insights
Mechanical circulatory support with Impella CP shows potential for carefully selected cardiogenic shock patients in Canada. Early support and monitoring lactate levels are key to improving survival outcomes.
Area of Science:
- Cardiology
- Mechanical Circulatory Support
- Critical Care Medicine
Background:
- Mechanical circulatory support (MCS) with percutaneous left ventricular assist devices (PVADs) is expanding globally.
- There is limited Canadian data on PVAD use in cardiogenic shock (CS).
- Conflicting reports exist regarding the benefits of PVADs in CS.
Purpose of the Study:
- To describe the 5-year experience with Impella CP for CS at a Canadian tertiary care center.
- To evaluate patient characteristics, care patterns, and outcomes.
- To identify predictors of survival.
Main Methods:
- Retrospective assessment of consecutive adult patients with CS supported by Impella CP.
- Collection of comprehensive clinical data and outcomes.
- Evaluation of in-hospital outcomes, 6-month survival, and survival predictors.
Main Results:
- Thirty-four patients received Impella CP support for CS over 5 years.
- Most patients (94%) had acute myocardial infarction and advanced CS (68% SCAI stage D or E).
- Survival to discharge was 58%, with 100% 6-month survival for discharge survivors. SCAI CS stage and initial lactate levels were significant predictors of survival. Bleeding (26%) and vascular complications occurred.
Conclusions:
- Impella CP may benefit carefully selected CS patients.
- SCAI shock classification and serum lactate can aid patient selection.
- Minimizing support time and bleeding complications are crucial. Further Canadian studies are needed.
Background:
Mechanical circulatory support in cardiogenic shock (CS) with percutaneous left ventricular assist devices (PVADs) has expanded rapidly, but there is a paucity of Canadian data. Conflicting observational reports have emerged regarding the benefit of PVADs in CS. We describe a 5-year experience with Impella CP for CS at a single Canadian tertiary care centre.
Methods:
Consecutive adult patients with CS supported with Impella CP were included. Comprehensive clinical data and outcomes were retrospectively assessed. We evaluated patient characteristics, patterns of care, in-hospital outcomes, 6-month survival, and predictors of survival.
Results:
Thirty-four patients were supported with Impella CP for CS over 5 years. A majority had acute myocardial infarction (94%) with advanced CS (68% Society for Cardiovascular Angiography and Intervention [SCAI] stage D or E). Survival to discharge was 58%. In patients who survived to discharge, 6-month survival was 100% with excellent functional status. SCAI CS stage and initial serum lactate showed significant associations with survival. There was also a trend towards improved survival with shorter door-to-PVAD time. Clinically significant bleeding was common (26%), and 3 patients had device-related vascular complications.
Conclusion:
Impella CP may have a role in carefully selected patients with CS. The SCAI shock classification and serum lactate may facilitate patient selection, and minimizing door-to-support time as well as bleeding complications are important considerations. Further clinical investigations, particularly in a Canadian setting, will be necessary to establish the role of this new technology in CS.
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