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Preoperative Impella therapy in patients with ventricular septal rupture and cardiogenic shock: haemodynamic and
Ikuko Shibasaki1, Shunsuke Saito1, Yuta Kanazawa1
1Department of Cardiac and Vascular Surgery, Dokkyo Medical University School of Medicine, Tochigi, Japan.
Insights
Preoperative Impella treatment improved haemodynamic stability and organ function in patients with postinfarction ventricular septal rupture and cardiogenic shock. However, prolonged support poses risks, necessitating studies to optimize treatment duration.
Area of Science:
- Cardiology
- Mechanical Circulatory Support
- Critical Care Medicine
Background:
- Postinfarction ventricular septal rupture (PIVSR) with cardiogenic shock (CS) presents a critical challenge.
- Mechanical circulatory support, such as Impella, is increasingly used in high-risk cardiac conditions.
Purpose of the Study:
- To evaluate the impact of preoperative Impella therapy on haemodynamic stability, organ recovery, and postoperative outcomes in patients with PIVSR and CS.
- To assess the safety and efficacy of Impella/ECpella support in this patient population.
Main Methods:
- Retrospective analysis of 10 patients with PIVSR and CS treated with Impella or ECpella between April 2018 and February 2024.
- Generalized linear mixed model used to evaluate organ ischaemia via blood parameter changes post-Impella insertion.
- Emergency surgery was performed based on haemodynamic stability, unless organ failure was present.
Main Results:
- Impella/ECpella support significantly reduced key biomarkers of myocardial injury and organ stress, including lactate, ALT, CK-MB, and troponin I.
- No significant changes were observed in AST levels or estimated glomerular filtration rate (eGFR).
- A significant decrease in haemoglobin and platelet counts occurred, despite transfusions. No in-hospital surgical deaths were reported, but 70% required prolonged mechanical ventilation and 80% needed transfer for rehabilitation.
Conclusions:
- Preoperative Impella or ECpella support can enhance haemodynamic stability and improve organ function in patients with PIVSR and CS.
- Prolonged support is associated with risks, including haemorrhagic events and extended rehabilitation needs.
- Further comparative studies are required to optimize the duration of mechanical circulatory support in these critically ill patients.
Objectives:
We examined the effects of preoperative Impella treatment on haemodynamic stability, organ recovery and postoperative outcomes in patients with postinfarction ventricular septal rupture (PIVSR) and cardiogenic shock (CS).
Methods:
Between April 2018 and February 2024, the data of 10 of 15 patients with PIVSR and CS who underwent Impella therapy were analysed. Emergency surgery was contingent on haemodynamic stability with the Impella/ECpella, except in the presence of organ failure. We utilized a generalized linear mixed model to evaluate organ ischaemia through changes in blood parameters upon admission and at subsequent intervals post-Impella insertion.
Results:
Preoperative Impella or combined Impella and ECpella (5 patients each) support was provided, with diagnoses and operations occurring at an average of 4 days (interquartile range: 2-5) and 8 days (interquartile range: 2-14) after myocardial infarction, respectively. Treatment significantly reduced lactate, alanine aminotransferase, creatine kinase-MB and troponin I levels (P ≤ 0.05 for all). Conversely, no significant change was noted in the aspartate aminotransferase level or the estimated glomerular filtration rate. Haemoglobin and platelet counts decreased despite transfusions (P < 0.001). No surgical deaths occurred; however, 70% of the patients required prolonged mechanical ventilation, and 80% were transferred to other facilities for rehabilitation.
Conclusions:
Impella or ECpella treatment can improve haemodynamic and organ failure outcomes in patients with PIVSR and CS. However, the risks of prolonged support, including haemorrhagic events and the need for extended rehabilitation, point to a need for comparative studies to optimize support duration.
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