Related Experiment Video
Updated: Jul 26, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Multi-institutional outcomes of Impella use in pediatric patients: A brief communication from the ACTION Network
Jonathan B Edelson1, Shahnawaz Amdani2, David N Rosenthal3
1Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
The Impella device shows promise for pediatric advanced heart failure, with 89.3% achieving positive outcomes. Further research is needed to minimize adverse events in pediatric mechanical circulatory support.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Advanced Heart Failure
Background:
- Refractory advanced heart failure in children presents significant management challenges.
- Mechanical circulatory support devices are crucial for pediatric patients awaiting recovery or transplantation.
- The Impella device offers a potential therapeutic option in this complex patient population.
Purpose of the Study:
- To evaluate the safety and efficacy of the Impella device in pediatric patients with advanced heart failure.
- To analyze patient characteristics, implantation strategies, and clinical outcomes associated with Impella use.
- To identify adverse events and explore strategies for risk mitigation.
Main Methods:
- Retrospective cohort study of 150 pediatric patients (weight ≥19.0kg) supported with Impella from April 2018 to November 2024.
- Analysis of implantation sites (axillary vs. femoral artery), underlying etiologies (cardiomyopathy, graft dysfunction, congenital heart disease), and prior/concomitant use of extracorporeal membrane oxygenation (ECMO).
- Review of major adverse events including bleeding, infection, device malfunction, and stroke, alongside clinical outcomes such as recovery, transplantation, or device change.
Main Results:
- Impella was used in pediatric patients with a median weight of 62.9kg, with axillary artery implantation in 40.1% and femoral in 29%.
- Common indications included dilated cardiomyopathy (57.3%), transplant graft dysfunction (14.7%), and congenital heart disease (13.3%).
- Positive clinical outcomes were observed in 89.3% of patients, with 32.7% explanted for recovery, 32% transplanted, and 23.3% switched to another device. Major adverse events occurred in 28% of patients.
Conclusions:
- The Impella device demonstrates potential utility in pediatric patients with refractory advanced heart failure.
- Careful patient selection and implantation strategies are important for optimizing outcomes.
- Continued efforts are necessary to reduce the incidence of adverse events associated with Impella use in pediatric populations.
Abstract:
This retrospective cohort study includes 150 pediatric patients supported with the Impella between April 2018 and November 2024. Median weight was 62.9 kg (interquartile range [IQR] 51.0-79.7 kg) and the smallest weighed 19.0 kg. Axillary artery implants occurred in 40.1% of patients while the femoral artery was used in 29%. Most patients had dilated cardiomyopathy (57.3%); however, a significant portion had transplant graft dysfunction (14.7%) or congenital heart disease (13.3%). One quarter of the cohort (N = 38) were supported with extracorporeal membrane oxygenation (ECMO) before Impella; 76% (N = 29) used ECMO and Impella in tandem, while 24% (N = 9) transitioned from ECMO to Impella. Major bleeding, major infection, device malfunction, or stroke were reported in 28% of patients (N = 42). Positive clinical outcomes were achieved in 89.3% of patients; 32.7% explanted for recovery, 32% transplanted, and 23.3% changed to another device. These data demonstrate a potential role for this device in children with refractory advanced heart failure and a need for increased work to limit adverse events.
