A Canadian Experience With a Percutaneous Microaxial Ventricular Assist Device in Children With Cardiogenic Shock

The experience of a percutaneous microaxial (Impella) left ventricular assist device in children with cardiogenic shock is limited. The primary objective of this study was to review our institutional clinical outcomes of Impella use in children with cardiogenic shock.

This is a single-center retrospective study of all adult-sized children who underwent Impella implantation from June 2019 to December 2024. Clinical outcomes, hemodynamics, and device complication data were collected.

A total of 7 patients (female = 4) with a median (interquartile range [IQR]) age of 15 years (14.5, 16.5 years) and a median weight of 50.9 kg (46.5, 59.85 kg) underwent Impella insertion during the study period. Five patients underwent Impella insertion for hemodynamic support and 2 for left ventricular decompression while on extracorporeal membrane oxygenation (ECMO) support. The underlying cardiac diagnoses were dilated cardiomyopathy (4 of 7), myocarditis (2 of 6), and hypertrophic cardiomyopathy with presumed myocarditis (1 of 7). The median (IQR) duration of support was 5 days (2, 7 days). The median (IQR) duration of intensive care unit and hospital stay was 13 days (10.5, 19 days) and 23 days (15, 54 days), respectively. Three patients were ultimately bridged to a durable ventricular assist device, and 2 patients had recovery of myocardial function. One patient developed significant aortic regurgitation, which necessitated device explantation and conversion to central ECMO after 38 hours of support, and one patient had withdrawal of life-sustaining measures due to significant brain injury unrelated to Impella.

There is increasing use of percutaneous microaxial pumps for supporting children in cardiogenic shock and left ventricle decompression on ECMO support. This report identifies the initial Canadian experience as an addition to the mechanical circulatory support armamentarium.