Outcomes of microaxial flow pump use in acute-on-chronic heart failure

The mortality rate associated with acute decompensated heart failure (ADHF) is high, and prognosis depends on restoring cardiac output. Patients frequently require mechanical circulatory support (MCS). The Impella microaxial flow pump (mAFP) is a short-term MCS used to stabilize patients. We report outcomes of mAFP use in patients with pre-existing chronic heart failure who presented with ADHF.

This retrospective single-center study included all patients with a history of chronic heart failure who presented with ADHF and were managed with mAFP. Demographic characteristics, hemodynamic variables, complications, and clinical outcomes were evaluated.

Fifty-eight patients were included. Patients were managed with the Impella 5.5/5.0 (n = 52, 89.7%) or CP (n = 6, 10.3%). After mAFP implantation, there was a significant reduction in vasoactive inotropic score (p < 0.001), increase in glomerular filtration rate (p < 0.001), and reduction in lactate levels (p < 0.001). Two patients (3.4%) were lost to follow-up, 28 (51.2%) were bridged to durable left ventricular assist device (LVAD), and 3 (5.2%) were bridged to heart transplant. Eight patients (13.8%) were successfully weaned; 17 (29.3%) died while receiving mAFP support. Major complications included bleeding (n = 23, 39.7%), local infection (n = 37, 63.8%), sepsis (n = 9, 15.5%), and renal dysfunction (n = 34, 58.6%).

The mAFP demonstrates favorable outcomes in patients with chronic heart failure who present with ADHF. It resulted in significant improvements in hemodynamic parameters, and most patients survived to durable LVAD or transplantation. In this heterogenous patient group, only a few survived definitive weaning from mAFP.