The Use of Impella 2.5 in Severe Refractory Cardiogenic Shock Complicating an Acute Myocardial Infarction

Journal of Interventional Cardiology - Tập 28 Số 1 - Trang 41-50 - 2015
Frédéric Casassus1, Jérôme Corré1, Lionel Leroux1, PIERRE CHEVALEREAU2, AURELIE FRESSELINAT3, Benjamin Séguy1, Joachim Calderon4, Pierre Coste1, Alexandre Ouattara4, Xavier Roques5, Laurent Barandon6
1Department of Interventional Cardiology and Intensive Care, Haut-Leveque Hospital, Pessac, France
2Department of Cardiology, Libourne Hospital, Libourne, France
3Department of Pharmacology, Haut-Leveque Hospital, Pessac, France
4Department of Anesthesiology and Intensive Care, Bordeaux University Hospital, Bordeaux, France
5Department of Cardiothoracic Surgery, Haut-Leveque Hospital, Pessac, France
6National Institute of Health and Medical Research (INSERM) U1034 Pessac France

Tóm tắt

ObjectivesTo investigate the outcome of patients with acute myocardial infarction (AMI) complicated by refractory cardiogenic shock (CS) who underwent mechanical circulatory support with Impella 2.5.BackgroundAMI complicated by CS remains a highly fatal condition. A potent and minimally invasive left ventricular assist device might improve patient outcomes.MethodsWe analyzed the procedural characteristics and outcomes of 22 consecutive patients who underwent, between July 2008 and December 2012, a percutaneous coronary intervention and Impella 2.5 support for AMI complicated by CS refractory to first‐line therapy with inotropes and/or Intra‐aortic balloon pump.ResultsIn this analysis, patients were relatively young with a mean age of 57.9 ± 11.6 year old and 59.1% were male. The majority of patients (77.3%) were admitted in CS and 40.9% sustained cardiac arrest prior to admission. Hemodynamics improved significantly upon initiation of support, end‐organ and tissue perfusion improved subsequently demonstrated by a significant decrease in lactate levels from 6.37 ± 5.3 mmol/L to 2.41 ± 2.1 mmo/L, (P =  0.008) after 2 days of support. Thirteen (59.1%) patients were successfully weaned‐off Impella 2.5 and 4 (18.2%) were transitioned to another device. We observed a functional recovery of the left ventricle when compared to baseline (43 ± 10% vs. 27 ± 9%, P < 0.0001). The survival rate at 6 months and 1 year was 59.1% and 54.5%, respectively.ConclusionImpella 2.5 was initiated as a last resort therapy to support very sick patients with refractory CS after failed conventional therapy. The use of the device yielded favorable short and mid‐term survival results with recovery being the most frequently observed outcome. (J Interven Cardiol 2015;28:41–50)

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Journal of Interventional Cardiology

Tập 28 Số 1

41-50

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