Clinical experience with permanent mechanical circulatory assistance

Preliminary experience with Impella Recover(®) LP5.0 in nine patients with cardiogenic shock: a new circulatory support system in the intensive cardiac care unit

AIM

Cardiogenic shock is associated with high mortality. We report our experience with the short-term left ventricular axial pump Impella LP5.0 in nine patients with severe ischaemic heart failure.

METHODS

Six patients (group 1) presented with cardiogenic shock at the acute phase of an ST elevation myocardial infarction. Three patients (group 2) had severe ischaemic cardiomyopathy with temporary contra-indication to LVAD or transplantation. We measured haemodynamic and metabolic variables up to 96hours and recorded morbidity, mechanical pump failures, and mortality up to one year postimplantation.

RESULTS

In all patients the Impella LP5.0 was safely placed through the right subclavian artery. Cardiac power output increased from 0.64 (0.07) W to 0.94 (0.44) W and 1.02 (0.30) W at 24 and 72hours, respectively. The Impella LP5.0 remained in place for 12 (7.2) days. In group 1, five patients were in INTERMACS Profile 3 at the time of pump insertion. Three could be weaned and survived. One patient in INTERMACS Profile 1 died of intractable heart failure within hours. In group 2, two of three patients underwent heart transplantation. Haemorrhage requiring transfusions was observed in four patients but only one case was directly related to the Impella LP5.0.

CONCLUSION

Left ventricular assistance with the Impella LP5.0 appears to be well tolerated. It may be especially useful in patients with acute myocardial infarction complicated by cardiogenic shock who achieve INTERMACS Profile 3 with initial treatment.

External counterpulsation in low cardiac output states

External counterpulsation represents a rational extension of the basic principles of counterpulsation as developed over the past 20 years. Its unique properties of being totally noninvasive, free of significant morbidity, and easily and quickly instituted clinically suggest that it may have a significant therapeutic role in the prevention and treatment of cardiogenic shock following acute myocardial infarction as well as being helpful in other cardiac disorders. Continuing evaluation is necessary, and it should be thought of as one of several useful mechanical circulatory assist devices now available to the internist, cardiologist, and surgeon caring for the critically ill patient.