Mark Anderson1, D Lynn Morris2, Daniel Tang3, George Batsides4, Ajay Kirtane5, Ivan Hanson6, Perwais Meraj7, Navin Kumar Kapur8, William O'Neill9. 1. Division of Cardiothoracic Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA. Electronic address: mbandersonmd@gmail.com. 2. Division of Cardiology, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA. 3. Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA. 4. Division of Cardiothoracic Surgery, Rutgers / Robert Wood Johnson, New Brunswick, New Jersey, USA. 5. Division of Cardiology, Columbia University / New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA. 6. Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA. 7. Division of Cardiology, Northwell Health, Manhasset, New York, USA. 8. Division of Cardiology, Tufts Medical Center, Boston, Massachusetts, USA. 9. Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA.
Abstract
BACKGROUND: Right ventricular failure (RVF) after myocardial infarction, cardiotomy, or left ventricular assist device (LVAD) implantation increases morbidity and mortality. RVF also contributes to prolonged length of hospital stay and higher costs of care. The aim of this study was to evaluate the efficacy and safety of the Impella RP (Abiomed, Danvers, MA) in patients with severe RVF in these clinical settings. METHODS: This is a prospective cohort study of patients with severe RVF treated with a percutaneous right ventricular assist device (RVAD). Sixty patients with RVF refractory to medical treatment received the Impella RP device at 14 United States institutions as part of the Impella RP pre‒ and post‒market approval studies. The study population included 2 cohorts: Cohort A, patients with RVF post-(LVAD) implantation (n = 31); and Cohort B, patients with RVF post-cardiotomy, heart transplant, or myocardial infarction (n = 29). The primary end-point was survival at 30 days or hospital discharge (whichever was longer). RESULTS: Mean age of patients was 59 ± 15 years; 68% were males, 84% had a history of congestive heart failure, 44% had valvular disease, and 35% had pre-operative renal dysfunction. Patients received an average of 3.4 inotropes/vasopressors before the Impella RP implant. Patients were supported with the Impella RP for 4.0 ± 1.5 (0.5 to 14) days. Hemodynamics improved immediately after initiation of device support, with an increase in cardiac index from 1.9 ± 0.1 to 3.1 ± 0.2 liters/min/m2 (p < 0.001) and a decrease in central venous pressure from 19.0 ± 1 to 13 ± 1 mm Hg (p < 0.001). The overall survival at 30 days (or discharge) was 72%. CONCLUSIONS: To the best of our knowledge, this study represents the largest prospective study of patients with life-threatening RVF. Mechanical support with the Impella RP device in patients with RVF resulted in rapid hemodynamic improvement with reversal of shock and favorable survival.
BACKGROUND:Right ventricular failure (RVF) after myocardial infarction, cardiotomy, or left ventricular assist device (LVAD) implantation increases morbidity and mortality. RVF also contributes to prolonged length of hospital stay and higher costs of care. The aim of this study was to evaluate the efficacy and safety of the Impella RP (Abiomed, Danvers, MA) in patients with severe RVF in these clinical settings. METHODS: This is a prospective cohort study of patients with severe RVF treated with a percutaneous right ventricular assist device (RVAD). Sixty patients with RVF refractory to medical treatment received the Impella RP device at 14 United States institutions as part of the Impella RP pre‒ and post‒market approval studies. The study population included 2 cohorts: Cohort A, patients with RVF post-(LVAD) implantation (n = 31); and Cohort B, patients with RVF post-cardiotomy, heart transplant, or myocardial infarction (n = 29). The primary end-point was survival at 30 days or hospital discharge (whichever was longer). RESULTS: Mean age of patients was 59 ± 15 years; 68% were males, 84% had a history of congestive heart failure, 44% had valvular disease, and 35% had pre-operative renal dysfunction. Patients received an average of 3.4 inotropes/vasopressors before the Impella RP implant. Patients were supported with the Impella RP for 4.0 ± 1.5 (0.5 to 14) days. Hemodynamics improved immediately after initiation of device support, with an increase in cardiac index from 1.9 ± 0.1 to 3.1 ± 0.2 liters/min/m2 (p < 0.001) and a decrease in central venous pressure from 19.0 ± 1 to 13 ± 1 mm Hg (p < 0.001). The overall survival at 30 days (or discharge) was 72%. CONCLUSIONS: To the best of our knowledge, this study represents the largest prospective study of patients with life-threatening RVF. Mechanical support with the Impella RP device in patients with RVF resulted in rapid hemodynamic improvement with reversal of shock and favorable survival.
Authors: Manal Alasnag; Alexander G Truesdell; Holli Williams; Sara C Martinez; Syeda Kashfi Qadri; John P Skendelas; William A Jakobleff; Mirvat Alasnag Journal: Curr Atheroscler Rep Date: 2020-04-23 Impact factor: 5.113
Authors: Mark S Goodin; Michael S Showalter; David J Horvath; Barry D Kuban; Christine R Flick; Anthony R Polakowski; Kiyotaka Fukamachi; Jamshid H Karimov Journal: ASAIO J Date: 2021-11-10 Impact factor: 3.826
Authors: David Santer; Anita Boltres; Luca Koechlin; Patrick Hunziker; Raban Jeger; Markus Maurer; Martin Grapow; Friedrich Eckstein; Oliver Reuthebuch Journal: ESC Heart Fail Date: 2020-04-29
Authors: Varinder Kaur Randhawa; Karlee Hoffman; Ashley Bock; Pavan Bhat; Laura Young; Jeffrey Rossi; Joseph Campbell; Corrine Bott-Silverman; Edward G Soltesz; Michael Z Y Tong; Shinya Unai; Ravi Nair; Jerry D Estep; Antonio L Perez Journal: ESC Heart Fail Date: 2020-05-19
Authors: Valeria Lo Coco; Maria Elena De Piero; Giulio Massimi; Giovanni Chiarini; Giuseppe M Raffa; Mariusz Kowalewski; Jos Maessen; Roberto Lorusso Journal: J Thorac Dis Date: 2021-02 Impact factor: 2.895