Impact of Impella Support on Clinical Outcomes in Patients with Postcardiotomy Cardiogenic Shock

Annals of Thoracic and Cardiovascular Surgery, vol. 30, pp. n/a

Abstract

PURPOSE: This study aimed to elucidate the strategy of an effective Impella support for better clinical outcomes in patients with a postcardiotomy cardiogenic shock (PCCS). METHODS: This single-center retrospective observational study enrolled 31 patients with PCCS undergoing an elective open-heart surgery followed by Impella support between November 2018 and February 2022 for further analysis. RESULTS: The preoperative Euroscore II and left ventricular (LV) ejection fraction were 9.1 ± 10.4 and 35.7% ± 12.6%, respectively. The in-hospital mortality rate was 51.6% (n = 16). In survivors (n = 15), the mean Impella support time was 6.9 ± 3.5 days. Patients were discharged on the postoperative day 24.9 ± 16.4. Regarding LV remodeling, LV end-diastolic diameter was significantly decreased after Impella support (59.2 ± 6.0 mm vs. 54.4 ± 4.7 mm, p = 0.01, preoperative vs. postoperative). In-hospital mortality rates were comparable with small (CP, n = 6) or large (5.0, n = 25) Impella systems (33.3% [n = 2] vs. 56.0% [n = 14], p = 0.39). However, a lower in-hospital mortality rate was observed in the group with early initiation (i.e., intraoperative) of Impella support (n = 14) than that with delayed Impella initiation (i.e., in the postoperative course) (n = 11) (28.6% [n = 4] vs. 90.9% [n = 10], p = 0.004). CONCLUSIONS: Impella support contributes to LV remodeling in PCCS patients. In-hospital mortality was comparable in different Impella sizes and lower in early Impella initiation.

Authors 7

1. Yukiharu Sugimura Aachen Department of Cardiac Surgery Medical Faculty and

   RWTH Aachen University · Universitätsklinikum Aachen · Düsseldorf University Hospital · Heinrich Heine University Düsseldorf

   Affiliation as printed

   Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Hospital, Düsseldorf, Germany

   Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

2. Moritz Benjamin Immohr Aachen Department of Cardiac Surgery Medical Faculty and

   RWTH Aachen University · Universitätsklinikum Aachen · Düsseldorf University Hospital · Heinrich Heine University Düsseldorf

   Affiliation as printed

   Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Hospital, Düsseldorf, Germany

   Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

3. Arash Mehdiani Aachen Department of Cardiac Surgery Medical Faculty and

   RWTH Aachen University · Universitätsklinikum Aachen · Düsseldorf University Hospital · Heinrich Heine University Düsseldorf

   Affiliation as printed

   Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Hospital, Düsseldorf, Germany

   Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

4. Udo Boeken

   Düsseldorf University Hospital · Heinrich Heine University Düsseldorf

   Affiliation as printed

   Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Hospital, Düsseldorf, Germany

5. Hug Aubin

   Düsseldorf University Hospital · Heinrich Heine University Düsseldorf

   Affiliation as printed

   Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Hospital, Düsseldorf, Germany

6. Artur Lichtenberg

   Düsseldorf University Hospital · Heinrich Heine University Düsseldorf

   Affiliation as printed

   Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Hospital, Düsseldorf, Germany

7. Payam Akhyari Aachen Department of Cardiac Surgery Medical Faculty and

   RWTH Aachen University · Universitätsklinikum Aachen · Düsseldorf University Hospital · Heinrich Heine University Düsseldorf

   Affiliation as printed

   Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Hospital, Düsseldorf, Germany

   Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany