| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 2004;127:812-822
© 2004 The American Association for Thoracic Surgery
Evolving technology |
a Department of Cardiovascular Surgery, University of Freiburg, Freiburg, Germany
b Institute of Medical Biometry, University of Freiburg, Freiburg, Germany
c Department of Cardiovascular Surgery, University of Lübeck, Lübeck, Germany
d Department of Cardiovascular Surgery, The University of Erlangen-Nürnberg, Erlangen-Nürnberg, Germany
Read at the Eighty-third Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 4-7, 2003.
Received for publication May 2, 2003; revisions received August 26, 2003; revisions received September 9, 2003; accepted for publication November 11, 2003.
* Address for reprints: Michael P. Siegenthaler, MD, Department of Cardiovascular Surgery, University of Freiburg, Hugstetterstrasse 55, 79106 Freiburg , Germany
siegenth{at}ch11.ukl.uni-freiburg.de
BACKGROUND: We evaluated patient outcomes and complications associated with the microaxial Impella Recover left ventricular assist device (Impella Cardiosystems AG, Aachen, Germany) for postcardiotomy low-output syndrome. This low-cost device is inserted across the aortic valve through a 10-mm vascular graft sewn to the ascending aorta.
METHODS: Impella patients were compared with 198 patients treated with an intraoperative intra-aortic balloon pump between January 2000 and December 2002. Three risk scores were used: the Hausmann score, the Texas Heart Institute score, and the Cleveland intensive care unit score. Between September 2001 and March 2003, 24 patients were treated with the Impella Recover for low-output syndrome. Before device insertion, 21 could not be separated from cardiopulmonary bypass, and 3 had postoperative hemodynamic instability despite high-dose catecholamines. Sixteen were treated with the Impella and intra-aortic balloon pump and 8 with the Impella alone (no intra-aortic balloon pump because of peripheral vascular disease or because deemed unnecessary).
RESULTS: No technical problems with device insertion occurred. Pump flow was 3.3 ± 0.7 L/min at 28,000 ± 4500 RPM. Support time was 61 ± 56 hours (range, 7-228 hours). Four devices required repositioning. One device failed (leaking purge line) and was removed. Hemolysis was minimal (lactate dehydrogenase levels of 540 ± 260 U/dL for Impella survivors). Mortality for Impella patients was 54% (13/24), similar to that for high-risk intra-aortic balloon pump patients (Hausmann score 
2 [57%], intensive care unit score 2 [51%], Texas Heart Institute score 0.75 [55%], and cardiac index 
2.3 [45%]). Cardiac output data were available in 19 Impella patients. Impella patients able to increase their cardiac output to 1 L/min or more above the pump flow of the Impella Recover had a 10% (1/10) mortality, versus 88% (8/9) in patients with a residual cardiac function of 1 L/min or less (P = .001). Comparison of high-risk intra-aortic balloon pump patients with Impella patients with residual cardiac function of 1 L/min or more showed a significant reduction in mortality, regardless of the high-risk definition used. Residual cardiac function was the strongest predictor of survival in Impella patients.
CONCLUSIONS: The Impella Recover device provides 3 to 4 L/min flow. It improves survival in patients with low-output syndrome if the heart is able to pump 1 L/min or more above device flow.
This article has been cited by other articles:
|
|
 |
|
  L.-G. Dahlin and B. Peterzen Impella Used for Hemostasis by Left Ventricular Unloading, in a Case With Left Ventricular Posterior Wall Rupture Ann. Thorac. Surg., April 1, 2008; 85(4): 1445 - 1447. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Aggarwal, F. Cheema, M. C. Oz, and Y. Naka Long-Term Mechanical Circulatory Support Card. Surg. Adult, January 1, 2008; 3(2008): 1609 - 1628. [Full Text]
|
|
|
|
|
|
A. A. Pitsis, A. N. Visouli, D. Burkhoff, P. Dardas, N. Mezilis, G. Bougioukas, and G. Filippatos Feasibility Study of a Temporary Percutaneous Left Ventricular Assist Device in Cardiac Surgery Ann. Thorac. Surg., December 1, 2007; 84(6): 1993 - 1999. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Markl, C. Benk, D. Klausmann, A. F. Stalder, A. Frydrychowicz, J. Hennig, and F. Beyersdorf Three-dimensional magnetic resonance flow analysis in a ventricular assist device. J. Thorac. Cardiovasc. Surg., December 1, 2007; 134(6): 1471 - 1476. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Garatti, T. Colombo, and E. Vitali Placement of the Impella Recover LD microaxial blood pump through a bioprosthesis is technically feasible J. Thorac. Cardiovasc. Surg., October 1, 2006; 132(4): 989 - 990. [Full Text] [PDF]
|
|
|
|
|
|
J. T. Strauch, U. F.W. Franke, M. Breuer, J. Wippermann, T. Wittwer, N. Madershahian, M. Kaluza, and T. Wahlers Technical feasibility of Impella Recover 100 microaxial left ventricular assist device placement after biologic aortic valve replacement (21 mm) for postcardiotomy failure J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1715 - 1716. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Catena, F. Milazzo, M. Merli, R. Paino, A. Garatti, T. Colombo, and E. Vitali Echocardiographic evaluation of patients receiving a new left ventricular assist device: the Impella(R) recover 100 Eur J Echocardiogr, December 1, 2004; 5(6): 430 - 437. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
