Proof of Concept: Microcirculation Pre & Post Impella5.5 in patients with end stage HF listed for OHT (MICRO-C-SHOCK Study Group)

Background: Favorable macro-hemodynamics but poor micro-hemodynamics lead to worse 30 day outcomes in CS. Impella 5.5 (I5.5-mAFP) improves macrocirculatory hemodynamics. It is used as BTTt for patients with HF failing medical therapy. We analyzed changes in macro- and micro-circulatory hemodynamics before and after I5.5-mAFP support in patients listed for heart transplant

Methods: Single-arm, prospective study of serial microcirculation measurements in I5.5-mAFP support assessed with handheld sublingual incident dark-field videomicroscopy (CytoCam, Braedius Medical). Microvascular flow index (MFI), microvascular heterogeneity index (MHI), proportion of perfused vessels (PPV), and perfused vessel density (PVD) were measured at baseline and on days 1, 2, and 3 of I5.5-mAFP support.

Outcome: 3 participants with an average age 54±8.1 years, SCAI stage (D: 3), male 2 (67%). Results are displayed in Figure.

Conclusion: It is safe and feasible to measure microcirculation pre and post I5.5-mAFP support in patients waiting for OHT. VIS scores decreased post tMCS. Improved parameters of microcirculation and renal function after i5.5-mAFP support were noted. Microcirculatory perfusion correlated with i5.5-mAFP flow more closely than macro-hemodynamics measured by Fick CO.