Professor of Clinical Medicine Penn Medicine Penn Medicine Philadelphia, Pennsylvania, United States
Background: The Impella 5.5 is a micro-axial, percutaneous left ventricular assist device often used for patients in advanced heart failure or cardiogenic shock. We sought to investigate the immediate effects of device placement on hemodynamic and echocardiographic parameters
Methods: All patients implanted with the Impella 5.5, for whom we had data, at our academic tertiary care hospital were included. Patients with multiple concurrent mechanical circulatory support devices were excluded. Pre-implant data was collected prior to transfer to the operating room, while post-implant data was collected upon return to the intensive care unit. Patients are only included in statistical analyses for which both pre-implant and post-implant data were available. Data is reported as mean [STD].
Outcome: A total of 103 patients were included in this study with an average age at implant of 55 years (42-68). Most (n=64, 62%) patients had non-ischemic cardiomyopathy, followed by ischemic cardiomyopathy (n=32, 31%). A total of 79 (77%) were SCAI Class D and 7 (7%) Class E prior to implant. Hemodynamic and echocardiographic data before and after Impella 5.5 implant can be found in the included table. There was a statistically significant decrease in PA systolic pressure and PA diastolic pressure; however, there was no statically significant difference in mean PA pressure. No changes in right atrial pressure or left ventricular internal diameter at end diastole were observed. There was a decrease in mitral regurgitation severity (p=0.04). The severity right ventricular dysfunction (p=0.80) and right ventricular dilation were unaffected (p=0.80).
Conclusion: Impella 5.5 implant had minimal immediate effect on right sided pressures, RV diastolic function, and RV dilation. Some improvement was noted in mitral regurgitation likely secondary to left ventricular unloading. Impella 5.5 univentricular support is frequently successful despite biventricular failure
