Abstract Body (Do not enter title and authors here): Background: Cardiogenic shock in the perioperative period of cardiovascular (CV) surgery is a major challenge that worsens the prognosis and jeopardizes of treatment opportunities. Recently, the preoperative use of circulatory assist pump catheter (Impella) has been reported as a bridge to CV surgery in patients presenting with cardiogenic shock. However, the clinical impact has not been fully investigated.
Aims: In this study, we aimed to investigate the safety and efficacy of utilization of Impella for preoperative cardiogenic shock as a bridge to CV surgery using the national database of Japanese Registry for Percutaneous Ventricular Assist Devices (J-PVAD).
Methods: We selected and analyzed 102 patients with cardiogenic shock who utilized Impella before CV surgery from J-PVAD registry database from 2020 to 2021. The average age was 70.2 years, the etiologies were ischemic in 94 cases (92.2%), valvular disease in 8 cases (7.8%). The median time from onset to Impella support was 2.5 hours, the lactate level before insertion was 5.8±4.9 mmol/l, and LVEF was 37.7±14.6%. The devices used were Impella alone in 72 case (CP/2.5 in 66, 5.0 in 6) and combination of ECMO in 30 cases.
Results: The detail of CV surgery was CABG alone in 43 cases, VSP repair in 27 cases, MV surgery in 25 cases and repair of LV rupture in 7cases. The mean duration of Impella support was 6.7 days, with 79 patients (77.5%) weaning off Impella, 21 patients (20.5%) dying during support, and 2 patients (2.0%) converting to durable LVAD. Bleeding events were observed in 26 patients (25.4%). Hemolysis in 10 patients and lower extremity ischemia in 5 patients, all of whom were CP cases. Post-weaning mortality was observed in 25 cases, and in-hospital mortality in 46 cases (45.1%). Freedom from all cause death at 30-day was 68.8% with no significant difference between ECPELLA and Impella alone (Log rank p=0.38).
Conclusions: The clinical outcomes of bridge to CV surgery using Impella for preoperative cardiogenic shock from J-PVAD registry demonstrated acceptable postoperative weaning rate, however several cases of post-weaning mortality were observed, suggesting that appropriate protocol of weaning the device and prevention of complication is mandatory to improve outcomes.