Article

A31 - Institutional Experience with Impella 5.0 and its Effect on Renal Function

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Citation:Interventional Cardiology Review 2019;14(3 Suppl 1):A31.

Correspondence: Daniel Nelson, wexbee09@gmail.com

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Background: In recent years the use of the Impella 5.0 for patients in cardiogenic shock and decompensated heart failure (HF) has increased. However, the impact of the Impella 5.0 on renal function and recovery remains unclear. We report our institutional experience with the Impella 5.0 and its effect on renal function in this critically ill population.

Hypothesis: The Impella 5.0 will help preserve kidney function in patients in cardiogenic shock and decompensated HF.

Methods: A retrospective review was performed on all consecutive patients supported with Impella 5.0 from August 2017 to April 2019 at Froedtert and the Medical College of Wisconsin.

Results: Out of 44 Impella 5.0 devices implanted, 34 were evaluated as a ‘bridge to decision’ regarding the potential for recovery versus evaluation for long-term ventricular assist device (VAD). Twenty-three patients presented in cardiogenic shock and 11 in severely decompensated HF. The majority of the implantations were performed via axillary approach, and four via carotid. The average length of Impella duration was 11.7 days (range 0–48 days). Five patients (15%) died and 29 (85%) survived to next therapy. Of those who survived, 15 (44%) were weaned off Impella, eight (24%) had a left VAD placed, four (12%) required escalation to veno-arterial extracorporeal membrane oxygenation and two (6%) had cardiac transplant. Major adverse complications included one case of flail mitral leaflet requiring urgent mitral valve replacement and one case of ischaemic stroke. No devices malfunctioned. Twelve (35%) patients had chronic kidney disease (CKD) prior to admission, 10 of whom (29%) had end-stage renal disease and were on haemodialysis (HD). Average serum creatinine before Impella implantation was 2.10 and on discharge was 2.07. Three (9%) patients required new HD on discharge. Of the three patients requiring new HD on discharge, one (33%) had stage 3 CKD before admission, one (33%) had normal renal function before admission and one (33%) had unknown baseline renal function.

Conclusion: For patients in cardiogenic shock and decompensated HF, prolonged haemodynamic support with the Impella 5.0 is feasible and improves mortality compared to historical values. Less than 10% of patients in cardiogenic shock and decompensated HF required new HD on discharge, while the majority of patients preserved their baseline kidney function.