Article

A39 - Left Ventricular Assist Device Implantation after Extracorporeal Membrane Oxygenation Therapy and Subsequent Impella 5.0 Therapy: A Multicentre Analysis

Received:

Accepted:

Published online:

Citation:Interventional Cardiology Review 2019;14(3 Suppl 1):A39.

Correspondence: Alexander Bernhardt, al.bernhardt@uke.de

Open access:

The copyright in this work belongs to Radcliffe Medical Media. Only articles clearly marked with the CC BY-NC logo are published with the Creative Commons by Attribution Licence. The CC BY-NC option was not available for Radcliffe journals before 1 January 2019. Articles marked ‘Open Access’ but not marked ‘CC BY-NC’ are made freely accessible at the time of publication but are subject to standard copyright law regarding reproduction and distribution. Permission is required for reuse of this content.

Background: Left ventricular assist device (LVAD) therapy in INTERMACS 1 and 2 patients is associated with a less favourable outcome compared to stable patients. Often, an arterial-venous extracorporeal membrane oxygenation therapy (ECMO) is implanted to stabilise patients first and improve end-organ function. However, ECMO therapy itself is associated with complications, such as thromboembolism and bleeding. Therefore, an Impella 5.0 is implanted to avoid these complications and unload the left ventricle. We report the multicentre experience in patients after change from ECMO to Impella 5.0 therapy with subsequent LVAD implantation.

Methods: We retrospectively evaluated nine patients in two European centres after ECMO, Impella 5.0 and subsequent LVAD implantation. The mean age was 53.0 ± 6.2 years and eight (88.9%) were men. ECMO was placed for acute MI in seven patients (77.8%) and eight patients (88.9%) were resuscitated. Median follow-up was 227 days (range 127–380 days).

Results: The median time on ECMO before Impella 5.0 implantation was 8 days (range 4–14 days). The ECMO was weaned successfully in all patients over a median of 22 hours (range 0–72 hours). Eight patients (88.9%) were mobilised while on Impella support. The total median time on Impella 5.0 was 17 days (range 12–21 days). Two patients underwent LVAD implantation as a re-do operation. Seven patients (77.8%) had a Medtronic HVAD and two patients (22.2%) had Abbott HeartMate 3 implantation. One patient (11.1%) experienced right ventricular (RV) failure requiring temporary RV assist device implantation. The 30-day survival was 100%. During follow-up, one patient was transplanted after 8 days. One patient died after 380 days. All other patients are still on the device.

Conclusion: The change from ECMO to Impella 5.0 therapy before LVAD implantation allowed LV unloading, end-organ recovery and assessment of RV function. Excellent survival was seen in this small patient cohort. This promising approach should be evaluated in a larger patient series.