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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Outcomes of patients with right ventricular failure requiring short-term hemodynamic support with the Impella RP device

      BACKGROUND

      Right ventricular failure (RVF) after myocardial infarction, cardiotomy, or left ventricular assist device (LVAD) implantation increases morbidity and mortality. RVF also contributes to prolonged length of hospital stay and higher costs of care. The aim of this study was to evaluate the efficacy and safety of the Impella RP (Abiomed, Danvers, MA) in patients with severe RVF in these clinical settings.

      METHODS

      This is a prospective cohort study of patients with severe RVF treated with a percutaneous right ventricular assist device (RVAD). Sixty patients with RVF refractory to medical treatment received the Impella RP device at 14 United States institutions as part of the Impella RP pre‒ and post‒market approval studies. The study population included 2 cohorts: Cohort A, patients with RVF post-(LVAD) implantation (n = 31); and Cohort B, patients with RVF post-cardiotomy, heart transplant, or myocardial infarction (n = 29). The primary end-point was survival at 30 days or hospital discharge (whichever was longer).

      RESULTS

      Mean age of patients was 59 ± 15 years; 68% were males, 84% had a history of congestive heart failure, 44% had valvular disease, and 35% had pre-operative renal dysfunction. Patients received an average of 3.4 inotropes/vasopressors before the Impella RP implant. Patients were supported with the Impella RP for 4.0 ± 1.5 (0.5 to 14) days. Hemodynamics improved immediately after initiation of device support, with an increase in cardiac index from 1.9 ± 0.1 to 3.1 ± 0.2 liters/min/m2 (p < 0.001) and a decrease in central venous pressure from 19.0 ± 1 to 13 ± 1 mm Hg (p < 0.001). The overall survival at 30 days (or discharge) was 72%.

      CONCLUSIONS

      To the best of our knowledge, this study represents the largest prospective study of patients with life-threatening RVF. Mechanical support with the Impella RP device in patients with RVF resulted in rapid hemodynamic improvement with reversal of shock and favorable survival.

      KEYWORDS

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      References

        • Drakos SG
        • Janicki L
        • Horne BD
        • et al.
        Risk factors predictive of right ventricular failure after left ventricular assist device implantation.
        Am J Cardiol. 2010; 105: 1030-1035
        • Kormos RL
        • Teuteberg JJ
        • Pagani FD
        • et al.
        Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes.
        J Thorac Cardiovasc Surg. 2010; 139: 1316-1324
        • Rich JD
        Right ventricular failure in patients with left ventricular assist devices.
        Cardiol Clin. 2012; 30: 291-302
        • Voelkel NF
        • Quaife RA
        • Leinwand LA
        • et al.
        Right ventricular function and failure: report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure.
        Circulation. 2006; 114: 1883-1891
        • Zehender M
        • Kasper W
        • Kauder E
        • et al.
        Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction.
        N Engl J Med. 1993; 328: 981-988
        • Mehta SR
        • Eikelboom JW
        • Natarajan MK
        • et al.
        Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction.
        J Am Coll Cardiol. 2001; 37: 37-43
        • Matthews JC
        • Koelling TM
        • Pagani FD
        • et al.
        The right ventricular failure risk score a pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates.
        J Am Coll Cardiol. 2008; 51: 2163-2172
        • Jacobs AK
        • Leopold JA
        • Bates E
        • et al.
        Cardiogenic shock caused by right ventricular infarction: a report from the SHOCK registry.
        J Am Coll Cardiol. 2003; 41: 1273-1279
        • Apostolakis S
        • Konstantinides S
        The right ventricle in health and disease: insights into physiology, pathophysiology and diagnostic management.
        Cardiology. 2012; 121: 263-273
        • Goldstein JA
        • Kern MJ
        Percutaneous mechanical support for the failing right heart.
        Cardiol Clin. 2012; 30: 303-310
        • Anderson MB
        • Goldstein J
        • Milano C
        • et al.
        Benefits of a novel percutaneous ventricular assist device for right heart failure: the prospective RECOVER RIGHT study of the Impella RP device.
        J Heart Lung Transplant. 2015; 34: 1549-1560
        • Karimov JH
        • Sunagawa G
        • Horvath D
        • et al.
        Limitations to chronic right ventricular assist device support.
        Ann Thorac Surg. 2016; 102: 651-658
        • Moazami N
        • Fukamachi K
        • Kobayashi M
        • et al.
        Axial and centrifugal continuous-flow rotary pumps: a translation from pump mechanics to clinical practice.
        J Heart Lung Transplant. 2013; 32: 1-11
        • Morgan JA
        • O'Neill WW
        percutaneous right ventricular assist device support in a patient supported by an LVAD.
        ASAIO J. 2016; 62 (e41-e2)
        • John R
        • Long JW
        • Massey HT
        • et al.
        Outcomes of a multicenter trial of the Levitronix CentriMag ventricular assist system for short-term circulatory support.
        J Thorac Cardiovasc Surg. 2011; 141: 932-939
        • Kapur NK
        • Paruchuri V
        • Jagannathan A
        • et al.
        Mechanical circulatory support for right ventricular failure: the TandemHeart in Right VEntricular support (THRIVE) Registry.
        JACC Heart Fail. 2013; 1: 127-134
        • den Uil CA
        • Jewbali LS
        • Heeren MJ
        • et al.
        Isolated left ventricular failure is a predictor of poor outcome in patients receiving veno-arterial extracorporeal membrane oxygenation.
        Eur J Heart Fail. 2017; 19: 104-109
        • Kapur NK
        • Paruchuri V
        • Korabathina R
        • et al.
        Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure.
        J Heart Lung Transplant. 2011; 30: 1360-1367
        • Kapur NK
        • Esposito ML
        • Bader Y
        • et al.
        Mechanical circulatory support devices for acute right ventricular failure.
        Circulation. 2017; 136: 314-326
      1. Basir B, Schreiber T, O'Neill WW et al. Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: the Detroit Cardiogenic Shock Initiative. Cathet Cardiovasc Interv, in press.