Key result
Prophylactic perioperative Impella is linked to ~93% 30-day survival and improved LVEF in high-risk cardiac surgery.
Why the study?
Patients with severely reduced LV-EF ≤ 30% undergoing CABG face a high risk of postoperative cardiogenic shock, and the timing of hemodynamic support impacts mortality.
Does prophylactic perioperative Impella support improve outcomes in high-risk patients with LVEF ≤30% undergoing cardiac surgery?
Observational (n=14)
No
Does prophylactic perioperative Impella support improve outcomes in high-risk patients with LVEF ≤30% undergoing cardiac surgery?
Prophylactic perioperative Impella support in patients with LVEF ≤30% undergoing cardiac surgery is associated with high 30-day survival and improved postoperative LVEF.
Prophylactic Impella was associated with high survival and LVEF gain in this small cohort; hypothesis-generating and requires randomized trials before practice change.
Background: Patients with severely reduced LV-EF ≤ 30% undergoing CABG have a high risk for postoperative cardiogenic shock. The optimal timing of an adequate hemodynamic support has an impact on short- and midterm mortality after CABG. This study aimed to assess the prophylactic use of the Impella pump in high-risk patients undergoing elective cardiac surgery. Methods: In this single-center retrospective study, 14 patients with LV-EF (≤30%) undergoing cardiac surgery received a prophylactic, perioperative Impella (5.0, 5.5) support between 2020 and 2022. Results: The mean age at surgery was 64.2 ± 2.6 years, the mean preoperative LV-EF was 20.7% ± 1.56%. The duration of Impella support was 4 (3–7.8) days and the 30-day survival rate was 92.85%. Acute renal failure occurred in four patients who were dialyzed on average for 1.2 ± 0.7 days. Mechanical ventilation was needed for 1.75 (0.9–2.7) days. Time to inotrope/vasopressor independence was 2 (0.97–7.25) days with a highest lactate level (24 h postoperatively) of 3.8 ± 0.6 mmol/l. Postoperative LV-EF showed a significant improvement when compared to preoperative LV-EF (29.1% ± 2.6% vs. 20.7% ± 1.56% (p = 0.022)). Conclusion: The prophylactic Impella application seems to be a safe approach to improve the outcomes of this patient population.
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Benke et al. (2022) conducted an observational in High-risk patients with severely reduced LV-EF (≤30%) undergoing cardiac surgery (n=14). Prophylactic perioperative Impella (5.0, 5.5) support vs. Preoperative baseline was evaluated on Postoperative LV-EF (p=0.022). Prophylactic perioperative Impella support in high-risk cardiac surgery patients yielded a 92.85% 30-day survival rate and significantly improved LV-EF from 20.7% to 29.1% (p=0.022).
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