Key result
Early intraoperative Impella linked to ~69% lower in-hospital mortality versus delayed initiation in postcardiotomy shock.
Why the study?
To elucidate the strategy of effective Impella support for better clinical outcomes in patients with postcardiotomy cardiogenic shock.
Does early initiation of Impella support reduce in-hospital mortality in patients with postcardiotomy cardiogenic shock compared to delayed initiation?
Observational (n=31)
No
Does early initiation of Impella support reduce in-hospital mortality in patients with postcardiotomy cardiogenic shock compared to delayed initiation?
Absolute Event Rate: 28.6% vs 90.9%
p-value: p=0.004
Early intraoperative initiation of Impella support in patients with postcardiotomy cardiogenic shock is associated with significantly lower in-hospital mortality compared to delayed postoperative initiation.
May support earlier Impella use in postcardiotomy shock; hypothesis-generating and requires randomized confirmation.
PURPOSE: This study aimed to elucidate the strategy of an effective Impella support for better clinical outcomes in patients with a postcardiotomy cardiogenic shock (PCCS). METHODS: This single-center retrospective observational study enrolled 31 patients with PCCS undergoing an elective open-heart surgery followed by Impella support between November 2018 and February 2022 for further analysis. RESULTS: The preoperative Euroscore II and left ventricular (LV) ejection fraction were 9.1 ± 10.4 and 35.7% ± 12.6%, respectively. The in-hospital mortality rate was 51.6% (n = 16). In survivors (n = 15), the mean Impella support time was 6.9 ± 3.5 days. Patients were discharged on the postoperative day 24.9 ± 16.4. Regarding LV remodeling, LV end-diastolic diameter was significantly decreased after Impella support (59.2 ± 6.0 mm vs. 54.4 ± 4.7 mm, p = 0.01, preoperative vs. postoperative). In-hospital mortality rates were comparable with small (CP, n = 6) or large (5.0, n = 25) Impella systems (33.3% [n = 2] vs. 56.0% [n = 14], p = 0.39). However, a lower in-hospital mortality rate was observed in the group with early initiation (i.e., intraoperative) of Impella support (n = 14) than that with delayed Impella initiation (i.e., in the postoperative course) (n = 11) (28.6% [n = 4] vs. 90.9% [n = 10], p = 0.004). CONCLUSIONS: Impella support contributes to LV remodeling in PCCS patients. In-hospital mortality was comparable in different Impella sizes and lower in early Impella initiation.
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Sugimura et al. (2023) conducted an observational in Postcardiotomy cardiogenic shock (n=31). Early (intraoperative) Impella initiation vs. Delayed (postoperative) Impella initiation was evaluated on In-hospital mortality (p=0.004). Early intraoperative initiation of Impella support was associated with a significantly lower in-hospital mortality rate compared to delayed postoperative initiation (28.6% vs. 90.9%) in patients with postcardiotomy cardiogenic shock.
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