Experience with the Impella® recovery axial-flow system for acute heart failure at three cardiothoracic centers in Sweden

Figures & data

Figure 1.  Impella assist device for left (upper) and right (lower) ventricular support. (With permission from AbioMed)

Table I.  Demographic data of Impella patients

	Surgical group (n = 33)		Non-surgical group (n = 17)
Demographics	(n)		(n)
Age, years (mean, range)		58.1(27 to 84)		47.5(36 to 63)
Male	24	73%	11	79%
BSA, m^2 (mean, range)		1.9 (1.5 to 2.7)		1.9 (1.1 to 2.1)
Previous cardiac surgery	7	21%	0	0%
Myocardial infarction	14	42%	6	43%
Stroke	1	3	0	0%
Diabetes Mellitus	7	21%	2	14%
Atrial fibrillation	11	33%	1	7%
Impaired kidney function	4	12%	2	14%
CPB-time, min (mean, range)		249 (57 to 452)
X-clamp time, min (mean, range)		100 (0 to 236)
NYHA (mean)		3.6		3.8
EuroScore standard (mean, range)		9.1 (2 to 18)		10.1 (3 to 17)
Indication for treatment
Postcardiotomy LOS	19	58%
Cardiogenic shock	10	30%	9	53%
Myocarditis	1	3%	5	29%
Prophylactic use			3	18%
Other	3	9%
Treatment aim
Bridge to recovery	22	67%	15	88%
Bridge to other LVAD	8	24%	2	12%
Bridge to Tx	3	9%

Abbreviations: BSA, Body Surface Area; CPB-time, cardiopulmonary bypass time; LOS, low output syndrome; LVAD, left ventricular assist device; NYHA, New York Heart Association Class; Tx, Heart transplantation; X-clamp time, aortic cross-clamp time.

Figure 2.  Cumulative survival in the surgical group (n = 33) and non-surgical group (n = 17). Unfilled circles in the surgical group and filled squares in the non-surgical group shows non-survivors.

Table II.  Surgical group.

	Survived (n = 18)	Died (n = 15)	p-value
Survivors versus non-survivors at 30 days
Age	56.8± 14 years	59.5±12.7 years	n.s
CPB-time (mean, range)	246 (57 to 452 min)	251 (125 to 445 min)	n.s
EuroScore standard (mean)	9.5	8.5	n.s
NYHA (mean)	3.6	3.5	n.s
Preop IABP	8	0	0.01
Support time	4.1±2.3 days	3.6±2.6 days	n.s
CPO (6 hours po)	0.72±0.2 W	0.53±0.2 W	0.04
CPO (12 hours po)	0.88±0.2 W	0.55±0.2 W	0.03
CO (12 hours po)	5.5±1.0 L/min	4.1±1.1 L/min	0.04
PaPm (12 hours po)	23.6±6.9 mmHg	32.9±13.3 mmHg	n.s
CVP (12 hours po)	13.2±3.5 mmHg	16.4±3.6 mmHg	n.s
SvO2 (12 hours po)	62.5±9.2%	53.6±15.8%	n.s
Survivors versus non-survivors at 1 year
	Survived (n = 12)	Died (n = 21)	p-value
CPO (12 hours po)	0.94±0.1 W	0.66±0.2 W	0.04
SvO2 (12 hours po)	67±8%	55±13%	0.02

Abbreviations: CO, cardiac output; CPB, Cardiopulmonary bypass; CPO, cardiac power output; CVP, central venous pressure; IABP, intra-aortic balloon counter-pulsation; NYHA, New York Association class; PaPm, mean pulmonary artery pressure; SvO₂, mixed venous oxygen saturation.