Author + information
- Guillermo Andres Cortes,
- Kevin Platt,
- Ryan Kobayashi,
- Ray Matthews,
- Anilkumar Mehra,
- Michael Gaglia,
- David Shavelle and
- Leonardo Clavijo
Previous studies demonstrate that in patients with cardiogenic shock the Impella® (Abiomed, Danvers, MA) and Tandem Heart® (CardiacAssist, Pittsburg, PA) percutaneous left ventricular hemodynamic support devices improve cardiac index, systemic blood pressure and mixed venous oxygen saturation. These devices are expensive, survival data in this patient population is missing and comparisons between devices are lacking.
Compare clinical and procedural characteristics, outcomes and complications in patients with refractory cardiogenic shock (RCS) treated with the TH and IMP for hemodynamic support.
Baseline demographics, clinical characteristics, procedural information and hospital outcomes were investigated from January 2008 to June 2013 in patients treated with either IMP or TH at Keck Medical Center of USC and LAC-USC Medical Center.
A total of 83 patients had TH or IMP for circulatory support; 20 patients had device implantation for RCS (12 TH and 8 IMP). Mean age was 54.1±16.4, 80% of patients were male, 45% smokers, 35% diabetic and 20% CRI. Ischemic cardiomyopathy was the etiology of RCS in 55% of patients. Ejection fraction averaged 21±12%. IMP patients were older (66±9 vs. 46±15, p=0.004). The overall mortality was 65% (TH 58.3% vs. IMP 75%, p=0.64). Table outlines in-hospital outcomes.
In this small patient cohort we found no significant difference between IMP and TH for the treatment of RCS. Vascular, neurological and rhythm related complications were similar. Overall mortality remains high in patients with RCS despite TH and IMP support. Prospective trials and comparative studies of TH and IMP in patients with RCS are needed before a recommendation for use is made.
|Complications||All n (%)||Impella® n (%)||Tandem Heart® n (%)||p value|
|Acute Limb Ischemia||2(10.0)||1(12.50)||1(8.33)||1.0|
|Acute Renal Failure||16(80.0)||7(87.50)||9(75.0)||0.62|