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Perioperative temporary mechanical circulatory support with Impella in cardiac surgery patients
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  • Mateo Marin-Cuartas,
  • Katharina Wehrmann,
  • Michael Höbartner,
  • Sven Lehmann,
  • Christian Etz,
  • Diyar Saeed,
  • Michael Borger
Mateo Marin-Cuartas
Herzzentrum Leipzig Universitätsklinik
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Katharina Wehrmann
Herzzentrum Leipzig Universitätsklinik
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Michael Höbartner
Herzzentrum Leipzig Universitätsklinik
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Sven Lehmann
Herzzentrum Leipzig Universitätsklinik
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Christian Etz
Herzzentrum Leipzig Universitätsklinik
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Diyar Saeed
Herzzentrum Leipzig Universitätsklinik
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Michael Borger
Herzzentrum Leipzig Universitätsklinik
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Abstract

Background: The benefits of perioperative mechanical circulatory support (MCS) in cardiac surgery patients are still uncertain. This study aims to review early outcomes of perioperative temporary MCS using the Impella device in cardiac surgery patients. Methods: Retrospective, single center analysis in cardiac surgery patients presenting with cardiogenic shock (CS) in whom Impella was used for perioperative temporary MCS, whether as single device therapy or as left ventricular (LV) venting strategy for concomitant extra corporeal membrane oxygenation (ECPELLA). Study outcomes were 30-day mortality and occurrence of complication composite outcome. Results: Between 2016 and 2019, a total of 33 consecutive patients were supported with Impella [single-device therapy in 19 (57.6%) patients and ECPELLA in 14 (42.4%) patients]. The 30-day mortality of Impella-alone and ECPELLA groups was 15.8% and 50.0% (P=0.03).The 30-day mortality according to pre-, intra- and postoperative implantation was 12.5%, 60.0% and 28.6% (P=0.04), and it was significantly lower in those patients in whom a left ventricular assist device was implanted in comparison to all other surgical procedures (P<0.01). The complication composite outcome occurred more frequently after axillary implantation in comparison to femoral Impella (P=0.05) due to higher stroke rates (P=0.03). Bleeding requiring surgical re-exploration was more frequent in the ECPELLA than in the Impella-alone group [1 (3.0%) vs 5 (15.1%);P=0.03]. Conclusions: Temporary MCS with Impella is associated with high complication and mortality rates. However, preoperative use of Impella as single-device temporary MCS is associated with lower mortality rates and is a reasonable alternative as bridge-to-decision strategy for acutely decompensated patients.

Peer review status:UNDER REVIEW

21 May 2021Submitted to Journal of Cardiac Surgery
21 May 2021Assigned to Editor
21 May 2021Submission Checks Completed
02 Jun 2021Reviewer(s) Assigned