the impella 5.0 device: surgical and cardiogenic shock ... · the impella 5.0 device: surgical and...
TRANSCRIPT
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The Impella 5.0 Device: Surgical and
Cardiogenic Shock Applications
Anson Cheung, MD
Surgical Director of Cardiac Transplantation and Mechanical
Circulatory Assist Program of British Columbia
Associate Professor of Surgery
St. Paul’s Hospital
University of British Columbia
Vancouver, Canada
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Disclosures
• Abiomed
Speaker’s Bureau
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2
Surv
iva
l
Time (Hours)
Initial Insult (Pump Failure)- AMI, myocarditis, post-partum cardiomyopathy, etc
Circulatory Insufficiency- Hypotension, end-organ hypoperfusion
Acute Heart Failure Cascade
Activation of Inflammatory Cascade- Endothelial dysfunction, vasoplegia, tissue edema, worsening pump failure
Worsening Circulatory Insufficiency- Hypotension, end-organ hypoperfusion
Total Circulatory Collapse
Death
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Impella 5.0 Device
Acute Cardiogenic Shock
Decision
1. Recovery
- End-organs
- Myocardial
2. Bridge
- Implantable VAD
3. Transplant
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Impella Microaxial Flow Pumps
Impella 2.5 and 5.0 are investigational devices in the United States. Impella RD is not FDA approved.
Co
ns
ole
Pu
mp
s
LP 2.5
LP 5.0LD 5.0 RD
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12 F = 4 mm
21 F = 7 mm
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Femoral Cutdown – Purse-string
Technique
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Femoral Cutdown – Graft Technique
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Vancouver Experience
Oct, 07 – Sept, 09
28 IMPELLA LP 5.0 devices
were implanted
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Etiology of Cardiogenic Shock
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Age 53.5 ± 13.9 (13-77)
Male Sex 24 (86%)
BSA (m2) 2.1 ± 0.2
Previous MI 14 (58%)
COPD 8 (33%)
Previous OHS 7 (29%)
Diabetes Mellitus 6 (25%)
Patient Demographics
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At Implant
Cardiac Index (l/min/m2) 1.7 ± 0.7
LVEF (%) 19 ± 10
SV02 (%) 54 ± 6
SBP (mmHg) 85 ± 18
Mean Number of Inotropes 3
IABP 16 (57%)
Other Device Support 2 (8%)
Acute Renal Failure 22 (79%)
Intubation 27 (96%)
Cath Lab Implant 3 (11%)
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Hemodynamics
Cardiac Index (l/min/m2) 2.7 ± 0.7
SV02 (%) 69
Continuous Renal Replacement
Therapy
10 (22 ARF)
Duration of Support (days) 4.4 ± 3 (1 – 11)
On Support
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28 IMPELLA LP 5.0 Patients
Bridge to Recovery
Weaned/Explanted
(15)
Bridge to Bridge
Implantable VAD
(7)
Died on
Support
(6)
30-day Survival – 61%
Survival to Discharge – 56%
All discharge patients in NYHA Class I, II
Died
3
Discharged
Home
(11)
Died
(3)
Discharged
Home
(4)
In-patient
(1)
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Device Related Complications….
• No mechanical failure
• No pump repositioning required during
support
• Pressure sensor malfunctioning in 4 Impella
LP5.0
False pump misplacement alarms
No flow display on console
No negative hemodynamic effect
No pump replacement
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Device Related Complications….
• No peripheral vascular complications
• No cerebrovascular events
• No reoperation for bleeding or tamponade
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Clinical Case
• 41 y/o male with ADHF
• EF ~ 10%, LVEDD 71 mm
• Prev. IVDU, current smoker and marijuna user, poor
social support, depression
• Cath
– Normal coronaries
– Endomyocardial biopsy
– CI 1.7, PAWP 28
• 6 hrs post cath
• Cardiogenic shock on multiple, high dose inotropes
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Clinical Case
• Impella LP5.0 inserted in Cath lab
• Post-implant Care
– CCU
• Recovery in 5 days (EF at explant - 40%)
• Explanted in CCU (local anesthetics)
• Discharged home in 10 days
• ~2 yr F/U – EF 47% NYHA I
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Summary
• Impella 5.0 microaxial flow pump provide
sufficient circulatory support in patients
with severe cardiogenic shock
• In our early experience, Impella LVAD is
easy and safe to operate with no major
device related adverse events
• The ease of implant, explant and transport
may be advantageous over other current
devices
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Thank You
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Impella RD
• Right ventricular
support
• Days to months
• Allows ambulation