causes of mortality table

The Insertion of Impella 5.0™ in the Right Subclavian Artery for Treatment of Acute Decompensated Heart Failure

December 9, 2016

Key Takeaways

  • In this study, all patients were in cardiogenic shock and on at least 2 pressors.
  • Using the right subclavian artery, heart failure patients experienced an improvement in end organ function and hemodynamic stability. The device was placed via cutdown through an 8 mm vascular graft.
  • A survival-to-discharge rate of 62.5% and bridge-to-success rate of 70.8% were reported for patients receiving Impella 5.0™ support using the right subclavian artery.

A recent retrospective review published in The Ochsner Journal reveals advantages to using the right subclavian artery (RSA) for the insertion of Impella 5.0™ in the management of acute decompensated heart failure (ADHF). This synopsis provides a brief overview of how this technique may benefit end organ function in ADHF patients while improving left ventricular unloading and time to recovery.

As an exacerbated form of cardiac dysfunction, ADHF comprises a significant proportion of money spent on HF care.1 The use of minimally invasive left ventricular assist devices (LVADs), like Impella 5.0™, can be used for ADHF patients to provide hemodynamic support.

Although Impella® is often inserted via the femoral artery, this retrospective review of 24 patients with ADHF examined the benefits of inserting the device via a cutdown through the RSA.2 As usual for device placement, transesophageal echocardiography and fluoroscopy were used to position the device.

Table 1. Causes of Mortalitya
causes of mortality table
aData from Bansal A, Bhama JK, Patel R, et al2

Patients experienced a significant improvement in both hemodynamics and end organ function, as assessed by the Model for End-Stage Liver Disease (MELD) score. The authors also point out that Impella® provided a survival-to-discharge rate of 62.5% and bridge-to-success rate of 70.8%.

Six patients recovered, 9 patients received permanent LVAD support, 2 required heart transplantation, and 7 patients died. Mortality was attributable to a number of different causes, including pneumonia, shock, and ventricular arrhythmia, among others (Table 1).a

References:

  1. Joseph SM, Cedars AM, Ewald GA, Geltman EM, and Mann DL. Acute Decompensated Heart Failure: Contemporary Medical Management. Tex Heart Inst J. 2009;36(6):510-520.
  2. Bansal A, Bhama JK, Patel R, et al. Using the Minimally Invasive Impella 5.0 via the Right Subclavian Artery Cutdown for Acute on Chronic Decompensated Heart Failure as a Bridge to Decision. Ochsner J. 2016;16(3):210-216.

To learn more about the Impella® platform of heart pumps, including important risk and safety information associated with the use of the devices, please visit: www.protectedpci.com/indications-use-safety-information/

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