Treatment With Impella Increases the Risk of De Novo Aortic Insufficiency Post Left Ventricular Assist Device Implant

Sriram D. Rao, Bryce Johnson, Salim E. Olia, Joyce Wald, Venessa Medina, J. Eduardo Rame, Jeremy A. Mazurek, Lee R. Goldberg, Pavan Atluri, Christian Bermudez, Michael Acker, Edo Y. Birati

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background: Impella (Abiomed Inc, Danvers, MA) is a temporary mechanical support device positioned across the aortic valve, and can be used to support patient before LVAD implantation. There are no data on the incidence of aortic insufficiency (AI) in patients supported with Impella as a bridge to durable LVAD implantation. We sought to assess the incidence of AI in patients with Impella support as a bridge to durable left ventricular assist device (LVAD) implantation. Methods: We reviewed all patients undergoing primary LVAD implantation at the University of Pennsylvania from January 2015 onward, comparing those supported with Impella as temporary mechanical support with those supported by either venoarterial extracorporeal life support or an intra-aortic balloon pump. We reviewed transthoracic echocardiography preoperatively, as well as at 1 week, 1, 3, 6, 9, and 12 months after LVAD implantation. Results: A total of 215 echocardiograms were analyzed in 41 patients. Eleven patients were supported with Impella before LVAD implant—6 patients with Impella alone (5 with Impella CP, 1 with Impella 5.0) and 5 with Impella in conjunction with venoarterial extracorporeal life support (2 with Impella 2.5, 2 with Impella CP, and 1 with Impella 5.0). After LVAD implant, mild or moderate AI developed in 82% of patients supported with Impella (9 of 11) compared with 43% of those without Impella (13 of 30) (P = .038). Conclusions: Patients supported by Impella as a bridge to durable LVAD have a higher risk of developing AI. Further studies are needed to assess this risk as the use of the Impella increases.

Original languageEnglish
Pages (from-to)870-875
Number of pages6
JournalJournal of Cardiac Failure
Volume26
Issue number10
DOIs
StatePublished - Oct 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2020 Elsevier Inc.

Keywords

  • Aortic incompetence/regurgitation
  • Impella
  • Left ventricular assist device
  • cardiogenic shock
  • mechanical circulatory support
  • temporary circulatory support

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