BACKGROUND Cardiogenic shock involving biventricular failure (BiVF) is associated with increased in-hospital mortality. This study explored the clinical utility of employing two micro-axial flow Impella catheters for biventricular support (BiPella) in the setting of BiVF. METHODS We retrospectively reviewed data from 14 patients receiving BiPella support for BiVF from 3 tertiary-care hospitals in the United States. Medical records were reviewed for demographics, hemodynamics, laboratory data, and BiPella implant details. RESULTS BiVF was due to acute myocardial infarction (n=6), advanced heart failure (n=4), cardiac surgery (n=2), and myocarditis (n=2). Mean ejection fraction was 22+11%. BiPella patients had moderate or severe systolic dysfunction (100%), elevated right atrial (RA) pressure (21±4), elevated RA: wedge ratio (0.9±0.2), a low pulmonary artery (PA) pulsatility index (0.9±0.7). The duration of LV and RV support was 4±3 and 4±2 days with mean LV and RV flows of 3.2±0.9 and 3.4±0.5 liters/minute respectively. RA pressure and PA saturation improved after BiPella activation. In-hospital mortality was 50%. No intra-procedural mortality was observed. Complications included limb ischemia (n=1), bleeding requiring a transfusion (n=7), and hemolysis (n=5). Among survivors, 2 bridged to LVAD before discharge. No patients were bridged to ECMO, BiVAD, or transplant. Survivors were younger, had higher vasopressor use, lower mean PA pressures, and lower glomerular filtration rates. All survivors received RV support at the same time as LV support (Simultaneous), whereas 57% of non-survivors received delayed RV support (Staged). CONCLUSION This is the largest multicenter report describing the clinical utility of BiPella support in BiVF. BiPella is feasible and associated with improved hemodynamics. Simultaneous, not staged, LV and RV support is associated with improved survival. (Table Presented).
Kapur, N., Breton, C., O’Kelly, R., Esposito, M., Mullin, A., Annamalai, S., … Morris, D. L. (2016). TCT-126 Simultaneous, not Staged, Deployment of Biventricular Micro-Axial Flow Impella Catheters (BiPella) is Associated with Improved Survival for Cardiogenic Shock Involving Biventricular Failure. Journal of the American College of Cardiology, 68(18), B51. https://doi.org/10.1016/j.jacc.2016.09.032