Application of Impella mechanical circulatory support devices in transcatheter aortic valve replacement and balloon aortic valvuloplasty: A single center experience

Authors

M. Ramzi Almajed, Henry Ford HealthFollow
Shazil Mahmood, Henry Ford HealthFollow
Mark Obri, Henry Ford HealthFollow
Paul Nona, Henry Ford HealthFollow
Pedro Engel Gonzalez, Henry Ford HealthFollow
Michael Chiang, Henry Ford HealthFollow
Dee Dee Wang, Henry Ford HealthFollow
Tiberio Frisoli, Henry Ford HealthFollow
James Lee, Henry Ford HealthFollow
Mir B. Basir, Henry Ford HealthFollow
Brian P. O'Neill, Henry Ford HealthFollow
William O'Neill, Henry Ford HealthFollow
Pedro Villablanca, Henry Ford HealthFollow

Recommended Citation

Almajed MR, Mahmood S, Obri M, Nona P, Gonzalez PE, Chiang M, Wang DD, Frisoli T, Lee J, Basir M, O'Neill B, O'Neill W, and Villablanca P. Application of Impella mechanical circulatory support devices in transcatheter aortic valve replacement and balloon aortic valvuloplasty: A single center experience. Cardiovasc Revasc Med 2023.

Document Type

Article

Publication Date

3-21-2023

Publication Title

Cardiovasc Revasc Med

Abstract

BACKGROUND/PURPOSE: Percutaneous valve interventions for aortic stenosis (AS) include transcatheter aortic valve replacement (TAVR) and balloon aortic valvuloplasty (BAV). Intraprocedural mechanical circulatory support (MCS) with Impella devices (Abiomed, Danvers, MA) is used in select high-risk patients, although data regarding its efficacy is limited. This study sought to evaluate the clinical outcomes of Impella use in patients with AS who underwent TAVR and BAV at a quaternary-care center.

METHODS/MATERIALS: All patients with severe AS who underwent TAVR and BAV with Impella between 2013 and 2020 were included. Patient demographics, outcomes, complications, and 30-day mortality data was analyzed.

RESULTS: Over the study period 2680 procedures were performed, 1965 TAVR and 715 BAV. 120 utilized Impella support, 26 TAVR and 94 BAV. Among TAVR Impella cases, justifications for MCS included cardiogenic shock (53.9 %), cardiac arrest (19.2 %), and coronary occlusion (15.4 %). Among BAV Impella cases, justifications for MCS included cardiogenic shock (55.3 %) and protected percutaneous coronary intervention (43.6 %). The 30-day mortality rate in TAVR Impella was 34.6 % and in BAV Impella was 28 %. BAV Impella cases involving cardiogenic shock had a higher rate of 45 %. Impella remained in-use past 24 h from the procedure in 32.2 % cases. Vascular access-related complications occurred in 4.8 % cases and bleeding complications occurred in 1.5 % cases. Conversion to open-heart surgery occurred in 0.7 % cases.

CONCLUSIONS: MCS is an option for high-risk patients with severe AS who require TAVR and BAV. Despite hemodynamic support, the 30-day mortality rate remained high especially in cases where support was employed for cardiogenic shock.

PubMed ID

37012106

ePublication

ePub ahead of print