Impella Mechanical Circulatory Support for Takotsubo Syndrome With Shock: A Retrospective Multicenter Analysis
Recommended Citation
Napp LC, Westenfeld R, Møller JE, Pappalardo F, Ibrahim K, Bonello L, Wilkins C, Pershad A, Mannino SF, Schreiber TL, Hall PA, Medjamia AM, Haurand JM, Sieweke JT, Schäfer A, Grines CL, Burkhoff D, Moses JW, Ohman EM, O'Neill WW, Kapur NK, and Bauersachs J. Impella Mechanical Circulatory Support for Takotsubo Syndrome With Shock: A Retrospective Multicenter Analysis. Cardiovasc Revasc Med 2022; 40:113-119.
Document Type
Article
Publication Date
7-1-2022
Publication Title
Cardiovasc Revasc Med
Abstract
OBJECTIVES: To analyze the characteristics and outcome of Impella mechanical circulatory support (MCS) for Takotsubo syndrome (TS) with cardiogenic shock.
BACKGROUND: TS is an acute heart failure syndrome characterized by transient severe reduction of left ventricular (LV) systolic function, with cardiogenic shock occurring in around 10% of patients. Since inotropes should be avoided due to their role in TS pathogenesis and aggravation of LV outflow tract obstruction, the use of MCS as treatment is a viable treatment option, however, studies are lacking.
METHODS: The catheter-based ventricular assist device (cVAD) registry and local MCS databases were screened for TS patients with cardiogenic shock (TS-CS) supported with an Impella percutaneous ventricular assist device (pVAD). Patient and treatment characteristics and in-hospital outcomes were retrospectively analyzed.
RESULTS: At 10 US and European centers, 16 TS-CS patients supported with an Impella pVAD were identified between December 2013 and May 2018 (mean age, 61.8 ± 15.5 years; 87.5% women). LV ejection fraction (LVEF) at presentation was severely reduced (mean, 19.4 ± 8.3%). Prior to MCS, 13 patients (81.3%) were mechanically ventilated, 4 patients (25.0%) had been resuscitated, and mean serum lactate was 4.7 ± 3.5 mmol/L. Mean duration of Impella support was 1.9 ± 1.0 days (range, 1-4 days). Thirteen patients (81.3%) survived to discharge, and all survivors experienced cardiac recovery with significant improvement of LVEF at discharge compared to baseline (20.4 ± 8.8 vs. 52.9 ± 12.0, P < 0.001).
CONCLUSIONS: This is the first series of TS-CS patients supported with an Impella pVAD. Mortality was low, and LV systolic function recovered in all survivors. Prospective studies of Impella support in this special condition are warranted.
Medical Subject Headings
Aged; Female; Heart-Assist Devices; Humans; Male; Middle Aged; Prospective Studies; Retrospective Studies; Shock, Cardiogenic; Takotsubo Cardiomyopathy; Treatment Outcome
PubMed ID
34916157
Volume
40
First Page
113
Last Page
119
