The impella micro-axial flow catheter is safe and effective for treatment of myocarditis complicated by cardiogenic shock: An analysis from the global CVAD registry
Annamalai S, Esposito M, Kuchibhotla S, Hall S, Schreiber T, O'Neill W, Kapur N. The impella micro-axial flow catheter is safe and effective for treatment of myocarditis complicated by cardiogenic shock: An analysis from the global CVAD registry. J Am Coll Cardiol. 2017;70(18):B212.
J Am Coll Cardiol
BACKGROUND Myocarditis complicated by cardiogenicshock (Myo- CS) remains a complex clinical problem. Theuse of acute circulatory support devices for CS is growing. We explored the clinical utility of Impella micro-axial flowcatheters in the setting of Myo-CS. METHODS We retrospectively analyzed data from 21 sites within the cVADregistry, an ongoing multicenter voluntary registry at sites in North America and Europe that have used Impella in patients with Myo-CS. Myocarditis was defined byendomyocardial biopsy in 34% (n=11) or by clinical history without angiographic evidence of coronary disease (n=23). RESULTS A total of 34 patients receiving Impella support forMyo-CS were identified. Mean age was 42±17 years with 17 males and mean left ventricular ejection fraction (LVEF) on admission was 18±10%. Baseline mean cardiac index was 1.8±0.5 L/min/m2, pulmonary capillary wedge pressure was 25±7 mmHg, and right atrial pressure was 22±3 mmHg. Mean lactate was 27±31 mg/dL. 32% (n=11) of patients required intra-aortic balloon pump and 85% (n=29) required pressor/inotrope therapy prior to Impellaplacement. Impella support was used for a mean duration of 90.56±74.26 hours. Mean LVEF improved from admission to discharge (18+10% to 37+20%, p=0.001). In-hospital mortality was 38% (n=13), 47% (n=16) of patients were discharged alive with 94% recovering without need forfurther device therapy (Figure). CONCLUSION This is thelargest analysis of Impella-supported myocarditis cases to date. The use of the Impella appears to be safe and effective in the setting of Myo-CS. (Figure Presented).