The Impella 5.5 as a Short Term Mechanical Circulatory Support Device in High Risk Cardiac Surgery

Purpose Post-cardiotomy cardiogenic shock (PCCS) is a life-threatening condition characterized by severe myocardial contractile impairment and reduced end organ perfusion. PCCS has been reported to occur in up to 9% of all cardiac surgery cases with a mortality approaching 40%. The Impella 5.5 micro-axial, full support, surgical pump has emerged as a useful support device in the setting of weaning from cardiopulmonary bypass (CPB) and for the mitigation of a low cardiac output syndrome. Methods From July 2020 to September 2020, 7 consecutive patients underwent urgent cardiac surgery supported by the Impella 5.5 device. In all cases, the Impella 5.5 was implanted during the index cardiac surgery via the ascending aorta using a 10mm woven Dacron graft and positioned using transesophageal echo guidance. In this retrospective study, we evaluated short-term outcomes of hospital mortality, acute kidney injury, cerebrovascular events, and device-related adverse events. Results The mean age was 61 years (range 46-71). Mean preoperative LVEF was 31% (range 25-50). Six patients underwent coronary artery bypass grafting and one patient underwent redo sternotomy and mitral valve replacement. The Impella 5.5 was implanted prior to weaning from cardiopulmonary bypass in six patients and for the onset of post-cardiotomy shock in one patient. In all patients, hemodynamics improved and stabilized immediately after the initiation of Impella support. The mean duration of Impella support was 3.8 days (1.9-6.6 days). There were no in-hospital deaths, no reoperation for bleeding, and no patients suffered a neurologic complication or renal failure requiring dialysis. There was no incidence of hemolysis requiring device explantation. All patients experienced native heart recovery. Four patients (57%) were discharged home, and three patients were discharged to a skilled nursing facility or rehabilitation center. Conclusion The peri-operative use of the Impella 5.5 heart pump facilitates surgery on high‐risk patients with depressed left ventricular ejection fraction and helps to prevent post-cardiotomy shock. Prospective studies looking at the preemptive use of the Impella 5.5 in these patients are needed.