Dual-Center Retrospective Analysis of 30-Day Survival in Cardiogenic Shock Patients Supported with Catheter-Based Microaxial Left Ventricular Assist Devices

Objectives: Catheter-based microaxial left ventricular assist devices are becoming increasingly important in cardiogenic shock treatment. Percutaneous Impella CP and surgical implantable Impella 5.0/5.5 are the most commonly used devices worldwide. We compared the short-term outcomes of patients suffering from cardiogenic shock supported with Impella CP and 5.0/5.5.

Methods: Propensity score-adjusted retrospective analysis of adult cardiogenic shock patients treated with Impella CP (n = 64) and Impella 5.0/5.5 (n = 62) devices at the Cardiology Department of the Charité University Hospital Berlin and the German Heart Center Berlin. Propensity score adjustment included demographic parameters and the severity of cardiogenic shock. The primary endpoint was 30-day survival.

Result: Patients in the Impella CP group were older (69 ± 10.7 vs. 58.6 years, p = 0.001), more likely in INTERMACS stage 1 (76.6 vs. 50%, p = 0.003), and had a higher incidence of cardiopulmonary resuscitation (36 vs. 13%, p = 0.006). The 30-day survival of unadjusted patients was significantly higher in patients supported with Impella 5.0/5.5 devices (58 vs. 36%, p = 0.021). The hazard ratio for Impella CP was 1.96 [1.24, 3.08], p = 0.004. After propensity score adjustment, the 30-day survival was similar in both groups (HR 1.08 [0.55, 2.13], p = 0.822). The bootstrapping analysis, used to estimate optimal cut-off levels for preoperative lactate, did not reveal significant differences between devices (41.1 mg/dL for Impella CP and 36.3 mg/dL for Impella 5.0/5.5).

Conclusion: Both Impella devices offer similar effects in outcomes of patients suffering from profound cardiogenic shock. Patients in INTERMACS stage 1 have a high mortality. The benefit of more advanced support employing extracorporeal life support or its combination with Impella should be further evaluated.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021