Abstract 15103: Impella 5.0 as a Bridge to Clinical Decision Making

Introduction:Impella 5.0 As A Bridge To Clinical Decision MakingHypothesis:Mortality from cardiogenic shock remains a significant clinical challenge. We report our institutional experience with the Impella 5.0 as a means to improve survival and serve as a bridge to clinical decision making in patients presenting with cardiogenic shock and severely decompensated end stage heart failure (HF).Methods:A retrospective review was performed on all consecutive patients supported with Impella 5.0 from August 2017 to April 2019 at Froedtert and the Medical College of Wisconsin.Results:Out of 44 Impella 5.0 devices implanted, 34 were evaluated as a ?bridge to decision? regarding the potential for recovery vs. evaluation for long-term ventricular assist device (VAD). Twenty-three patients presented in cardiogenic shock and 11 in severely decompensated HF. All implantations were performed via axillary approach except four via carotid. The average number of pressors was 1.5 and patients were on pressors an average of 1.7 days after Impella implantation. The average length of Impella duration was 11.7 days (range 0 - 48 days). Five patients (15%) died and 29 (85%) survived to next therapy. Of all patients, 15 (44%) were weaned off Impella, 8 (24%) had an LVAD placed, 4 (12%) required escalation to VA ECMO, and 2 (6%) had cardiac transplant. Of the 5 that died, 4 (80%) were not VAD candidates (for psychosocial reasons) so decided on withdrawal of care. Major adverse complications included one case of flail mitral leaflet requiring urgent mitral valve replacement and one case of ischemic stroke. No devices malfunctioned and there were six major bleeding events from axillary cutdown with one requiring surgery. Two (6%) patients had hemolysis requiring device removal on days 6 and 18. Average serum creatinine before Impella was 2.10 and on discharge was 2.07 with 3 patients requiring dialysis on discharge.Conclusions:For patients with cardiogenic shock and decompensated HF, prolonged hemodynamic support with the Impella 5.0 is feasible and improves mortality compared to historical values. This strategy serves as a bridge to clinical decision making, buying time for VAD evaluation and recovery of cardiac function in a subset of the population.