Pitié-Salpêtrière experience with Abiomed Impella LP 5.0

Impella LP 5.0 is a micro-axial, catheter-based left ventricle assist device (LVAD), which is inserted retrograde into the left ventricle across the aortic valve through a surgical peripheral access. From December 2010 to October 2011 we supported 14 patients with Impella 5.0. The mean age was 53 years and male gender was prevalent (78.6%). All patients had cardiogenic shock due to different etiologies: 8 acute coronary syndrome, 5 postcardiotomy, 1 myocarditis. Preoperatively 11 patients had inotropic support, 8 patients had IABP and 3 patients had femoral-femoral extra corporeal life support (ECLS). Surgical implantation was performed using right axillary artery in 13 patients and right femoral artery in 1 patient. Impella was utilized as follows: bridge to recovery in 6 cases, bridge to long-term LVAD in 4 cases, bridge to transplantation in 1 case, left ventricle unloading in presence of pulmonary oedema on ECLS in 3 cases. Mean support time was 9 days. After 24 hours following implantation: median arterial blood pressure increased from 68 to 83 mm Hg and median blood lactate levels decreased from 2.9 to 2.0 mmol/L. Survival rate at one month after intensive care unit discharge was 64%. We reported 2 cases of Impella thrombosis (1 patient required Impella replacement and 1 patient Impella ablation) and 1 case of infection at the right axillary access. Abiomed Impella LP 5.0 is a safe device and can be utilized for low cardiac output in various indications as short-term support as well as to discharge left cavities in case of pulmonary edema on ECLS