title: The RECOVER I: a multicenter prospective study of Impella 5.0/LD for postcardiotomy circulatory support.
abstract: OBJECTIVE
  Cardiogenic shock after cardiac surgery is accompanied by a high mortality rate. Early institution of hemodynamic support with a versatile, easy to insert left ventricular assist device might help bridge patients to recovery or to the next therapy, and improve the outcomes.
  
  
  METHODS
  Patients developing cardiogenic shock or low cardiac output syndrome after being weaned off cardiopulmonary bypass were enrolled in a prospective single-arm feasibility study (RECOVER I). The primary safety endpoint was the frequency of major adverse events (death, stroke) at 30 days or discharge, whichever was longer. The primary efficacy endpoint was survival of the patient to implementation of the next therapy, which included recovery at 30 days after device removal and bridge-to-other-therapy.
  
  
  RESULTS
  Sixteen patients provided informed consent and were enrolled in the study. Hemodynamics improved immediately after the initiation of mechanical support: cardiac index, 1.65 versus 2.7 L/min/m(2) (P = .0001); mean arterial pressure, 71.4 versus 83.1 mm Hg (P = .01); and pulmonary artery diastolic pressure, 28.0 versus 19.8 mm Hg (P < .0001). The pump provided an average of 4.0 ± 0.6 L/min of flow for an average duration of 3.7 ± 2.9 days (range, 1.7-12.6). The primary safety endpoint occurred in 2 patients (13%; 1 stroke and 1 death). For the primary efficacy endpoint, recovery of the native heart function was obtained in 93% of the patients discharged, with bridge-to-other-therapy in 7%. Survival to 30 days, 3 months, and 1 year was 94%, 81%, and 75%, respectively.
  
  
  CONCLUSIONS
  The use of the Impella 5.0/left direct device is safe and feasible in patients presenting with postcardiotomy cardiogenic shock. The device was rapidly inserted, enabled early support, and yielded favorable outcomes.
authors.affiliation: Department of Cardiac Surgery, University of Maryland Baltimore, Baltimore, MD, USA. BGRIFFITH@smail.umaryland.edu
authors.forename: Bartley P
authors.initials: BP
authors.lastname: Griffith
authors.forename: Mark B
authors.initials: MB
authors.lastname: Anderson
authors.forename: Louis E
authors.initials: LE
authors.lastname: Samuels
authors.forename: Walter E
authors.initials: WE
authors.lastname: Pae
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: O Howard
authors.initials: OH
authors.lastname: Frazier
mesh_terms: D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D020127:Recovery of Function; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States