title: Impella to unload the left ventricle during peripheral extracorporeal membrane oxygenation.
abstract: Peripheral venoarterial extracorporeal membrane oxygenation (VA ECMO) for acute cardiac failure reestablishes normal oxygen delivery and perfusion. However, VA ECMO can be limited by insufficient ventricular unloading, resulting in thrombus formation and pulmonary edema. Impella 2.5 has been used to unload the left ventricle and provide hemodynamic support during acute heart failure. We present our experience of the Impella 2.5 as an adjunct for left ventricular unloading during peripheral VA ECMO support and as a bridge for the HeartMate II left ventricular assist device (LVAD). An Impella 2.5 was placed in patients who were on peripheral VA ECMO with evidence of left ventricular distension. Patients who were candidates for heart transplant were transitioned to the HeartMate II LVAD. Five patients on VA ECMO with ventricular distension underwent Impella 2.5 implantation, resulting in a decreased left ventricular end-diastolic diameter as measured by echocardiography (7.8 ± 1.4 vs. 6.2 ± 0.8 cm, p = 0.001). Four patients were subsequently transitioned to the HeartMate II LVAD after restoration of end-organ function. Impella 2.5 is a safe means to unload the left ventricle while on peripheral VA ECMO to prevent left ventricle thrombus formation and worsening pulmonary edema in patients transitioning to a HeartMate II LVAD.
authors.affiliation: Division of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, New York 14642, USA.
authors.forename: Allen
authors.initials: A
authors.lastname: Cheng
authors.forename: Michael F
authors.initials: MF
authors.lastname: Swartz
authors.forename: H Todd
authors.initials: HT
authors.lastname: Massey
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000503:physiopathology; D004452:Echocardiography; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006333:Heart Failure / Q000628:therapy*; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000503:physiopathology*; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D011654:Pulmonary Edema / Q000517:prevention & control / Q000628:therapy; D013927:Thrombosis / Q000517:prevention & control; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000628:therapy*