title: The contemporary role of Impella in a comprehensive mechanical circulatory support program: a single institutional experience.
abstract: BACKGROUND
  The treatment of cardiogenic shock with percutaneous mechanical circulatory support (MCS) is attractive: however, at present it is not clear which is the best strategy, as no survival benefit has been demonstrated for any device as single therapy. Aim of this study is to describe the role of percutaneous Impella in a comprehensive MCS program.
  
  
  METHODS
  Observational study on 22 patients supported with the Impella device in our hospital from May 2013 to June 2014.
  
  
  RESULTS
  Four patients (18 %) were treated with Impella alone, 8 patients (36 %) were treated with Impella and IABP, 6 patients (27 %) with Impella and VA ECMO, and 4 patients (18 %) with Impella, IABP and VA ECMO. The cause of cardiogenic shock was myocardial infarction (CSMI) in 9 patients (41 %), postcardiotomic cardiogenic shock in 5 (23 %), and a miscellaneous of other causes in the remaining 8 (36 %). Eight Impella devices (36 %) were placed under transesophageal echocardiographic guidance, while 14 (64 %) under fluoroscopy. The device was removed with manual compression at bedside and no vascular complications were observed. Duration of Impella support was 107 (54-141) hours and duration of ventilation was 48 (14-92) hours. Hemolysis occurred in 6 patients (27 %), while major bleeding in 4 patients (18 %). Survival was 73 %: 13 patients (58 %) showed recovery of cardiac function; 1 patient (5 %) was bridged to left ventricular assist device (LVAD) implantation, 1 patient (5 %) to heart transplantation (HTx) and 1 patient (5 %) received a BiVAD and was eventually bridged to HTx.
  
  
  CONCLUSIONS
  Our data suggest that a multi-device approach, encompassing active LV support with Impella, is safe and can significantly improve survival in patients with cardiogenic shock.
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. pieri.marina@hsr.it.
authors.forename: Marina
authors.initials: M
authors.lastname: Pieri
authors.affiliation: Department of Interventional Cardiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. rachele.contri@gmail.com.
authors.forename: Rachele
authors.initials: R
authors.lastname: Contri
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. dario.winterton@gmail.com.
authors.forename: Dario
authors.initials: D
authors.lastname: Winterton
authors.affiliation: Department of Interventional Cardiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. montorfano.matteo@hsr.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.affiliation: Department of Interventional Cardiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. colombo.antonio@hsr.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. zangrillo.alberto@hsr.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
authors.affiliation: Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. debonis.michele@hsr.it.
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. pappalardo.federico@hsr.it.
authors.forename: Federico
authors.initials: F
authors.lastname: Pappalardo
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000150:complications / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome