title: Impella 5.0 as a Second-Line Mechanical Circulatory Support Strategy After Extracorporeal Life Support.
abstract: The catheter-based Impella 5.0 left ventricular assist device is a powerful and less invasive alternative for patients in cardiogenic shock. The use as second-line therapy in patients with precedent extracorporeal life support (ECLS) has not been described before now. We analyzed our experience of consecutive patients treated with this alternative strategy. From April 2014 to December 2014, eight patients had been implanted as a second-line option after ECLS support. The reason for the change from ECLS to Impella 5.0 was absence of cardiac recovery for primary weaning and complications of ECLS therapy. The mean time of ECLS support prior to Impella implantation was 12 ± 7 days. The implantation of the Impella 5.0/CP was technically successful in all patients, and the ECLS could be explanted in all eight patients who received Impella implantation as a second-line treatment. The second-line Impella 5.0 therapy resulted in two patients who turned into left ventricular assist device (LVAD) candidates, two primary weaning candidates, and four patients who died in the setting of sepsis or absent cardiac recovery and contraindications for durable LVAD therapy. Thereby, the overall hospital discharge survival as well as the 180-day survival was 50% for Impella 5.0 implantations as second-line procedure after ECLS. The latest follow-up survival of this second-line strategy after ECLS was three out of eight, as one patient died after 299 days of LVAD support due to sepsis. The use of Impella 5.0 constitutes a possible second-line therapeutic option for those patients who do not show cardiac recovery during prolonged ECLS support or suffer from complications of ECLS therapy. This treatment allows additional time for decisions regarding cardiac recovery or indication for durable LVAD therapy.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Schibilsky
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Kruger
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Germany.
authors.forename: Henning F
authors.initials: HF
authors.lastname: Lausberg
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Eisenlohr
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Haller
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Germany.
authors.forename: Attila
authors.initials: A
authors.lastname: Nemeth
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Schibilsky
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Medical Center Tuebingen, Tuebingen, Germany.
authors.forename: Helene
authors.initials: H
authors.lastname: Haeberle
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Medical Center Tuebingen, Tuebingen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Rosenberger
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Germany. tobias.krueger@med.uni-tuebingen.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Walker
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schlensak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D062906:Cardiac Catheters; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012770:Shock, Cardiogenic / Q000150:complications / Q000601:surgery / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Mechanical circulatory support-Impella-Cardiogenic shock-Left ventricular assist device-Extracorporeal life support