title: Percutaneous Mechanical Circulatory Support Using Impella Devices for Decompensated Cardiogenic Shock: A Pediatric Heart Center Experience.
abstract: Cardiogenic shock remains a significant cause of mortality and morbidity in children with heart failure. Percutaneous mechanical circulatory support may be an additional tool to augment left heart support and decompression in addition to conventional therapies. This report aims to review the clinical and hemodynamic outcomes of the Impella device at a pediatric center. A retrospective review of all implants between October 2014 and November 2016 was conducted. Clinical outcomes, device implant techniques, complications, and hemodynamic data were collected. Statistical analysis was performed on hemodynamic and echocardiographic data. There were 10 Impella device placements in 8 patients with a median age of 17 years (6.5-25) and support duration of 8 days (1-21). Implant diagnosis included 5 patients with either posttransplant rejection or allograft vasculopathy, 2 patients with myocarditis, and 1 patient with refractory ventricular tachycardia. Extracorporeal membrane oxygenation support was required in 4 patients. Significant reduction in pulmonary capillary wedge pressures/left atrial pressures (p = 0.031) and increase in near infrared spectroscopy (p = 0.039) was seen pre- and post-Impella implant. All patients survived to discharge from the intensive care unit with one late death. Percutaneous mechanical circulatory support is a viable option in experienced pediatric centers as a mode to augment cardiac output or to decompress the left heart in patients on extracorporeal membrane oxygenation or with cardiogenic shock.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Parekh
authors.forename: Aamir
authors.initials: A
authors.lastname: Jeewa
authors.forename: Sebastian C
authors.initials: SC
authors.lastname: Tume
authors.forename: William J
authors.initials: WJ
authors.lastname: Dreyer
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pignatelli
authors.forename: David
authors.initials: D
authors.lastname: Horne
authors.forename: Henri
authors.initials: H
authors.lastname: Justino
authors.forename: Athar M
authors.initials: AM
authors.lastname: Qureshi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004452:Echocardiography; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult