The Approach of Insertion of the Impella Ventricular Assist Device Does Not Impact Stroke Risk
Dov Levine, Lindsay Volk, Fady Soliman, Hirohisa Ikegami, Mark J. Russo, Leonard Lee, Anthony Lemaire
Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
OBJECTIVE: The Impella pump is an intravascular micro-axillary device that provides mechanical circulatory support through the femoral, axillary, or central vessels. One feared complications is post-procedure stroke. The purpose of the study is to determine if Insertion approach or access vessel effects surgical outcomes.
METHODS: A retrospective review of consecutive patients who underwent Impella placement from January 1st, 2007 to September 15th, 2018. Four groups were compared: (a) minimally invasive Impella (femoral or axillary access); (b) minimally invasive Impella upgraded to another peripheral impella; (c) minimally invasive Impella upgraded to a central Impella; (d) central Impella. Outcome measures including stroke, and mortality were compared amongst the groups.
RESULTS: 349 patients (or 407 Impellas) were identified and the majority of the devices were inserted minimally invasively (n=248, 60.9%), while the remainder were implanted via central access (n=159, 39.1%). 44 patients had their minimally invasive Impellas upgraded. The mean age was 63.1 ± 13.6 years and the majority of the patients were male (n=262, 75%). The risk of stroke for the entire cohort was 10.3% (n=36). Overall mortality was 44.4% (n=155). Of the patients who initially received a minimally invasive Impella, those who were upgraded had significantly higher rates of mortality (56.8% vs. 39.4%, p=0.03), post-op dialysis (50.0% vs. 27.4%, p<0.01); and sepsis (43.2% vs. 20.0%, p<0.01).
CONCLUSIONS: This study found no statistically significant difference in rates of postoperative stroke based on technique or the initial access vessel selected. Furthermore, of the patients who had their impellas upgraded, they had worse outcomes.
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