Clinical Pharmacy Specialist - Advanced Heart Failure and Transplant Missouri City, Texas, United States
Background: The surgically inserted microaxial Impella 5.5® temporary percutaneous left ventricular assist device (pVAD) has demonstrated clinical efficacy as a mechanical circulatory support device in various patient populations suffering from cardiogenic shock. While the performance of the device is well-established, specific reports describing observed effect on vasoactive medication requirements are limited.
Methods: This was a single-center retrospective analysis. All patients who underwent Impella 5.5® cardiac support were screened for inclusion. Patients were excluded if they were supported for less than 7 days or did not have adequate clinical data available for analysis. The primary outcomes of interest was change in vasoactive-inotropic score (VIS) during first 7 days of support. Other secondary outcomes included lactic acid, serum creatinine, alanine transferase (ALT) and total bilirubin assessed pre-implant (baseline), day 1, day 3 and day 7 post-implant.
Outcome: The VIS was reduced from pre-implant (baseline) to day 7 of support (9.60 ± 27.13 vs 2.37 ± 5.64; p=0.045). Lactic acid and serum creatinine were also both improved from baseline to day 7. There was no significant change in measures of liver function assessed.
Conclusion: A significant improvement in VIS was observed by day 7 post-implant of the Impella 5.5® pVAD demonstrating favorable effects of this device support on the need for pharmacologic hemodynamic support. Lactic acid and serum creatinine were also both improved, however the clinical significance of the degree of improvement is uncertain.
