Cardiology Fellow Texas Heart Institute Houston, Texas, United States
Disclosure(s):
Seulgi E. Kim, MD: No financial relationships to disclose
Background: Impella 5.5 (Abiomed; Danvers, MA), a temporary microaxial pump, provides mechanical circulatory support (MCS) for patients with heart failure cardiogenic shock (HF CS), offering greater left ventricle (LV) support, mobility, and durability. We evaluated temporal effects of LV unloading on right-sided hemodynamics, namely pulmonary pressures and right ventricle loading.
Methods: We performed a retrospective chart review of 87 patients who had undergone Impella 5.5 insertion at Baylor St. Luke’s Medical Center between January 2020 and May 2025 for HF-CS. We then evaluated for changes in Pulmonary Artery (PA) pressures, right atrial (RA) pressures, and pulmonary artery pulsatility index (PAPi) while on MCS and performed bivariate analysis to assess statistical significance.
Outcome: Mean age was 61 ±13 years. The median duration of support was 14 days (range 1-102 days). Bivariate analysis demonstrated a statistically significant decrease between baseline mean PA pressures (32±1 mmHg) and those at prespecified time points (24h: 26±1.2 mmHg; 72 h 28±1 mmHg; 1 week: 25±1.5 mmHg; 2 week: 20±3.8 mmHg; prior to removal: 24±2.3 mmHg). Additionally, mean RA pressures were also noted to have a statistically significant decrease between baseline pressures (14±0.8 mmHg) and those at prespecified time points (24h: 8.5±0.7 mmHg; 72.h 8.4±0.6 mmHg; 1 week: 9±0.9 mmHg; 2 week 9±1.2 mmHg; prior to removal: 8.9±1.3 mmHg). We also observed a statistically significant increase in PAPi from baseline (2.2±0.3) to 24 h (4.2±0.7), 72h (4.5±0.9), and 1 wk (3.8±0.4) (Figure 1C), but not at time of device removal (2.3±0.5).
Conclusion: Our single center study demonstrates improvement in right-sided hemodynamics in patients with HF-CS as early as 24 hours post insertion which were sustained until device removal. Further studies and HF CS phenotyping are needed to investigate optimal timing and duration of support for these patients.
