Percutaneous Impella RP use for refractory right heart failure in adolescents and young adults-A multicenter U.S. experience

Catheter Cardiovasc Interv. 2020 Aug;96(2):376-381. doi: 10.1002/ccd.28830. Epub 2020 Mar 4.

Abstract

Objective: To assess the outcomes of the use of the percutaneous Impella RP device (Abiomed, Danvers, MA) in adolescents and young adults.

Background: Results of the Impella RP device have been reported in adults, but a multicenter experience in adolescents and young adults has yet to be reported.

Methods: Patients ≤21 years of age who underwent implantation of an Impella RP device for refractory right heart failure from June, 2016 to April, 2018 at nine U.S. Centers were included.

Results: A total of 12 adolescents, median age of 18 (14-21) years and median weight 74.4 (49-112.4) kg underwent Impella RP implantation (INTERMACS Profile 1 in nine and Profile 2 in three patients. The central venous pressure decreased from 20 (16-35) to 12 (7-17) mmHg, (p = .001). One patient was concomitantly supported with an intra-aortic balloon pump (IABP) and the rest with a percutaneous/surgically placed left ventricular assist device. There was one adverse event related to the Impella RP device (thrombosis requiring explant). The support duration was 6.5 days (4.8 hr-18.4 days) and survival to hospital discharge was 83%. At a median follow-up of 11 months (5 days-2.5 years), 8 of 12 (67%) patients are alive.

Conclusions: In this multicenter experience, the Impella RP device was found to be efficacious and safe when used in adolescents and young adults. Further studies are warranted to identify suitable young/pediatric candidates for Impella RP therapy for right heart failure.

Keywords: ECMO/IABP/Tandem/Impellamechanical circulatory support; pediatric intervention; ventricular assist device.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Age Factors
  • Female
  • Heart Failure / diagnosis
  • Heart Failure / mortality
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Heart-Assist Devices*
  • Hemodynamics*
  • Hospital Mortality
  • Humans
  • Male
  • Prosthesis Design
  • Prosthesis Implantation / adverse effects
  • Prosthesis Implantation / instrumentation*
  • Prosthesis Implantation / mortality
  • Recovery of Function
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • United States
  • Ventricular Function, Right*
  • Young Adult