Clinical indications of IMPELLA short-term mechanical circulatory support in a tertiary Centre María Monteagudo-Vela a, ⁎, Andre Simon a , Fernando Riesgo Gil a , Alex Rosenberg b , Miles Dalby c,d , Tito Kabir c , Diana García Saez a , Vasileios Panoulas c,d a Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom b Intensive Care Unit, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom c Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom d Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London abstract article info Article history: Received 15 September 2019 Received in revised form 15 November 2019 Accepted 3 December 2019 Available online xxxx Keywords: Impella Bridge to heart transplantation Cardiogenic shock Bridge to durable ventricular assist device Introduction: The Impella family of devices are short-term mechanical circulatory support (MCS) pumps that hold promise in treating patients with acute cardiogenic shock, acting as bridge to recovery, transplant or durable left ventricular assist device. We assessed the clinical utility, indications and outcomes of the Impella family of devices in a tertiary centre. Methods: In the current study we present our initial 2-year experience with different Impella types. We explored the indications for device implantation, initial hemodynamic and biochemical response and mid-term survival. Results: A total of 57 patients underwent Impella implantation; 36 Impella CP, 14 Impella 5.0 and 7 Impella RP. Mean age was 54.2 ± 15.2 whereas 78.9% were males. The main indications for left sided MCS included cardio- genic shock secondary to ACS, decompensated dilated or ischemic end stage cardiomyopathy and myocarditis. Mean LVEF pre-Impella implantation was 23 ± 13.7%. PCI was performed in 24 (54.5%) patients. Main indication for Impella RP was RV failure following LVAD implantation. The median duration of support was 5 days (IQR 1 to 10.5 days). 24 h following Impella implantation, there was significant improvement in all hemodynamic parameters as well as renal and liver function. Patients presenting with INTERMACS I had a 30-day survival of 40% whereas patients with INTEMACS 2 or above had a 30-day survival of 82.4%. Conclusions: The Impella short-term mechanical assist device provides immediate improvement in hemody- namic parameters and end organ function recovery. Patient outcomes are heavily influenced by the stage of shock and the timely insertion of MCS. © 2019 Elsevier Inc. All rights reserved. Introduction Despite all clinical and surgical advances, the management of cardio- genic shock (CS) remains a clinical challenge with high morbidity and mortality, ranging from 40 to 60% [1]. Treating CS patients in high vol- ume tertiary centres with 24/7 primary percutaneous coronary intervention (PPCI) services and access to short-intermediate term me- chanical circulatory support (MCS) potentially increases the survival of these patients [1,2]. One of the short-term MCS devices is the Impella (Abiomed, Dan- vers, MA) [3], a microaxial minimally invasive ventricular assist pump based on the principle of the Archimedes screw. The left sided Impella devices include the percutaneously implanted 2.5 (2.5 L/min) and CP (4.0 L/min) and the surgically implanted 5.0 (5 L/min). These pumps di- rectly unload the left ventricle, reducing the myocardial oxygen demand whilst increasing the myocardial blood flow as well as the coronary flow. The right sided Impella RP (Abiomed, Danvers, MA) is designed for right heart support at a maximum rate of ~ 4 L/min. The treatment algorithms incorporating novel MCS devices for the management of the various types of cardiogenic shock remain a matter of debate in international meetings and global literature. It has been established however, that early revascularization is key for the manage- ment of cardiogenic shock secondary to acute myocardial infarction Cardiovascular Revascularization Medicine xxx (xxxx) xxx Abbreviations: CS, Cardiogenic shock; PPCI, Primary Percutaneous Coronary Intervention; MCS, Mechanical Circulatory Support; MI, Myocardial Infarction; STEMI, ST elevation Myocardial Infarction; IABP, Intra-Aortic Balloon Pump; LVAD, Left Ventricular Assist Device; LV, Left Ventricle; RV, Right Ventricle; RVF, Right Ventricular Failure; DCM, Dilated Cardiomyopathy; ICM, Ischemic Cardiomyopathy; ECMO, Extra Corporeal Membrane Oxygenation; HTx, Heart Transplantation; OOHCA, Out Of Hospital Cardiac Arrest. ⁎ Corresponding author at: Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex, UB9 6JH, UK. E-mail address: m.monteagudo-vela@rbht.nhs.uk (M. Monteagudo-Vela). CARREV-01772; No of Pages 9 https://doi.org/10.1016/j.carrev.2019.12.010 1553-8389/© 2019 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Cardiovascular Revascularization Medicine Please cite this article as: M. Monteagudo-Vela, A. Simon, F. Riesgo Gil, et al., Clinical indications of IMPELLA short-term mechanical circulatory support in a tertiary Centre, Cardiovascular Revascularization Medicine, https://doi.org/10.1016/j.carrev.2019.12.010