Abstract 19972: Simultaneous, Not Staged, Deployment of Biventricular Micro-Axial Flow Impella Catheters (BiPella) is Associated With Improved Survival For Cardiogenic Shock Involving Biventricular Failure

Cardiogenic shock involving biventricular failure (BiVF) is associated with high in-hospital mortality. This study explored the utility of employing two micro-axial flow Impella catheters for biventricular support (BiPella; Figure A).MethodsWe retrospectively reviewed data from 14 patients receiving BiPella support for BiVF from 3 tertiary-care hospitals in the United States. Medical records were reviewed for demographics, hemodynamic and laboratory data, and details of BiPella implantation.ResultsBiVF was due to acute myocardial infarction (n=6), advanced heart failure (n=4), cardiac surgery (n=2), and myocarditis (n=2). Mean LV ejection fraction was 22+11%. BiPella recipients had moderate or severe systolic dysfunction (100%), elevated right atrial (RA) pressure (21±4), elevated RA:pulmonary capillary wedge ratio (0.9±0.2), a low pulmonary artery pulsatility index (0.9±0.7). The duration of LV and RV support was 4±3 and 4±2 days with mean LV and RV flows of 3.2±0.9 and 3.4±0.5 liters/minute respectively. Compared to pre-procedural values, RA pressure and mixed venous oxygen saturation improved after BiPella activation. In-hospital mortality was 50%. No intra-procedural mortality was observed. Complications included limb ischemia (n=1), bleeding (n=7), and hemolysis (n=5). Among survivors, 2 bridged to LVAD. No patients were bridged to ECMO, BiVAD, or cardiac transplant. Survivors were younger, had a higher vasoactive drug use, lower mean pulmonary artery pressures, and lower glomerular filtration rates (Figure B). All survivors received RV support at same time as LV support (Simultaneous), whereas 57% of patients who died received delayed RV support (Staged).ConclusionThis is the largest multicenter report describing the clinical utility of BiPella support for BiVF. BiPella is feasible and associated with improved hemodynamics. Simultaneous, not staged, LV and RV support is associated with improved survival.