Early experience Impella percutaneous ventricular assist device complications from a multi-ethic asian cohort

Hwei Sung, Ling (2024) Early experience Impella percutaneous ventricular assist device complications from a multi-ethic asian cohort. European Journal of Heart Failure, 26 (S2). pp. 3-643. ISSN 1879-0844

PDF European J of Heart Fail - 2024.pdf Download (312MB)

Abstract

Background/ Purpose: Complications during percutaneous ventricular assist device (pVAD) use can be fatal. From our pVAD registry, we evaluate the complications encountered at an Asian tertiary heart centre. Methods: We performed an observational registry, evaluating complications from Impella CP pVAD use from 2019 to 2023, involving patients with cardiogenic shock (CS) or high-risk percutaneous coronary intervention (HR-PCI). Complications were stratified by initial (year 2019-2021) and later (year 2022-2023) implantation experience. Device related complications include access side bleeding, infection, haemolysis, limb ischemia, vascular injury, stroke, device failure, dislodge or exchange. Non-device related complications were defined as procedural or disease related complications. Results: 30 patients were analysed, 36.7% had CS and 23% experienced in-hospital mortality. 57% of patients had complication during pVAD support, of which device related and non-device related complications incidences were 50% and 40%, respectively. Major access site bleeding was the most common device related complications (47%) and majority had BARC score of 2 and above. Non device related complications include requirement of vasopressors or inotropic support (40%), mechanical ventilation (37%) and renal replacement therapy (17%). In later stage of the registry, more pVAD therapies (60%) were delivered. More complete revascularization (22%), rotational atherectomy (11%) and concurrent VA-ECMO support was observed (22%). Access site bleeding incidence trended lower over time (58% vs 39%) while non-device related complications trended higher (33% vs 44%). In the later stage, more inotropy support (33% vs 44%) was given. CS cohort experienced more device (50% vs 67%) and non-device related complications (75% vs 100%) over time. In later stages, less HR-PCI cohort had device related complications (62.5% vs 33%). Lesser patients (75% vs 67%) with complications had in-patient mortality over time. Conclusion: Access site bleeding is common in pVAD use. With experience, device related complications trended lower. The presence of sicker patients may explain increased non-device complications.

Actions (For repository members only: login required)

View Item