Abstract 4147438: Use of Impella RP Flex for Right Ventricular Failure (RVF): A Single Center Review

Introduction/Background: Right ventricular failure (RVF) is the inability of the RV to adequately perfuse pulmonary circulation and sufficiently fill the LV; it increases morbidity, mortality, and length of hospital stay. In critically ill patients, three main etiologies of RV failure are excessive preload, excessive afterload, and insufficient myocardial contractility. In addition to medical management, some patients at risk for refractory cardiogenic shock may require temporary mechanical circulatory support (TMCS). Research Questions/Hypotheses: The Impella RP flex (Abiomed, Danvers, MA) has provided an option for percutaneous RV support through the internal jugular vein and allows for early rehabilitation of complex cardiac patients. Methods/Approach: Consecutive cases at our center using the Impella RP flex were evaluated for hemodynamics and quality measures. Research/Data: Thirteen patients received RP flex support: 3 patients with pulmonary hypertension during mitral valve repair or replacement, 4 patients for prophylactic placement pre-LVAD, 3 patients with intraoperative placement during CABG, 2 patients with acute myocardial infarction, and 1 patient for salvage therapy. The average length of stay for our patients was 30.23 days; average duration of Impella support was 4.46 days. Twelve patients required inotropic support with milrinone and 91.7% received epinephrine. Of the 12 patients who required vasodilators, 100% received inhaled nitric oxide and 50% received sildenafil. Four patients required sildenafil at the time of discharge (36.4%). Internal jugular vein cannulation and intracorporeal support allows capable patients to participate in physical therapy early in the recovery process. Of our cohort, 30.77% of patients were successfully assisted out of bed to chair and 15.38% ambulated with assistance. All patients had pre- and post-creatinine levels collected, with an average pre-implantation creatinine level of 1.48 and post-explantation level of 1.76. The average pre-implantation lactic acid level was 4.75; only 11 patients had post-explantation lactic acid measurements collected, which averaged 3. Eleven patients were successfully discharged and no patients required home inotropes. Conclusions: The RP flex allows for RV unloading for patients requiring TMCS; it is best used early or prophylactically for patients who are otherwise high-risk for complications or who may require high-dose pressors and prolonged ICU level of care.