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      Short-term mechanical support with the Impella 5.x for mitral valve surgery in advanced heart failure—protected cardiac surgery

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          Abstract

          Introduction

          Surgical treatment of patients with mitral valve regurgitation and advanced heart failure remains challenging. In order to avoid peri-operative low cardiac output, Impella 5.0 or 5.5 (5.x), implanted electively in a one-stage procedure, may serve as a peri-operative short-term mechanical circulatory support system (st-MCS) in patients undergoing mitral valve surgery.

          Methods

          Between July 2017 and April 2022, 11 consecutive patients underwent high-risk mitral valve surgery for mitral regurgitation supported with an Impella 5.x system (Abiomed, Inc. Danvers, MA). All patients were discussed in the heart team and were either not eligible for transcatheter edge-to-edge repair (TEER) or surgery was considered favorable. In all cases, the indication for Impella 5.x implantation was made during the preoperative planning phase.

          Results

          The mean age at the time of surgery was 61.6 ± 7.7 years. All patients presented with mitral regurgitation due to either ischemic ( n = 5) or dilatative ( n = 6) cardiomyopathy with a mean ejection fraction of 21 ± 4% (EuroScore II 6.1 ± 2.5). Uneventful mitral valve repair ( n = 8) or replacement ( n = 3) was performed via median sternotomy ( n = 8) or right lateral mini thoracotomy ( n = 3). In six patients, concomitant procedures, either tricuspid valve repair, aortic valve replacement or CABG were necessary. The mean duration on Impella support was 8 ± 5 days. All, but one patient, were successfully weaned from st-MCS, with no Impella-related complications. 30-day survival was 90.9%.

          Conclusion

          Protected cardiac surgery with st-MCS using the Impella 5.x is safe and feasible when applied in high-risk mitral valve surgery without st-MCS-related complications, resulting in excellent outcomes. This strategy might offer an alternative and comprehensive approach for the treatment of patients with mitral regurgitation in advanced heart failure, deemed ineligible for TEER or with need of concomitant surgery.

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          Most cited references36

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          Transcatheter Mitral-Valve Repair in Patients with Heart Failure

          Gregg Stone, JoAnn Lindenfeld, William T. Abraham … (2018)
          Among patients with heart failure who have mitral regurgitation due to left ventricular dysfunction, the prognosis is poor. Transcatheter mitral-valve repair may improve their clinical outcomes.
          Article 0 comments Cited 555 times – based on 0 reviews     Review now
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            2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

            Catherine M Otto, Rick A. Nishimura, Robert Bonow … (2020)
            Article 0 comments Cited 474 times – based on 0 reviews     Review now
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              Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry.

              Ovidiu Chioncel, Mitja Lainscak, Petar Seferovic … (2018)
              The objectives of the present study were to describe epidemiology and outcomes in ambulatory heart failure (HF) patients stratified by left ventricular ejection fraction (LVEF) and to identify predictors for mortality at 1 year in each group.
              Article 0 comments Cited 273 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Cardiovasc Med
                Journal ID (iso-abbrev): Front Cardiovasc Med
                Journal ID (publisher-id): Front. Cardiovasc. Med.
                Title: Frontiers in Cardiovascular Medicine
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2297-055X
                Publication date (Electronic): 11 July 2023
                Publication date Collection: 2023
                Volume: 10
                Electronic Location Identifier: 1229336
                Affiliations
                [ 1 ]Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen , Essen, Germany
                [ 2 ]Department of Cardiac Surgery, University Hospital Heidelberg , Heidelberg, Germany
                [ 3 ]Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School , Hannover, Germany
                Author notes

                Edited by: Massimo Bonacchi, University of Florence, Italy

                Reviewed by: Paul Philipp Heinisch, German Heart, Germany Francesco Cabrucci, University of Florence, Italy

                [* ] Correspondence: Anja Osswald anja.osswald@ 123456uk-essen.de
                [ † ]

                These authors have contributed equally to this work and share last authorship

                Abbreviations CPB, cardiopulmonary bypass; LVEF, left ventricular ejection fraction; LCOS, low cardiac output syndrome; MV, mitral valve; MR, mitral valve regurgitation; PCCS, postcardiotomy cardiogenic shock; St-MCS, short-term mechanical circulatory support system; TEER, transcatheter edge-tot-edge repair; VA-ECMO, veno-arterial extracorporeal membrane oxygenation.

                Article
                DOI: 10.3389/fcvm.2023.1229336
                PMC ID: 10400355
                SO-VID: cdfa2339-4669-405b-9105-c793602d122d
                Copyright © © 2023 Osswald, Shehada, Zubarevich, Kamler, Thielmann, Sommer, Weymann, Ruhparwar, El Gabry and Schmack.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 26 May 2023
                Date accepted : 26 June 2023
                Page count
                Figures: 2, Tables: 4, Equations: 0, References: 36, Pages: 0, Words: 0
                Funding
                Funded by: German Research Foundation, doi 10.13039/501100001659;
                Award ID:  
                Funded by: Faculty of Medicine, University of Duisburg-Essen, doi 10.13039/501100010068;
                Award ID: FU 356/12-2
                AO was supported as a Clinician Scientist within the University Medicine Essen Academy (UMEA) program, funded by the German Research Foundation (DFG) and the Faculty of Medicine, University of Duisburg-Essen (grant: FU 356/12-2). Open Access Funding provided by the University of Duisburg-Essen.
                Categories
                Subject: Cardiovascular Medicine
                Subject: Original Research
                Custom metadata
                section-at-acceptance Heart Failure and Transplantation

                Keywords: impella,short-term mechanical circulatory support,mitral valve surgery,high-risk surgery,post-operative low cardiac output,advanced heart failure,protected cardiac surgery
                Data availability:
                Keywords: impella, short-term mechanical circulatory support, mitral valve surgery, high-risk surgery, post-operative low cardiac output, advanced heart failure, protected cardiac surgery

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