liu.seSearch for publications in DiVA
Change search
ReferencesLink to record
Permanent link

Direct link
Experience with the Impella® recovery axial-flow system for acute heart failure at three cardiothoracic centers in Sweden
Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
Uppsala University Hospital, Uppsala, Sweden.
Karolinska University Hospital, Stockholm, Sweden.
Uppsala University Hospital, Uppsala, Sweden.
Show others and affiliations
2009 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, Vol. 43, no 4, 233-239 p.Article in journal (Refereed) Published
Abstract [en]

Objectives. The Impella (R) recovery axial-flow system is a mechanical assist system for use in acute heart failure. This retrospective study reports the use of the device at three cardiothoracic units in Sweden. Design. Fifty patients (35 men, mean age 55.8 years, range 26 to 84 years) underwent implantation of 26 Impella (R) LP 2.5/5.0 (support-time 0.1 to 14 days), 16 Impella (R) LD (support-time 1 to 7 days) and 8 Impella (R) RD (support-time 0.1 to 8 days) between 2003 and 2007. Implantation was performed because of postcardiotomy heart failure (surgical group, n=33) or for various states of heart failure in cardiological patients (non-surgical group, n=17). The intention for the treatments was mainly to use the pump as a obridge-to-recoveryo. Results. Early mortality in the surgical and non-surgical groups was 45% and 23%, respectively. Complications included infection, 36% and right ventricular failure, 28%. Cardiac output and cardiac power output postoperatively were significantly higher among survivors than non-survivors. Conclusions. The Impella (R) recovery axial-flow system facilitates treatment in acute heart failure. Early intervention in patients with acute heart failure and optimized hemodynamics in the post-implantation period seem to be of importance for long-term survival. Insufficient early response to therapy should urge to consider further treatment options.

Place, publisher, year, edition, pages
2009. Vol. 43, no 4, 233-239 p.
Keyword [en]
Left ventricular assist device (LVAD), heart failure, temporary circulatory assistance
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-19792DOI: 10.1080/14017430802715954OAI: diva2:228988
Available from: 2009-08-10 Created: 2009-08-10 Last updated: 2010-05-11
In thesis
1. The use of mechanical circulatory support and passive ventricular constraint in patients with acute and chronic heart failure
Open this publication in new window or tab >>The use of mechanical circulatory support and passive ventricular constraint in patients with acute and chronic heart failure
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Many patients are diagnosed as having chronic heart failure (CHF) and apart from the fact that daily activities are impaired, they are great consumers of health care, and the prognosis is poor. The distinction between acute heart failure (AHF) and CHF may be difficult and is more a question of time rather than severity. The “gold standard” treatment for end‐stage heart failure is heart transplantation. Due to organ shortage this is reserved for selected patients only. Since the introduction of mechanical circulatory support (MCS) more and more patients with progressive CHF have been bridged‐to‐heart‐transplantation. There are MCS systems available for both short‐ and long‐term support. Newer concepts such as ventricular constraint to prevent ventricular remodelling are on the way. We have investigated short‐ (ImpellaTM) and long‐term (HeartMateTM I and II) MCS and ventricular constraint (CorCapTM CSD) as treatment concepts for all forms of heart failure, the aims being: bridge‐to‐decision, bridge‐to‐transplant and extended therapy, called “destination therapy” (DT).

Methods and results: In Paper I, the use of HM‐ITM pulsatile MCS in bridge‐to‐transplantation patients in Sweden was retrospectively investigated regarding outcome and risk factors for mortality and morbidity. Fifty‐nine patients were treated between 1993 and 2002. The dominating diagnosis was dilated cardiomyopathy in 61%. Median support time was 99.5 days. 18.6% died before transplantation. Four patients needed RV assist due to right ventricular failure. Haemorrhage was an issue. Six patients (10%) suffered a cerebrovascular thromboembolic lesion. 15% developed driveline infection. 45% of the MCS patients were discharged home while on pump treatment. Massive blood transfusion was a predictor for mortality and morbidity, p<0.001.

In Paper II the second generation long‐term MCS, the continuous axial flow pump HM‐IITM, was prospectively evaluated for mortality and morbidity. Eleven patients, from 2005 until 2008, were consecutively included at our institution. One patient received the pump for DT. The median pump time was 155 days. Survival to transplantation was 81.8%. Ten patients could be discharged home before transplantation after a median time of 65 days.

Paper III investigated the Swedish experience and outcome of short‐term axial flow MCS, the ImpellaTM, in patients with AHF. Fifty patients were collected between 2003 and 2007 and divided into two groups: 1. Surgical group (n=33) with cardiogenic shock after cardiac surgery; and 2. Non‐surgical group (n=17), patients with AHF due to acute coronary syndromes with cardiogenic shock (53%) and myocarditis (29%). The 1‐year survival was 36% and 70%, respectively. 52% were reoperated because of bleeding. Predictors for survival at 30 days were preoperatively placed IABP (p=0.01), postoperatively cardiac output at 12 hours and Cardiac Power Output at 6 and 12 hours.

In Paper IV we evaluated the use and long term outcome of ventricular constraint CorCapTM CSD. Since 2003, 26 consecutive patients with chronic progressive heart failure were operated with CSD via sternotomy (n=25) or left mini‐thoracotomy (n=1). Seven patients were operated with CorCapTM only. Nineteen patients had concomitant cardiac surgery. There were three early and three late deaths. The remaining cohort (n=18) was investigated in a cross‐sectional study regarding QoL with SF‐36. There was no difference in QoL measured with SF‐36 after a mean 3‐years follow up period, when compared to an age‐ and sex‐matched control group from the general population. The one‐year survival was 86%, and after three years 76%. Echocardiographic dimensions had improved significantly after three years.

Conclusion: In our unit, a non‐transplanting medium‐sized cardiothoracic department, short‐ and long‐term MCS (ImpellaTM resp. HMTM) in patients with acute or chronic HF have been used with good results. The use of ventricular constraint early in the course of the disease is a good adjunct to other treatment options in progressive chronic HF patients.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 68 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1178
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-56424 (URN)978‐91‐7393‐414‐5 (ISBN)
Public defence
2010-06-12, Elsa Brändströmsalen, Universitetssjukhuset, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Available from: 2010-05-11 Created: 2010-05-11 Last updated: 2010-05-11Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text

Search in DiVA

By author/editor
Granfeldt, HansAhn, Henrik
By organisation
Thoracic SurgeryFaculty of Health SciencesDepartment of Thoracic and Vascular Surgery
In the same journal
Scandinavian Cardiovascular Journal
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 113 hits
ReferencesLink to record
Permanent link

Direct link