Utilization of Impella RP Flex for Right Ventricular Recovery in Cardiogenic Shock: A Single-Center Experience.

BACKGROUND

Right ventricular failure (RVF) in patients with cardiogenic shock (CS) is associated with increased mortality. Mechanical circulatory support with Impella RP Flex may improve survival, but expert opinion is inconsistent due to lack of established best practices. We explore the impact of Impella RP Flex in treating patients with RVF.

METHODS

In this single-center, retrospective study, patients with RVF or biventricular failure treated with Impella RP Flex from December 2022 to March 2024 were reviewed. Clinical data included CS etiology, diagnostic laboratory values, and hemodynamics. Patient-oriented outcomes were duration of Impella RP Flex support, survival rate, and 30-day heart failure (HF) readmission rate. Secondary outcomes included incidence of complications.

RESULTS

Twenty-two SCAI stage D (72.7%) and E (27.3%) patients with RVF were implanted with Impella RP Flex, either alone or in combination with a left ventricular assist device (LVAD). The average duration of Impella RP Flex support was 6.6 (1, 14) days, and the overall mortality rate was 31.8% (n = 7/22). Among survivors, four received orthotopic heart transplant, one received durable LVAD support, and 10 recovered to discharge. Vasopressors (n = 17) and inotropes (n = 17) were initiated in most patients before device support. Incidence of 30-day HF readmission was 20% (n = 3/15), and 68.2% (n = 15/22) of patients required inpatient hemodialysis. Hemodynamics improved post-Impella RP Flex implant, though hemolysis occurred in 86.4% (n = 19/22) of patients, and bleeding requiring transfusion occurred in 63.6% (n = 14/22).

CONCLUSIONS

Impella RP Flex may provide a treatment option for patients with CS and RVF who require inotropic or vasopressor support when used with careful attention to procedural technique and individualized risk assessment.