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Catheter Based Left Ventricular Assistance with Impella®: An Eight Year Single Centre Experience in High Risk PCI and Cardiogenic Shock
Session:
Sessão de Posters 23 - Choque cardiogénico: preditores, suporte e desfechos
Speaker:
Didier Martinez
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.3 Acute Cardiac Care – CCU, Intensive, and Critical Cardiovascular Care
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Didier Martinez; Tatiana Santos; Maria João Primo; Ana Rita Ventura; Inês Brito e Cruz; Gonçalo Costa; Elisabete Jorge; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>INTRODUCTION</strong><br /> Catheter-based left ventricular assist devices, particularly the Impella<sup>®</sup> system, are increasingly used to provide haemodynamic support in cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR-PCI). We sought to characterise our single-centre experience and outcomes in patients supported with Impella<sup>®</sup> between 2017 and 2025, and to compare those treated for CS with patients undergoing HR-PCI.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>METHODS</strong><br /> We retrospectively analysed all consecutive patients receiving Impella<sup>®</sup> support between July 2017 and 2025. Clinical, laboratory, echocardiographic, angiographic and procedural data were collected. Coronary artery disease burden was graded using the British Cardiovascular Intervention Society Jeopardy Score (BCIS-JS). Follow-up data on major adverse cardiovascular events (MACE), heart-failure admissions, New York Heart Association (NYHA) functional class and survival were obtained where available. Patients were stratified by indication (HR-PCI vs CS).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>RESULTS</strong><br /> Forty-four patients were included (mean age 67.6±11.4 years; 33 (75.0%) male). Indications were HR-PCI in 35 (77.7%) and CS in 9 (21.0%). Most presented with chronic coronary syndrome (25, 57.0%), while 16 (36.3%) had acute coronary syndrome. Multivessel disease was present in 28 (62.2%) and left-main involvement in 12 (26.7%). Mean left ventricular ejection fraction was 30.9±12.1%, and median BCIS-JS was 8. Hypertension was common (32, 71.1%) and significantly more frequent in HR-PCI than CS patients (p=0.005). Stroke occurred in 2 patients (4.4%) and major haemorrhage in 7 (15.6%). Lower-limb ischaemia, access-site pseudoaneurysm, haemolysis and infection occurred in 1 (2.2%), 2 (4.4%), 2 (4.4%) and 1 (2.2%) patient, respectively. In-hospital mortality was 32.0% and significantly higher in patients supported for CS than in those undergoing HR-PCI (CS: 7 [77.78%] vs HR-PCI 2 [5.71%], p<0.001). There were no differences regarding complications. Composite endpoint of MACE, heart failure admissions and death occurred in only 6 patients (17.10%). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>CONCLUSION</strong><br /> Over an eight-year period, Impella<sup>®</sup> supported catheter-based left ventricular assistance was a feasible strategy to enable HR-PCI in patients with complex coronary artery disease and markedly impaired left ventricular function, with relatively low rates of stroke, major bleeding and adverse mid-term outcomes among survivors. In contrast, patients receiving Impella<sup>®</sup> for established CS experienced very high in-hospital mortality and a concentration of early adverse events, underscoring that the benefit of Impella<sup>®</sup> in CS remains uncertain and should be considered within a framework of careful patient selection and multidisciplinary decision-making.</span></span></p>
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