Background
The Impella 2.5 is a percutaneously inserted ventricular assist device used during high-risk angioplasty and in cardiogenic shock. It is relatively contraindicated in patients with peripheral arterial disease (PAD) because of its large sheath size. We evaluated the safety of using the device in patients with severe PAD.
Methods
We included all patients ( N =17) who received an Impella 2.5 device at our institution between April 2009 and June 2010. We compared baseline characteristics, major adverse cardiac events, procedural success and complication rates between patients with and without severe PAD (defined as presence of trans-atlantic society consensus type C or D lesions in the aortoiliac or femoral arteries).
Methods
We included all patients ( N =17) who received an Impella 2.5 device at our institution between April 2009 and June 2010. We compared baseline characteristics, major adverse cardiac events, procedural success and complication rates between patients with and without severe PAD (defined as presence of trans-atlantic society consensus type C or D lesions in the aortoiliac or femoral arteries).
Results
Nine patients (55%) had severe PAD at baseline ( Table 1 ). There was no difference in age, ejection fraction, prevalence of left main or multivessel disease between the PAD and non-PAD groups. The rates of ischemic cardiomyopathy ( P =.02) and vascular complications ( P =.04) were higher in the PAD group. There were no cardiac deaths in either group. Four patients underwent peripheral revascularization prior to Impella placement. There were three postprocedural vascular complications in the PAD group; however, none of the patients required vascular surgery.
| Impella ( n =17) | PAD ( n =9) | No PAD ( n =8) | P value |
|---|---|---|---|
| Age, years (S.D.) | 62.7 (10.2) | 54 (17) | .11 |
| EF, % (S.D.) | 20.6 (7.3) | 20 (7.1) | .44 |
| ICM, n (%) | 9 (100) | 5 (63) | .02 |
| LM disease, n (%) | 4 (44) | 3 (38) | .39 |
| Multivessel disease, n (%) | 8 (89) | 5 (63) | .11 |
| Shock, n (%) | 0 | 4 (50) | .01 |
| Cardiac/noncardiac death, n (%) | 0/0 (0) | 0/2 (25%) | .06 |
| MI or repeat revascularization, n (%) | 0 | 0 | – |
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