Impella malrotation affects left ventricle unloading in cardiogenic shock patients
Abstract Aims Impella malrotation—inlet orientation away from the left ventricular (LV) apex with normal console waveforms and proper device depth—is commonly observed and possibly associated worse haemodynamics. This study aimed to characterize the haemodynamic consequences of Impella malrotation i...
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| Format: | Article |
| Language: | English |
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Wiley
2025-02-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.15087 |
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| author | Luca Baldetti Davide Romagnolo Mariagiulia Festi Alessandro Beneduce Davide Gurrieri Beatrice Peveri André Frias Mario Gramegna Stefania Sacchi Lorenzo Cianfanelli Francesco Calvo Vittorio Pazzanese Alaide Chieffo Silvia Ajello Anna Mara Scandroglio |
| author_facet | Luca Baldetti Davide Romagnolo Mariagiulia Festi Alessandro Beneduce Davide Gurrieri Beatrice Peveri André Frias Mario Gramegna Stefania Sacchi Lorenzo Cianfanelli Francesco Calvo Vittorio Pazzanese Alaide Chieffo Silvia Ajello Anna Mara Scandroglio |
| author_sort | Luca Baldetti |
| collection | DOAJ |
| description | Abstract Aims Impella malrotation—inlet orientation away from the left ventricular (LV) apex with normal console waveforms and proper device depth—is commonly observed and possibly associated worse haemodynamics. This study aimed to characterize the haemodynamic consequences of Impella malrotation in cardiogenic shock (CS) patients. Methods and results We included 100 CS patients (60 ± 12 years; 79.0% males) with available echocardiography during Impella support and pulmonary artery catheter assessment before and during (at 48 h) Impella support. Impella malrotation was identified in 36%. At 48 h, malrotation patients had higher pulmonary artery wedge pressure (PAWP, 16.0 ± 8.2 vs. 13.0 ± 4.6 mmHg; P = 0.033), higher systolic pulmonary artery pressure (PAP, 35.0 ± 11.3 vs. 29.5 ± 9.0 mmHg; P = 0.015), higher diastolic‐PAP (19.3 ± 8.1 vs. 15.1 ± 6.1 mmHg; P = 0.007), higher mean‐PAP (25.7 ± 9.1 vs. 20.8 ± 6.8 mmHg; P = 0.005), higher right atrial pressure (10.3 ± 4.8 vs. 7.7 ± 4.3 mmHg; P = 0.009), higher pulmonary vascular resistance index (4.78 ± 2.75 vs. 3.49 ± 1.94 WUm2; P = 0.020) and higher pulmonary artery elastance (0.91 ± 0.60 vs. 0.67 ± 0.40 mmHg/mL; P = 0.045). Serum lactate at 48 h was higher in malrotation patients (6.63 ± 6.25 vs. 3.60 ± 4.21 mmol/L; P = 0.004). Malrotation patients presented larger LVEDD during support (52 ± 10 vs. 46 ± 11 mm; P = 0.006), higher rates of aortic regurgitation (AR, 86 vs. 56%; P = 0.004) and higher increase in AR severity (+0.94 ± 0.92 vs. + 0.46 ± 0.95; P = 0.016). No significant differences were found in major adverse outcomes. Conclusions In CS patients, Impella malrotation is associated with suboptimal unloading of the LV, worse pulmonary haemodynamics and worse indexes of right ventricular afterload. |
| format | Article |
| id | doaj-art-2b6fe8646e454b4d910116fd5d90e600 |
| institution | DOAJ |
| issn | 2055-5822 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-2b6fe8646e454b4d910116fd5d90e6002025-08-20T03:17:13ZengWileyESC Heart Failure2055-58222025-02-0112154255310.1002/ehf2.15087Impella malrotation affects left ventricle unloading in cardiogenic shock patientsLuca Baldetti0Davide Romagnolo1Mariagiulia Festi2Alessandro Beneduce3Davide Gurrieri4Beatrice Peveri5André Frias6Mario Gramegna7Stefania Sacchi8Lorenzo Cianfanelli9Francesco Calvo10Vittorio Pazzanese11Alaide Chieffo12Silvia Ajello13Anna Mara Scandroglio14Cardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan Italy‘Vita‐Salute San Raffaele’ University Milan ItalyGroupe Cardio‐Vasculaire lnterventionnel, Cinique Pasteur Toulouse FranceMathematics Department Polytechnic University of Milan Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan Italy‘Vita‐Salute San Raffaele’ University Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyAbstract Aims Impella malrotation—inlet orientation away from the left ventricular (LV) apex with normal console waveforms and proper device depth—is commonly observed and possibly associated worse haemodynamics. This study aimed to characterize the haemodynamic consequences of Impella malrotation in cardiogenic shock (CS) patients. Methods and results We included 100 CS patients (60 ± 12 years; 79.0% males) with available echocardiography during Impella support and pulmonary artery catheter assessment before and during (at 48 h) Impella support. Impella malrotation was identified in 36%. At 48 h, malrotation patients had higher pulmonary artery wedge pressure (PAWP, 16.0 ± 8.2 vs. 13.0 ± 4.6 mmHg; P = 0.033), higher systolic pulmonary artery pressure (PAP, 35.0 ± 11.3 vs. 29.5 ± 9.0 mmHg; P = 0.015), higher diastolic‐PAP (19.3 ± 8.1 vs. 15.1 ± 6.1 mmHg; P = 0.007), higher mean‐PAP (25.7 ± 9.1 vs. 20.8 ± 6.8 mmHg; P = 0.005), higher right atrial pressure (10.3 ± 4.8 vs. 7.7 ± 4.3 mmHg; P = 0.009), higher pulmonary vascular resistance index (4.78 ± 2.75 vs. 3.49 ± 1.94 WUm2; P = 0.020) and higher pulmonary artery elastance (0.91 ± 0.60 vs. 0.67 ± 0.40 mmHg/mL; P = 0.045). Serum lactate at 48 h was higher in malrotation patients (6.63 ± 6.25 vs. 3.60 ± 4.21 mmol/L; P = 0.004). Malrotation patients presented larger LVEDD during support (52 ± 10 vs. 46 ± 11 mm; P = 0.006), higher rates of aortic regurgitation (AR, 86 vs. 56%; P = 0.004) and higher increase in AR severity (+0.94 ± 0.92 vs. + 0.46 ± 0.95; P = 0.016). No significant differences were found in major adverse outcomes. Conclusions In CS patients, Impella malrotation is associated with suboptimal unloading of the LV, worse pulmonary haemodynamics and worse indexes of right ventricular afterload.https://doi.org/10.1002/ehf2.15087AngiographyCardiogenic shockHaemodynamicsImpellaMalrotationMechanical circulatory support |
| spellingShingle | Luca Baldetti Davide Romagnolo Mariagiulia Festi Alessandro Beneduce Davide Gurrieri Beatrice Peveri André Frias Mario Gramegna Stefania Sacchi Lorenzo Cianfanelli Francesco Calvo Vittorio Pazzanese Alaide Chieffo Silvia Ajello Anna Mara Scandroglio Impella malrotation affects left ventricle unloading in cardiogenic shock patients ESC Heart Failure Angiography Cardiogenic shock Haemodynamics Impella Malrotation Mechanical circulatory support |
| title | Impella malrotation affects left ventricle unloading in cardiogenic shock patients |
| title_full | Impella malrotation affects left ventricle unloading in cardiogenic shock patients |
| title_fullStr | Impella malrotation affects left ventricle unloading in cardiogenic shock patients |
| title_full_unstemmed | Impella malrotation affects left ventricle unloading in cardiogenic shock patients |
| title_short | Impella malrotation affects left ventricle unloading in cardiogenic shock patients |
| title_sort | impella malrotation affects left ventricle unloading in cardiogenic shock patients |
| topic | Angiography Cardiogenic shock Haemodynamics Impella Malrotation Mechanical circulatory support |
| url | https://doi.org/10.1002/ehf2.15087 |
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