Benefits of a novel percutaneous ventricular assist device for right heart failure: The prospective RECOVER RIGHT study of the Impella RP device

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• 作者：Mark B. Anderson ; MD^a ; ^{andersom@einstein.edu" class="auth_mail" title="E-mail the corresponding author} ; James Goldstein ; MD^b ; Carmelo Milano ; MD^c ; Lynn D. Morris ; MD^a ; Robert L. Kormos ; MD^d ; Jay Bhama ; MD^d ; Navin K. Kapur ; MD^e ; Aditya Bansal ; MD^f ; Jose Garcia ; MD^g ; Joshua N. Baker ; MD^g ; Scott Silvestry ; MD^h ; William L. Holman ; MDⁱ ; Pamela S. Douglas ; MD^j ; William O&rsquo ; Neill ; MD^k
• 关键词：heart failure ; hemodynamics ; right ventricular assist device ; cardiogenic shock ; right ventricular failure
• 刊名：Journal of Heart and Lung Transplantation
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：34
• 期：12
• 页码：1549-1560
• 全文大小：904 K

文摘

Right ventricular failure (RVF) increases morbidity and mortality. The RECOVER RIGHT study evaluated the safety and efficacy of a novel percutaneous right ventricular assist device, the Impella RP (Abiomed, Danvers, MA), in a prospective, multicenter trial.

Methods

Thirty patients with RVF refractory to medical treatment received the Impella RP device at 15 United States institutions. The study population included 2 cohorts: 18 patients with RVF after left ventricular assist device (LVAD) implantation (Cohort A) and 12 patients with RVF after cardiotomy or myocardial infarction (Cohort B). The primary end point was survival to 30 days or hospital discharge (whichever was longer). Major secondary end points included indices of safety and efficacy.

Results

The patients (77% male) were a mean age of 59 ± 15 years, 53% had diabetes, 88.5% had a history of congestive heart failure, and 37.5% had renal dysfunction. Patients were on an average of 3.2 inotropes/pressors. Device delivery was achieved in all but 1 patient. Hemodynamics improved immediately after initiation of Impella RP support, with an increase in cardiac index from 1.8 ± 0.2 to 3.3 ± 0.23 liters/min/m² (p < 0.001) and a decrease in central venous pressure from 19.2 ± 4 to 12.6 ± 1 mm Hg (p < 0.001). Patients were supported for an average of 3.0 ± 1.5 days (range, 0.5–7.8 days). The overall survival at 30 days was 73.3%. All patients discharged were alive at 180 days.

Conclusions

In patients with life-threatening RVF, the novel percutaneous Impella RP device was safe, easy to deploy, and reliably resulted in immediate hemodynamic benefit. These data support its probable benefit in this gravely ill patient population.