BackgroundBiventricular failure is associated with high in‐hospital mortality. Limited data regarding the efficacy of biventricular Impella axial flow catheters (BiPella) support for biventricular failure exist. The aim of this study was to explore the clinical utility of percutaneously delivered BiPella as a novel acute mechanical support strategy for patients with cardiogenic shock complicated by biventricular failure. Methods and ResultsWe retrospectively analyzed data from 20 patients receiving BiPella for biventricular failure from 5 tertiary‐care hospitals in the United States. Left ventricular support was achieved with an Impella 5.0 (n=8), Impella CP (n=11), or Impella 2.5 (n=1). All patients received the Impella RP for right ventricular (RV) support. BiPella use was recorded in the setting of acute myocardial infarction (n=11), advanced heart failure (n=7), and myocarditis (n=2). Mean flows achieved were 3.4±1.2 and 3.5±0.5 for left ventricular and RV devices, respectively. Total in‐hospital mortality was 50%. No intraprocedural mortality was observed. Major complications included limb ischemia (n=1), hemolysis (n=6), and Thrombolysis in Myocardial Infarction major bleeding (n=7). Compared with nonsurvivors, survivors were younger, had a lower number of inotropes or vasopressors used before BiPella, and were more likely to have both devices implanted simultaneously during the same procedure. Compared with nonsurvivors, survivors had lower pulmonary artery pressures and RV stroke work index before BiPella. Indices of RV afterload were quantified for 14 subjects. Among these patients, nonsurvivors had higher pulmonary vascular resistance (6.8; 95% confidence interval [95% CI], 5.5–8.1 versus 1.9; 95% CI, 0.8–3.0; P<0.01), effective pulmonary artery elastance (1129; 95% CI, 876–1383 versus 458; 95% CI, 263–653; P<0.01), and lower pulmonary artery compliance (1.5; 95% CI, 0.9–2.1 versus 2.7; 95% CI, 1.8–3.6; P<0.05). ConclusionsThis is the largest, retrospective analysis of BiPella for cardiogenic shock. BiPella is feasible, reduces cardiac filling pressures and improves cardiac output across a range of causes for cardiogenic shock. Simultaneous left ventricular and RV device implantation and lower RV afterload may be associated with better outcomes with BiPella. Future prospective studies of BiPella for cardiogenic shock are required.

Background: Biventricular Impella (BiPella) is a novel acute mechanical support strategy for patients with BiVF. We hypothesized that indices of right ventricular-pulmonary arterial coupling are associated with clinical outcomes among BiPella recipients. Methods: We retrospectively analyzed

Cardiogenic shock involving biventricular failure (BiVF) is associated with increased in-hospital mortality. This study explored the clinical utility of employing two micro-axial flow Impella catheters for biventricular support (BiPella) in the setting of BiVF. We retrospectively reviewed data from

Results: Mean age at the time of enrollment was 55.7 +13.1 years (range 18-86 years) and 91% of pts were female. Mean BMI was 25.5 + 5.2 kg/ m2 and 48.8% of patients had a BMI > 25 kg/m2. Mean blood pressure on enrollment was 130/75 + 20/12.4 mmHg and 77.9% of pts were taking at least one blood pressure medication. 60% of pts reported significant headaches and 27.5% had pulsatile tinnitus. A cervical or epigastric bruit was a presenting sign that led to FMD diagnosis in 22.2% and 9.4% of pts, respectively. A neurological and vascular PE was recorded at the time of enrollment in 92.6% (414/447). Findings suggestive of Horner’s syndrome (pupil abnormality or ptosis) were reported in 12.4% of pts. Cranial nerve abnormalities were reported in 9.4% and other focal neurological deficits were reported in 13.6%. Bruits were reported over the carotid arteries (30.5%; 18.1% bilateral), epigastrium (17.5%), and flanks (6.1%; 3.2% bilateral). Among pts with reported imaging of the extracranial circulation (carotid and vertebral) and a documented PE, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of carotid bruit in predicting extracranial carotid FMD were 45.4%, 93.7%, 95.4%, and 37.4%, respectively. The sensitivity, specificity, PPV and NPV of epigastric and/or flank bruit in predicting renal and/or mesenteric FMD were 24.0%, 93.3%, 92.6%, and 26.0%, respectively.

Results: Among pts with renal artery involvement alone, ultrasound (US) was the most common initial diagnostic modality (77%), followed by catheter-based angiography (66.7%), CT angiography (39.7%), MR angiography (21.4%), and intravascular US (5.6%). Among pts with extracranial carotid or vertebral alone, US remained the most commonly used imaging modality (79.2%); with fewer pts undergoing catheter-based angiography (37.5%). Pts with both renal and extracranial carotid/vertebral involvement underwent more imaging overall, with US (83.8%) and catheter-based angiography (64.1%) the most common. At follow-up, US remained the most common in pts with renal involvement alone (72.3%), extracranial carotid/vertebral alone (86.2%), or both (77.1%). Catheter-based angiography was common for renal alone (38.3%), extracranial carotid/vertebral alone (20.7%), or both (40%). 74.5% of pts with renal FMD underwent carotid/vertebral artery imaging; 83.7% of pts with carotid/vertebral FMD had renal artery imaging. Of pts diagnosed with extracranial carotid FMD, 63.7% also had imaging of the intracranial vasculature.