Clin Res Cardiol (2021)
DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Microaxial percutaneous left ventricular assist device vs. medical treatment for protection of acute kidney injury in patients with cardiogenic shock
A. Huseynov1, S. Baumann1, C. Schellenberg1, F. Eder1, T. Becher2, P. Fürner1, B. Krüger3, M. Behnes1, M. Borggrefe1, I. Akin1
1I. Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim; 2Laboratory of Molecular Metabolism, The Rockefeller University, New York, US; 3Med V. - Nephrologie, Endokrinologie und Rheumatologie, Universitätsklinikum Mannheim, Mannheim;

Background: Acute kidney injury (AKI) is a common and serious complication of cardiogenic shock (CS). Short-term support with a microaxial percutaneous left ventricular assist device (pLVAD) has become a popular strategy to maintain hemodynamic stability and to increase the cardiac output during CS. This gave rise to the hypothesis that the kidney function may be protected from major damage by remaining a continuous blood flow with a pLVAD.. However, usefulness of hemodynamic support with microaxial Impella® 2.5 pump (Abiomed, Danvers, MA, USA) as protection of AKI in patients with CS has not yet been proven.

Methods: In this retrospective single-centre registry, a total of 48 patients with CS protected with Impella® 2.5 microaxial pLVAD were enrolled. This cohort was compared to a control group of consecutive 48 patients with conservative medical treatment.

Results: The incidence of overall mortality was significantly higher in the pLVAD group (68.75% vs. 45.83%, p=0.02; OR 2.70 (95% CI: 1.17-6.19) with higher MACCE rate (70.83% vs. 47.29%; p=0.02; OR 2.63 (95% CI: 1.13-6.12), considering more left main trunk culprit lesions (27.0% vs. 8.7%; p=0.02; OR 4.08 (95% CI: 1.22-13.63)  and more involved coronary vessels  (2.63 vs. 2.36; p=0.03; OR 1.63 (95% CI: 0.96-2.77) in the pLVAD group. The pLVAD use could not improve the AKI (60.41% vs. 56.25%; p=0.67; OR 1.18 (95% CI: 0.52-2.67) and renal replacement therapy rate (35.42% vs. 31.25%; p=0.67; OR 1.20 (95% CI: 0.51-2.82).

Conclusions: The use of the Impella® 2.5 compared to conservative treatment appears not to reduce the rate of AKI considering more complex patients and higher morbidity in this patients’ group.

Variable

All,

n=96 (100%)

Impella 2.5,

n= 48

Conservative,

n= 48

p

Primary outcome

Acute kidney injury

AKI stage 1

AKI stage 2

AKI stage 3

24 (25.0%)

13 (13.5%)

6 (6.2%)

5 (5.2%)

12 (25.0%)

5 (10.4%)

4 (8.3%)

3 (6.2%)

12 (25.0%)

8 (16.7%)

2 (4.2%)

2 (4.2%)

1.00

0.37

0.68

1.00

Secondary outcomes
Need for hemodialysis, n (%)

32 (33.3%)

17 (35.4%)

15 (31.2%)

0.67

Death, n (%)

55 (57.3%)

33 (68.7%)

22 (45.8%)

0.02

Combined MACCE, n (%)

Death, n (%)

Repeat myocardial infarction, n (%)

Repeat revascularization, n (%)

Stroke, n (%)

57 (59.4%)

55 (57.3%)

3 (3.1%)

13 (13.5%)

3 (3.1%)

34 (70.8%)

33 (68.7%)

0 (0.0%)

7 (14.6%)

2 (2.1%)

23 (47.3%)

22 (45.8%)

3 (6.2%)

6 (12.5%)

1 (1.0%)

0.02

0.02

0.24

0.77

1.00

Bleeding, BARC ≥ 3, n (%)

14 (14.6%)

11 (22.9%)

3 (6.2%)

0.02

Hospital duration, day ± SD

6.6 ±9.7

6.7 ±10.7

6.5 ±8.6

0.18

 Table 1. In hospital follow up and in hospital adverse events. AKI= acute kidney injury, MACCE= major adverse cardiac and cerebrovascular events, BARC= Bleeding academic research consortium



Figure A Incidence of acute kidney injury (AKI) in Impella® 2.5 supported vs. unsupported patients with cardiogenic shock. B Incidence depending on the severity of chronic kidney disease.

 
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