Outcome of right ventricular microaxial pump support in patients undergoing cardiac surgery

Outcome of right ventricular microaxial pump support in patients undergoing cardiac surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Outcome of right ventricular microaxial pump support in patients undergoing cardiac surgery Medina Marta, Mahmoud Zada, Nils Theuerkauf, Georg Daniel Duerr, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3053944/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Apr, 2024 Read the published version in Scientific Reports → Version 1 posted 12 You are reading this latest preprint version Abstract Right ventricular failure (RVF) after cardiac surgery is associated with an in-hospital mortality rate of up to 75%. Axial flow pumps are one of the mechanical circulatory support (MCS) options available for the treatment of RVF, however the specifics of timing and indication for MCS, as well as predictors for survival, remain unclear due to a dearth published data. We evaluated the clinical outcome of patients treated with Impella RP for predictors of mortality and the hemodynamic effects of the pump. This is a single-center retrospective observational study involving adult patients who underwent cardiac surgery with cardiopulmonary bypass between January 2019 and December 2020 in cardiac surgery and required therapeutic management of RVF with an Impella RP. Overall, 18 patients were included and analyzed for factors that could be associated with mortality, or that could be predictors of patient outcomes for this population. Treatment of RVF with Impella-RP improved the patient hemodynamics significantly and had a survival rate of 61% within 30 days. Patients with isolated CABG or better liver function before implantation had a better survival rate, which may indicate that underlying disease and timing of implantation are significant for successful treatment of RVF. Health sciences/Cardiology/Cardiac device therapy Health sciences/Diseases/Cardiovascular diseases/Heart failure Figures Figure 1 Introduction Right ventricular failure (RVF) is a rare condition, but it is associated with high mortality rates. 1,2 Furthermore, RVF incidence may be underreported as the mechanisms underlying RVF are unclear and diagnosis is difficult. 3 Following conventional cardiac surgery, the prevalence of RVF is reported to be between 0.5-3%, while the incidence after left ventricular assist device (LVAD) implantation is reported with 15–25% of all LVAD cases. 4 Conservative treatment with inotropic or nitric oxide therapies has no significant effects on survival, although nitric oxide in particular is associated with hemodynamic improvement. In the last decade, mechanical circulatory support (MCS) of the right ventricle (RV) was introduced as a "bridging" intervention for faster recovery, offering an opportunity to rapidly stabilize patients with cardiogenic shock involving the RV. The Impella RP (Abiomed, Danvers, MA) is a minimally invasive percutaneous RV assist device for the treatment of RVF, and the only model approved by the Food and Drug Administration. The RECOVER RIGHT study demonstrated the safety and efficacy of Impella RP in supporting patients with RVF, enabling early recovery. 5 However, data regarding the Impella RP remains limited due to low implantation rates; to date, there have been only three multicentric publications and one single center experience. 2,6–8 The survival rate after Impella-RP support varies based on the indication for implantation and severity of shock; as such, it may range from 28.6%-49%. 2 It is therefore important to determine which patients may benefit from Impella RP use and what factors determine a better outcome after Impella-RP support. 2 The aim of this study was to evaluate the clinical outcome of patients treated with Impella-RP after cardiac surgery, examining the hemodynamic effects and determining predictors of mortality in the largest cohort in Europe. Results Demographic Analysis From January 2019 and December 2020, 24 patients were treated with an Impella-RP and qualified for this study. Of those, three patients were treated with Impella 5.0 and Impella RP (BiPella) for biventricular failure and were excluded from the analysis. An additional three patients had an early device dislocation, and therefore 18 patients were included for analysis. The 18 patient study population comprised 83% (n = 15) males and 17% (n = 3) females with a mean age of 65.83 ± 11.82 years (Table 1 ). Survival rate at 30 days after Impella-RP explantation was 61.1%, with an overall mortality rate of 38.9%. Table 1 Patient characteristics and association with mortality Total (n = 18) Survival (n = 11) Death (n = 7) p-value Age 65.83 ± 11.82 67.45 ± 14.29 63.29 ± 6.57 0.326 Gender, n (%) 0.280 Male 15 (83) 10(66) 5(34) Female 3 (17) 1(33) 2(66) BMI (kg/m 2 ) 26.72 ± 4.65 28.64 ± 4.63 23.71 ± 2.87 0.415 Impella-RP Support (days) 3.63 ± 2.69 4.28 ± 2.74 2.63 ± 2.48 0.190 Surgery, n (%) 0.036 Isolated CABG 5(28) 5(100) 0 Non-isolated CABG 13(72) 6(46) 7 (54) Diagnosis, n (%) 0.087 ICM 6 (33) 6 (100) 0 VCM 7 (39) 3 (43) 4 (57) Aorta 4 (22) 2 (50) 2 (50) DCM/Other 1 (6) 0 1 (100) Major Bleeding, n (%) 9 (50) 4 (44) 5 (56) 0.147 AvWS, n (%) 14 (78) 7(50) 7(50) 0.070 BMI, Body Max-Index; CABG, coronary artery bypass graft; ICM, ischemic cardiomyopathy; VCM, valvular cardiomyopathy; DCM, dilated cardiomyopathy; AvWS, Acquired von Willebrand Syndrome Demographic data were evaluated in relation to patient mortality, but there were no significant differences. To assess the relevance of the etiology of right heart failure and its impact on the outcome of treatment with Impella-RP, patients were divided according to the surgery received: patients who developed RVF after isolated bypass surgery, and patients who developed RVF after a non-isolated bypass surgery or a surgery other than bypass surgery. Patients undergoing isolated myocardial revascularization surgery had significantly higher survival (odds ratio [OR] = 2.16, 95% confidence interval [95% CI] = 1.2–3.89; p = 0.036) after Impella-RP treatment than patients who had undergone valve or combined surgery (Table 1 ). Factors such as severe bleeding or the presence of acquired von Willebrand syndrome (AvWs) did demonstrate a significant association with increased risk of death. Hemodynamic and Liver Function Analysis Liver function and lactate dehydrogenase (LDH) levels were evaluated to determine whether there was a significant, and therefore predictive, association between elevated values and patient outcomes (Table 2 ). However, no statistically significant relationship to mortality rate was detected. Total bilirubin on the last day of Impella-RP treatment and ALT on the first and third days of Impella-RP treatment all appeared to be trend parameters (p < 0.063, p < 0.052 and p < 0.094 respectively). This may indicate that patients receiving refractory therapy with Impella-RP may be at an advanced stage of RVF at the time of implantation. Table 2 Liver function and hemodynamic parameters during Impella-RP therapy and association with mortality Parameter Total (n = 18) Survival (n = 11) Death (n = 7) p-value Liver Total Bilirubin, mg/dL Day 1 2.43 ± 2.82 1.86 ± 1.48 3.32 ± 4.17 0.299 Day 3 4.6 ± 4.74 3.54 ± 4.47 6.27 ± 5.02 0.245 Last Day 5.55 ± 6.02 3.43 ± 4.74 8.87 ± 6.66 0.060 gGT, (U/L) Day 1 44.17 ± 27.09 50.64 ± 27.81 34 ± 24.34 0.214 Day 3 80.39 ± 127.79 107.36 ± 159.22 38 ± 24.34 0.274 Last Day 66.89 ± 60.4 72.73 ± 56.41 57.71 ± 69.81 0.622 ALT, (U/L) Day 1 341.5 ± 1078.64 536.36 ± 1367.61 35.29 ± 15.16 0.352 Day 3 341.94 ± 591.84 467.64 ± 709.34 144.43 ± 281.71 0.271 Last Day 254.89 ± 329.83 249.09 ± 317.37 264 ± 374.45 0.929 AST, (U/L) Day 1 577.06 ± 1463.6 872.36 ± 1841.2 113 ± 90.82 0.297 Day 3 589.28 ± 759.83 599.18 ± 671.1 573.71 ± 940.6 0.947 Last Day 358.22 ± 519.54 328 ± 516.92 405.71 ± 561.36 0.767 LDH, (U/L) Day 1 1870.49 ± 1935.35 2489.98 ± 2289.36 941.25 ± 763.32 0.235 Last Day 642.21 ± 487.22 755.85 ± 579.52 471.75 ± 296.41 0.398 Hemodynamic PCWP 19 ± 4 17.33 ± 3.21 26 0.029 Pre-Impella RP Post Impella RP 21.43 ± 13.99 18.75 ± 2.22 22 ± 5.65 0.114 mPAP Pre-Impella RP 29.27 ± 8.9 29.12 ± 9.41 29.66 ± 9.23 0.44 Post Impella RP 24.88 ± 9.02 23.43 ± 8.67 35 0.074 Charlson Comorbidity Index Pre-Impella RP 2.50 ± 0.80 2.65 ± 0.85 1.96 ± 0.22 0.063 Post Impella RP 3.15 ± 0.75 3.22 ± 0.68 2.9 ± 1.27 0.108 gGT, gamma-glutamyl transferase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, Body Max-Index; AvWS, Acquired von Willebrand syndrome; PCWP, Pulmonary Capillary Wedge Pressure; mPAP, Mean pulmonary artery pressure Though no significant statistical relationship was evinced between hemodynamic values and mortality, a rapid improvement in hemodynamic parameters was observed during treatment with a Impella-RP. Placement of Impella-RP resulted in a significative improvement in the cardiac index (CI) for almost all the patients (OR = 0.50, 95% CI=-1.22-0.29; p = 0.007; Table 3 ). Table 3 Paired T-Test for pre- and post Impella RP hemodynamic parameters Odds Ratio 95% CI p-Value Lower Upper PCWP 13.4 -23.84 9.44 0.296 mPAP 7.72 -0.706 12.21 0.073 CI 0.50 -1.22 -0.29 0.007 PCWP, Pulmonary Capillary Wedge Pressure; mPAP, mean Pulmonary Artery Pressure; CI, cardiac index Catecholamine Usage Due to the retrospective nature of this study, catecholamine data could not be obtained for all days of hospitalization. Regardless, after Impella-RP implantation, catecholamine support was significantly reduced (Fig. 1 ). Patients demonstrated a catecholamine peak at the time of Impella placement and at the time of explantation as bridging support, followed by a reduction or discontinuation of catecholamine therapy. Discussion This study is the largest single center retrospective cohort in Europe with Impella-RP for patients with RVF after cardiac surgery. We evaluated which factors provided an approximation of right ventricular function in the postoperative period. Due to the lack of a consensus definition of RVF, and the fact that RVF mechanisms have not been well defined, 9 we evaluated liver function and assessed catecholamine variability as a noninvasive hemodynamic prediction metric. As these factors could be influenced by external complications and were, by nature, secondary assessors for determining right heart function, we performed invasive hemodynamic prediction measurements of CI and mean pulmonary artery pressure (MPAP). We found that patients undergoing isolated myocardial revascularization surgery had significantly higher survival after Impella-RP treatment than patients who had undergone valve or combined surgery, and that Impella RP therapy significantly improved CI in most patients. We did not find any significant association with mortality for any of the metrics evaluated, though total bilirubin on the last day of Impella-RP treatment and ALT on the first and third days of Impella-RP treatment trended towards significance. The use of Impella-RP was most beneficial for patients undergoing isolated myocardial revascularization surgery who develop RVF after open-heart surgery. Importantly, despite hemodynamic instability at the time of Impella-RP implantation, these patients developed complete right heart recovery and hemodynamic stability with no mortalities, which was maintained after explantation of the Impella-RP. Impella RP treatment also resulted in an increased cardiac index in almost all patients, though likely due to the breadth of pathology of these patients, it was not significantly related to survival; regardless, it improved systemic perfusion, enhanced end-organ perfusion, and enabled prompt withdrawal of inotropic and vasopressor support. RVF as a complication after cardiac surgery is challenging to treat and is associated with increased short-term mortality 1,10,11 and extended hospitalizations; this unsurprisingly results in commensurate cost increases. Thus, implementation of Impella RP is not only beneficial to improving RV recovery and cardiac output, but it also reduces costs associated with complications from open heart surgery and extended hospitalization times. The overall mortality evinced by this study is notably lower than that seen in the literature, where overall mortality has reportedly been as high as 51%. 2 In this analysis, overall mortality was closer to that of the RECOVER RIGHT and subsequent conformity assessment and post approval studies (26.7%). 1,5 It may be that patient selection was important for this, as the cohort in this study contained exclusively patients who underwent cardiac surgery with cardiopulmonary bypass and required therapeutic management of RVF with an Impella RP. In studies that include consecutive Impella RP placements, patients could be experiencing RV failure due to numerous conditions, including post-LVAD implantation, acute pulmonary embolism, post-cardiotomy RV failure, post-myocardial infarction shock, and nonischemic cardiomyopathy; 2 it may be that the varied etiologies for RVF result in different therapeutic approaches in addition to MCS. Furthermore, the timing of Impella RP usage may be crucial to improving mortality outcomes for this population, as this is the case for left ventricular failure MCS, 12,13 and recent work has suggested this holds true for RVF as well. 14,15 Future analyses will need to focus on these factors to ensure the patients who are best served by Impella RP usage are treated when appropriate for the best odds of survival and recovery. The principal hemodynamic benefit of Impella-RP is a direct increase in pulmonary artery flow and a concomitant unloading of the RV. 6,16 As described in the RECOVER RIGHT study in 2015, 5 the use of Impella RP is safe and effective in improving hemodynamics in patients with severe RVF refractory to medical therapy. Given that Impella RP is a percutaneous RVAD support, it not only facilitates fast implantation, but also effectively reduces the right ventricular workload without the need for cardiotomy, achieving prompt hemodynamic stabilization of the patient before shock becomes irreversible. Complications such as bleeding or AvWS were managed by clinicians and did not demonstrate increased mortality. Due to the wide range of pathologies of our patients, it is difficult to clarify the specific pathophysiology that results in acute RVF. Factors such as elevated liver function parameters may indicate an advanced stage of RVF at the time of implantation and as such may not be sufficient for treatment with Impella-RP. Overall, Impella-RP is safe and effective and can be used as standard treatment for a select group of patients. Due to the very limited sample size, it will be necessary to perform further thorough multivariate analyses to identify predictors of mortality associated with Impella-RP usage in RVF. Methods Study Population In this retrospective observational cohort study, all patients undergoing cardiac surgery with cardiopulmonary bypass and who developed post-operative RVF between January 2019 and December 2020 at University Hospital Bonn were screened for study inclusion. A total of 21 patients were treated with Impella-RP, though 3 patients were excluded due to Impella RP dislocation with a treatment duration < 6h. As such, the study population included 18 adult patients evaluated through medical record review and descriptive analysis. This study was approved by the Rheineische Friedrich-Wilhelms-Universität Bonn ethics committee. (Ethics approval Number: 168/20) An informed consent for the retrospective analysis of the data was obtained from all subjects. All methods were performed in accordance with the relevant guidelines and regulations for good clinical and good scientific practice. The indication for RV-AFP implantation was the standard of care for isolated RVF. The definition of RVF was an elevated lactate levels over 8mmol/l, vasoconstrictors > 0.1γ and at least one inotropic drug, with a central venous pressure (CVP) > 15mmHg. Furthermore, a pulmonary catheter was introduced in each case and other reversible causes for cardiogenic shock were ruled out with transesophageal echocardiography. The implantation of Impella-RP was performed under fluoroscopy using a pigtail catheter to introduce the placing wire in the pulmonary artery in the operating room or catheterization lab. All patients were anticoagulated with intravenous heparin with an activated clotting time aim of 160–180. Study Endpoints The primary end point for the study was the survival rate at 30 days after device explantation. Secondary endpoints were the hemodynamic effects of device implantation after initiation of Impella-RP support, decreased use of inotropes during Impella-RP support, and device complications. Statistics Statistical analysis was performed using SPSS (Statistical Package for the Social Sciences) for macOs® version 26.0 (SPSS Inc., Chicago, Illinois, USA). All data were anonymized and treated according to data protection regulations. 17 The local research ethics committee approved the study. Continuous variables were expressed as mean ± standard deviation. Normality was tested using the Kolmogorow-Smirnow-Test. Categorical variables were shown as absolute (n) and relative (%) frequencies. Continuous variables with a normal distribution were tested using the Student's t-test, while those that were not normal were tested with the Mann-Whitney-Test. The non-parametric or categorical data were tested with Pearson chi-square test. Values were considered statistically significant at a probability factor p ≤ 0.05, where a p-value less than 0.05 was considered statistically significant. We use paired samples t-tests to compare means before and after Impella-RP treatment and determine the hemodynamic effect on the patient. Abbreviations AvWs: acquired von Willebrand syndrome RV-AFP: right ventricular axial flow pump RVF: right ventricular failure LVAD: left ventricular Assist Device MCS: mechanical circulatory support RV: right ventricle CI: cardiac index mPAP: mean pulmonary artery pressure Declarations Acknowledgements JetPub Scientific Communications LLC, supported by Abiomed, assisted in the preparation of this manuscript. Mehmet Oezkur is a consultant for Abiomed Inc. The other authors do not have any conflicts of interest to declare. Data availability All relevant data are included in the manuscript and its associated files. Due to data protection regulation, we are not allowed to submit the data with the publication. However, in case of a relevant question, the data is available and can be provided by the corresponding author. References Anderson, M. et al. Outcomes of patients with right ventricular failure requiring short-term hemodynamic support with the Impella RP device. The Journal of Heart and Lung Transplantation 37, 1448–1458 (2018). Shekiladze, N. et al. A single healthcare experience with Impella RP. Catheterization and Cardiovascular Interventions 97, E161–E167 (2021). Arrigo, M. et al. Right Ventricular Failure: Pathophysiology, Diagnosis and Treatment. Card Fail Rev 5, 140 (2019). Kormos, R. L. et al. Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: Incidence, risk factors, and effect on outcomes. Journal of Thoracic and Cardiovascular Surgery 139, 1316–1324 (2010). Anderson, M. B. et al. Benefits of a novel percutaneous ventricular assist device for right heart failure: The prospective RECOVER RIGHT study of the Impella RP device. J Heart Lung Transplant 34, 1549–1560 (2015). Anderson, M. et al. Impella RP Post Approval Study: First Multi-Center, Prospective Post Market Approval Results for the Impella RP in Patients with Right Ventricular Failure. The Journal of Heart and Lung Transplantation 36, S64–S65 (2017). Botti, G. et al. Impella RP for Patients with Acute Right Ventricular Failure and Cardiogenic Shock: A Subanalysis from the IMP-IT Registry. J Pers Med 12, (2022). Qureshi, A. M. et al. Percutaneous Impella RP use for refractory right heart failure in adolescents and young adults-A multicenter U.S. experience. Catheter Cardiovasc Interv 96, 376–381 (2020). Haddad, F., Couture, P., Tousignant, C. & Denault, A. Y. The right ventricle in cardiac surgery, a perioperative perspective: II. Pathophysiology, clinical importance, and management. Anesth Analg 108, 422–433 (2009). Apostolakis, S. & Konstantinides, S. The right ventricle in health and disease: insights into physiology, pathophysiology and diagnostic management. Cardiology 121, 263–273 (2012). Mehta, S. R. et al. Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction. J Am Coll Cardiol 37, 37–43 (2001). Basir, M. B. et al. Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock. Am J Cardiol 119, 845–851 (2017). Helgestad, O. K. L. et al. Contemporary trends in use of mechanical circulatory support in patients with acute MI and cardiogenic shock. Open Heart 7, e001214 (2020). Bhama, J. K. et al. Clinical experience with temporary right ventricular mechanical circulatory support. J Thorac Cardiovasc Surg 156, 1885–1891 (2018). Kapur, N. K. et al. Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure. The Journal of Heart and Lung Transplantation 30, 1360–1367 (2011). Gramegna, M. et al. Impella RP support in refractory right ventricular failure complicating acute myocardial infarction with unsuccessful right coronary artery revascularization. Int J Cardiol 302, 135–137 (2020). European Parliament. Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation) . EUR-Lex Access to European Union Law (2016). Additional Declarations Competing interest reported. Mehmet Oezkur is a consultant for Abiomed Inc. The other authors do not have any conflicts of interest to declare. Cite Share Download PDF Status: Published Journal Publication published 06 Apr, 2024 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 29 Jan, 2024 Reviews received at journal 20 Dec, 2023 Reviewers agreed at journal 19 Dec, 2023 Reviews received at journal 15 Dec, 2023 Reviewers agreed at journal 14 Dec, 2023 Reviews received at journal 30 Oct, 2023 Reviewers agreed at journal 19 Oct, 2023 Reviewers invited by journal 19 Sep, 2023 Editor assigned by journal 23 Jun, 2023 Editor invited by journal 23 Jun, 2023 Submission checks completed at journal 23 Jun, 2023 First submitted to journal 12 Jun, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3053944","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":212576238,"identity":"eb863a58-aadd-4fde-8867-a5a13d14eee6","order_by":0,"name":"Medina Marta","email":"","orcid":"","institution":"Department of Cardiovasular Surgery, University Medical Center of the Johannes Gutenberg University Mainz","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Medina","middleName":"","lastName":"Marta","suffix":""},{"id":212576239,"identity":"72ed8b67-1219-498b-b2b5-533cafb26ecc","order_by":1,"name":"Mahmoud Zada","email":"","orcid":"","institution":"Department of Cardiology and Rhythmology, Hospital Mechernich","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mahmoud","middleName":"","lastName":"Zada","suffix":""},{"id":212576240,"identity":"1a956648-be11-4bf8-b837-45ab074922c2","order_by":2,"name":"Nils Theuerkauf","email":"","orcid":"","institution":"Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nils","middleName":"","lastName":"Theuerkauf","suffix":""},{"id":212576241,"identity":"9c5d53b0-f913-407a-b876-30e4de581831","order_by":3,"name":"Georg Daniel Duerr","email":"","orcid":"","institution":"Department of Cardiovasular Surgery, University Medical Center of the Johannes Gutenberg University Mainz","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Georg","middleName":"Daniel","lastName":"Duerr","suffix":""},{"id":212576242,"identity":"e0e89c61-d6a3-429f-99bc-562d3af36d42","order_by":4,"name":"Sebastian Zimmer","email":"","orcid":"","institution":"Department of Cardiology, University Hospital of Bonn","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sebastian","middleName":"","lastName":"Zimmer","suffix":""},{"id":212576243,"identity":"6366d982-e7ff-4e7a-afef-28436b588085","order_by":5,"name":"Hendrik Treede","email":"","orcid":"","institution":"Department of Cardiovasular Surgery, University Medical Center of the Johannes Gutenberg University Mainz","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hendrik","middleName":"","lastName":"Treede","suffix":""},{"id":212576244,"identity":"ad141f46-712d-4aa7-b582-7e2dc7d7f39e","order_by":6,"name":"Mehmet Oezkur","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYNCCAwwM/CA6oYAULZINIC0GpGgxOABiEKNFt4H54MMfZw7nG59fnfjhgQGDPL/YAfxazA6wJRtI3Dhsue3G280SQIcZzpydQEgLj5mEwYfDBmY3zm4AaUkwuE1Yi/mPBKAW4xlnN/8gVosZw4Ebhw0M+Hu3EWnLYbZkyYYz6UD/8G6zSDCQIMIvx5sPfvxxzNqAv//s5ps/Kmzk+aUJaGFghjEkwColCChHAfwHSFE9CkbBKBgFIwkAAHo6RsNlu6gwAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Cardiovasular Surgery, University Medical Center of the Johannes Gutenberg University Mainz","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"","lastName":"Oezkur","suffix":""}],"badges":[],"createdAt":"2023-06-12 14:44:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3053944/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3053944/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-58602-w","type":"published","date":"2024-04-06T15:00:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":39260260,"identity":"95d796ea-4534-4dfe-80b0-2c02f28f21b4","added_by":"auto","created_at":"2023-06-28 20:32:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":121302,"visible":true,"origin":"","legend":"\u003cp\u003eMilrinone interaction during therapy with Impella-RP\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3053944/v1/16fc8d914e6c3f2c3a07aab2.png"},{"id":54303724,"identity":"03b36001-8a86-411d-8116-12a49463f57d","added_by":"auto","created_at":"2024-04-08 15:09:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":440735,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3053944/v1/c511b8b4-a26f-4a3f-b163-6d57656477da.pdf"}],"financialInterests":"Competing interest reported. Mehmet Oezkur is a consultant for Abiomed Inc. The other authors do not have any conflicts of interest to declare.","formattedTitle":"Outcome of right ventricular microaxial pump support in patients undergoing cardiac surgery","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRight ventricular failure (RVF) is a rare condition, but it is associated with high mortality rates.\u003csup\u003e1,2\u003c/sup\u003e Furthermore, RVF incidence may be underreported as the mechanisms underlying RVF are unclear and diagnosis is difficult.\u003csup\u003e3\u003c/sup\u003e Following conventional cardiac surgery, the prevalence of RVF is reported to be between 0.5-3%, while the incidence after left ventricular assist device (LVAD) implantation is reported with 15\u0026ndash;25% of all LVAD cases.\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eConservative treatment with inotropic or nitric oxide therapies has no significant effects on survival, although nitric oxide in particular is associated with hemodynamic improvement. In the last decade, mechanical circulatory support (MCS) of the right ventricle (RV) was introduced as a \"bridging\" intervention for faster recovery, offering an opportunity to rapidly stabilize patients with cardiogenic shock involving the RV.\u003c/p\u003e \u003cp\u003eThe Impella RP (Abiomed, Danvers, MA) is a minimally invasive percutaneous RV assist device for the treatment of RVF, and the only model approved by the Food and Drug Administration. The RECOVER RIGHT study demonstrated the safety and efficacy of Impella RP in supporting patients with RVF, enabling early recovery.\u003csup\u003e5\u003c/sup\u003e However, data regarding the Impella RP remains limited due to low implantation rates; to date, there have been only three multicentric publications and one single center experience.\u003csup\u003e2,6\u0026ndash;8\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe survival rate after Impella-RP support varies based on the indication for implantation and severity of shock; as such, it may range from 28.6%-49%.\u003csup\u003e2\u003c/sup\u003e It is therefore important to determine which patients may benefit from Impella RP use and what factors determine a better outcome after Impella-RP support.\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe aim of this study was to evaluate the clinical outcome of patients treated with Impella-RP after cardiac surgery, examining the hemodynamic effects and determining predictors of mortality in the largest cohort in Europe.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Analysis\u003c/h2\u003e \u003cp\u003eFrom January 2019 and December 2020, 24 patients were treated with an Impella-RP and qualified for this study. Of those, three patients were treated with Impella 5.0 and Impella RP (BiPella) for biventricular failure and were excluded from the analysis. An additional three patients had an early device dislocation, and therefore 18 patients were included for analysis. The 18 patient study population comprised 83% (n\u0026thinsp;=\u0026thinsp;15) males and 17% (n\u0026thinsp;=\u0026thinsp;3) females with a mean age of 65.83\u0026thinsp;\u0026plusmn;\u0026thinsp;11.82 years (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Survival rate at 30 days after Impella-RP explantation was 61.1%, with an overall mortality rate of 38.9%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient characteristics and association with mortality\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurvival (n\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDeath (n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65.83\u0026thinsp;\u0026plusmn;\u0026thinsp;11.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.45\u0026thinsp;\u0026plusmn;\u0026thinsp;14.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.29\u0026thinsp;\u0026plusmn;\u0026thinsp;6.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.280\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.72\u0026thinsp;\u0026plusmn;\u0026thinsp;4.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.64\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.71\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.415\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImpella-RP\u0026nbsp;Support (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgery,\u0026nbsp;n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.036\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated CABG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-isolated CABG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiagnosis, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVCM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAorta\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDCM/Other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMajor Bleeding, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAvWS, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eBMI, Body Max-Index; CABG, coronary artery bypass graft; ICM, ischemic cardiomyopathy; VCM, valvular cardiomyopathy; DCM, dilated cardiomyopathy; AvWS, Acquired von Willebrand Syndrome\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDemographic data were evaluated in relation to patient mortality, but there were no significant differences. To assess the relevance of the etiology of right heart failure and its impact on the outcome of treatment with Impella-RP, patients were divided according to the surgery received: patients who developed RVF after isolated bypass surgery, and patients who developed RVF after a non-isolated bypass surgery or a surgery other than bypass surgery. Patients undergoing isolated myocardial revascularization surgery had significantly higher survival (odds ratio [OR]\u0026thinsp;=\u0026thinsp;2.16, 95% confidence interval [95% CI]\u0026thinsp;=\u0026thinsp;1.2\u0026ndash;3.89; p\u0026thinsp;=\u0026thinsp;0.036) after Impella-RP treatment than patients who had undergone valve or combined surgery (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Factors such as severe bleeding or the presence of acquired von Willebrand syndrome (AvWs) did demonstrate a significant association with increased risk of death.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eHemodynamic and Liver Function Analysis\u003c/h2\u003e \u003cp\u003eLiver function and lactate dehydrogenase (LDH) levels were evaluated to determine whether there was a significant, and therefore predictive, association between elevated values and patient outcomes (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). However, no statistically significant relationship to mortality rate was detected. Total bilirubin on the last day of Impella-RP treatment and ALT on the first and third days of Impella-RP treatment all appeared to be trend parameters (p\u0026thinsp;\u0026lt;\u0026thinsp;0.063, p\u0026thinsp;\u0026lt;\u0026thinsp;0.052 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.094 respectively). This may indicate that patients receiving refractory therapy with Impella-RP may be at an advanced stage of RVF at the time of implantation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLiver function and hemodynamic parameters during Impella-RP therapy and association with mortality\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurvival (n\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDeath (n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Bilirubin, mg/dL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDay 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.32\u0026thinsp;\u0026plusmn;\u0026thinsp;4.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.299\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDay 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.54\u0026thinsp;\u0026plusmn;\u0026thinsp;4.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLast Day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.55\u0026thinsp;\u0026plusmn;\u0026thinsp;6.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.43\u0026thinsp;\u0026plusmn;\u0026thinsp;4.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.87\u0026thinsp;\u0026plusmn;\u0026thinsp;6.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003egGT, (U/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDay 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e44.17\u0026thinsp;\u0026plusmn;\u0026thinsp;27.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e50.64\u0026thinsp;\u0026plusmn;\u0026thinsp;27.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34\u0026thinsp;\u0026plusmn;\u0026thinsp;24.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDay 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e80.39\u0026thinsp;\u0026plusmn;\u0026thinsp;127.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e107.36\u0026thinsp;\u0026plusmn;\u0026thinsp;159.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u0026thinsp;\u0026plusmn;\u0026thinsp;24.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.274\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLast Day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e66.89\u0026thinsp;\u0026plusmn;\u0026thinsp;60.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e72.73\u0026thinsp;\u0026plusmn;\u0026thinsp;56.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.71\u0026thinsp;\u0026plusmn;\u0026thinsp;69.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.622\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eALT, (U/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDay 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e341.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1078.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e536.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1367.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.29\u0026thinsp;\u0026plusmn;\u0026thinsp;15.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.352\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDay 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e341.94\u0026thinsp;\u0026plusmn;\u0026thinsp;591.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e467.64\u0026thinsp;\u0026plusmn;\u0026thinsp;709.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e144.43\u0026thinsp;\u0026plusmn;\u0026thinsp;281.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.271\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLast Day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e254.89\u0026thinsp;\u0026plusmn;\u0026thinsp;329.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e249.09\u0026thinsp;\u0026plusmn;\u0026thinsp;317.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e264\u0026thinsp;\u0026plusmn;\u0026thinsp;374.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.929\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAST, (U/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDay 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e577.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1463.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e872.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1841.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113\u0026thinsp;\u0026plusmn;\u0026thinsp;90.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.297\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDay 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e589.28\u0026thinsp;\u0026plusmn;\u0026thinsp;759.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e599.18\u0026thinsp;\u0026plusmn;\u0026thinsp;671.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e573.71\u0026thinsp;\u0026plusmn;\u0026thinsp;940.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.947\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLast Day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e358.22\u0026thinsp;\u0026plusmn;\u0026thinsp;519.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e328\u0026thinsp;\u0026plusmn;\u0026thinsp;516.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e405.71\u0026thinsp;\u0026plusmn;\u0026thinsp;561.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.767\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLDH, (U/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDay 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1870.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1935.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2489.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2289.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e941.25\u0026thinsp;\u0026plusmn;\u0026thinsp;763.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.235\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLast Day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e642.21\u0026thinsp;\u0026plusmn;\u0026thinsp;487.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e755.85\u0026thinsp;\u0026plusmn;\u0026thinsp;579.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e471.75\u0026thinsp;\u0026plusmn;\u0026thinsp;296.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.398\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHemodynamic\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePCWP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e19\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e17.33\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.029\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-Impella RP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost Impella RP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e21.43\u0026thinsp;\u0026plusmn;\u0026thinsp;13.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e18.75\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u0026thinsp;\u0026plusmn;\u0026thinsp;5.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003emPAP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-Impella RP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e29.27\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e29.12\u0026thinsp;\u0026plusmn;\u0026thinsp;9.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.66\u0026thinsp;\u0026plusmn;\u0026thinsp;9.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost Impella RP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e24.88\u0026thinsp;\u0026plusmn;\u0026thinsp;9.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e23.43\u0026thinsp;\u0026plusmn;\u0026thinsp;8.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCharlson Comorbidity Index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-Impella RP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.96 \u0026plusmn; 0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost Impella RP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.9 \u0026plusmn; 1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003egGT, gamma-glutamyl transferase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, Body Max-Index; AvWS, Acquired von Willebrand syndrome; PCWP, Pulmonary Capillary Wedge Pressure; mPAP, Mean pulmonary artery pressure\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThough no significant statistical relationship was evinced between hemodynamic values and mortality, a rapid improvement in hemodynamic parameters was observed during treatment with a Impella-RP. Placement of Impella-RP resulted in a significative improvement in the cardiac index (CI) for almost all the patients (OR\u0026thinsp;=\u0026thinsp;0.50, 95% CI=-1.22-0.29; p\u0026thinsp;=\u0026thinsp;0.007; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePaired T-Test for pre- and post Impella RP hemodynamic parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePCWP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-23.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.296\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003emPAP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.706\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003ePCWP, Pulmonary Capillary Wedge Pressure; mPAP, mean Pulmonary Artery Pressure; CI, cardiac index\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eCatecholamine Usage\u003c/h2\u003e \u003cp\u003eDue to the retrospective nature of this study, catecholamine data could not be obtained for all days of hospitalization. Regardless, after Impella-RP implantation, catecholamine support was significantly reduced (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Patients demonstrated a catecholamine peak at the time of Impella placement and at the time of explantation as bridging support, followed by a reduction or discontinuation of catecholamine therapy.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study is the largest single center retrospective cohort in Europe with Impella-RP for patients with RVF after cardiac surgery. We evaluated which factors provided an approximation of right ventricular function in the postoperative period. Due to the lack of a consensus definition of RVF, and the fact that RVF mechanisms have not been well defined,\u003csup\u003e9\u003c/sup\u003e we evaluated liver function and assessed catecholamine variability as a noninvasive hemodynamic prediction metric. As these factors could be influenced by external complications and were, by nature, secondary assessors for determining right heart function, we performed invasive hemodynamic prediction measurements of CI and mean pulmonary artery pressure (MPAP). We found that patients undergoing isolated myocardial revascularization surgery had significantly higher survival after Impella-RP treatment than patients who had undergone valve or combined surgery, and that Impella RP therapy significantly improved CI in most patients. We did not find any significant association with mortality for any of the metrics evaluated, though total bilirubin on the last day of Impella-RP treatment and ALT on the first and third days of Impella-RP treatment trended towards significance.\u003c/p\u003e \u003cp\u003eThe use of Impella-RP was most beneficial for patients undergoing isolated myocardial revascularization surgery who develop RVF after open-heart surgery. Importantly, despite hemodynamic instability at the time of Impella-RP implantation, these patients developed complete right heart recovery and hemodynamic stability with no mortalities, which was maintained after explantation of the Impella-RP. Impella RP treatment also resulted in an increased cardiac index in almost all patients, though likely due to the breadth of pathology of these patients, it was not significantly related to survival; regardless, it improved systemic perfusion, enhanced end-organ perfusion, and enabled prompt withdrawal of inotropic and vasopressor support. RVF as a complication after cardiac surgery is challenging to treat and is associated with increased short-term mortality\u003csup\u003e1,10,11\u003c/sup\u003e and extended hospitalizations; this unsurprisingly results in commensurate cost increases. Thus, implementation of Impella RP is not only beneficial to improving RV recovery and cardiac output, but it also reduces costs associated with complications from open heart surgery and extended hospitalization times.\u003c/p\u003e \u003cp\u003eThe overall mortality evinced by this study is notably lower than that seen in the literature, where overall mortality has reportedly been as high as 51%.\u003csup\u003e2\u003c/sup\u003e In this analysis, overall mortality was closer to that of the RECOVER RIGHT and subsequent conformity assessment and post approval studies (26.7%).\u003csup\u003e1,5\u003c/sup\u003e It may be that patient selection was important for this, as the cohort in this study contained exclusively patients who underwent cardiac surgery with cardiopulmonary bypass and required therapeutic management of RVF with an Impella RP. In studies that include consecutive Impella RP placements, patients could be experiencing RV failure due to numerous conditions, including post-LVAD implantation, acute pulmonary embolism, post-cardiotomy RV failure, post-myocardial infarction shock, and nonischemic cardiomyopathy;\u003csup\u003e2\u003c/sup\u003e it may be that the varied etiologies for RVF result in different therapeutic approaches in addition to MCS. Furthermore, the timing of Impella RP usage may be crucial to improving mortality outcomes for this population, as this is the case for left ventricular failure MCS,\u003csup\u003e12,13\u003c/sup\u003e and recent work has suggested this holds true for RVF as well.\u003csup\u003e14,15\u003c/sup\u003e Future analyses will need to focus on these factors to ensure the patients who are best served by Impella RP usage are treated when appropriate for the best odds of survival and recovery.\u003c/p\u003e \u003cp\u003eThe principal hemodynamic benefit of Impella-RP is a direct increase in pulmonary artery flow and a concomitant unloading of the RV.\u003csup\u003e6,16\u003c/sup\u003e As described in the RECOVER RIGHT study in 2015,\u003csup\u003e5\u003c/sup\u003e the use of Impella RP is safe and effective in improving hemodynamics in patients with severe RVF refractory to medical therapy. Given that Impella RP is a percutaneous RVAD support, it not only facilitates fast implantation, but also effectively reduces the right ventricular workload without the need for cardiotomy, achieving prompt hemodynamic stabilization of the patient before shock becomes irreversible. Complications such as bleeding or AvWS were managed by clinicians and did not demonstrate increased mortality. Due to the wide range of pathologies of our patients, it is difficult to clarify the specific pathophysiology that results in acute RVF. Factors such as elevated liver function parameters may indicate an advanced stage of RVF at the time of implantation and as such may not be sufficient for treatment with Impella-RP.\u003c/p\u003e \u003cp\u003eOverall, Impella-RP is safe and effective and can be used as standard treatment for a select group of patients. Due to the very limited sample size, it will be necessary to perform further thorough multivariate analyses to identify predictors of mortality associated with Impella-RP usage in RVF.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003eIn this retrospective observational cohort study, all patients undergoing cardiac surgery with cardiopulmonary bypass and who developed post-operative RVF between January 2019 and December 2020 at University Hospital Bonn were screened for study inclusion. A total of 21 patients were treated with Impella-RP, though 3 patients were excluded due to Impella RP dislocation with a treatment duration\u0026thinsp;\u0026lt;\u0026thinsp;6h. As such, the study population included 18 adult patients evaluated through medical record review and descriptive analysis. This study was approved by the Rheineische Friedrich-Wilhelms-Universit\u0026auml;t Bonn ethics committee. (Ethics approval Number: 168/20) An informed consent for the retrospective analysis of the data was obtained from all subjects. All methods were performed in accordance with the relevant guidelines and regulations for good clinical and good scientific practice.\u003c/p\u003e \u003cp\u003eThe indication for RV-AFP implantation was the standard of care for isolated RVF. The definition of RVF was an elevated lactate levels over 8mmol/l, vasoconstrictors\u0026thinsp;\u0026gt;\u0026thinsp;0.1γ and at least one inotropic drug, with a central venous pressure (CVP)\u0026thinsp;\u0026gt;\u0026thinsp;15mmHg. Furthermore, a pulmonary catheter was introduced in each case and other reversible causes for cardiogenic shock were ruled out with transesophageal echocardiography.\u003c/p\u003e \u003cp\u003eThe implantation of Impella-RP was performed under fluoroscopy using a pigtail catheter to introduce the placing wire in the pulmonary artery in the operating room or catheterization lab. All patients were anticoagulated with intravenous heparin with an activated clotting time aim of 160\u0026ndash;180.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStudy Endpoints\u003c/h2\u003e \u003cp\u003eThe primary end point for the study was the survival rate at 30 days after device explantation. Secondary endpoints were the hemodynamic effects of device implantation after initiation of Impella-RP support, decreased use of inotropes during Impella-RP support, and device complications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistics\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using SPSS (Statistical Package for the Social Sciences) for macOs\u0026reg; version 26.0 (SPSS Inc., Chicago, Illinois, USA). All data were anonymized and treated according to data protection regulations.\u003csup\u003e17\u003c/sup\u003e The local research ethics committee approved the study.\u003c/p\u003e \u003cp\u003eContinuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Normality was tested using the Kolmogorow-Smirnow-Test. Categorical variables were shown as absolute (n) and relative (%) frequencies. Continuous variables with a normal distribution were tested using the Student's t-test, while those that were not normal were tested with the Mann-Whitney-Test. The non-parametric or categorical data were tested with Pearson chi-square test. Values were considered statistically significant at a probability factor p\u0026thinsp;\u0026le;\u0026thinsp;0.05, where a p-value less than 0.05 was considered statistically significant. We use paired samples t-tests to compare means before and after Impella-RP treatment and determine the hemodynamic effect on the patient.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAvWs: acquired von Willebrand syndrome\u003c/p\u003e\n\u003cp\u003eRV-AFP: right ventricular axial flow pump\u003c/p\u003e\n\u003cp\u003eRVF: right ventricular failure\u003c/p\u003e\n\u003cp\u003eLVAD: left ventricular Assist Device\u003c/p\u003e\n\u003cp\u003eMCS: mechanical circulatory support\u003c/p\u003e\n\u003cp\u003eRV: right ventricle\u003c/p\u003e\n\u003cp\u003eCI: cardiac index\u003c/p\u003e\n\u003cp\u003emPAP: mean pulmonary artery pressure\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJetPub Scientific Communications LLC, supported by Abiomed, assisted in the preparation of this manuscript. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMehmet Oezkur is a consultant for Abiomed Inc. The other authors do not have any conflicts of interest to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant data are included in the manuscript and its associated files. Due to data protection regulation, we are not allowed to submit the data with the publication. However, in case of a relevant question, the data is available and can be provided by the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAnderson, M. \u003cem\u003eet al.\u003c/em\u003e Outcomes of patients with right ventricular failure requiring short-term hemodynamic support with the Impella RP device. \u003cem\u003eThe Journal of Heart and Lung Transplantation\u003c/em\u003e 37, 1448\u0026ndash;1458 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShekiladze, N. \u003cem\u003eet al.\u003c/em\u003e A single healthcare experience with Impella RP. \u003cem\u003eCatheterization and Cardiovascular Interventions\u003c/em\u003e 97, E161\u0026ndash;E167 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArrigo, M. \u003cem\u003eet al.\u003c/em\u003e Right Ventricular Failure: Pathophysiology, Diagnosis and Treatment. \u003cem\u003eCard Fail Rev\u003c/em\u003e 5, 140 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKormos, R. L. \u003cem\u003eet al.\u003c/em\u003e Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: Incidence, risk factors, and effect on outcomes. \u003cem\u003eJournal of Thoracic and Cardiovascular Surgery\u003c/em\u003e 139, 1316\u0026ndash;1324 (2010).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnderson, M. B. \u003cem\u003eet al.\u003c/em\u003e Benefits of a novel percutaneous ventricular assist device for right heart failure: The prospective RECOVER RIGHT study of the Impella RP device. \u003cem\u003eJ Heart Lung Transplant\u003c/em\u003e 34, 1549\u0026ndash;1560 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnderson, M. \u003cem\u003eet al.\u003c/em\u003e Impella RP Post Approval Study: First Multi-Center, Prospective Post Market Approval Results for the Impella RP in Patients with Right Ventricular Failure. \u003cem\u003eThe Journal of Heart and Lung Transplantation\u003c/em\u003e 36, S64\u0026ndash;S65 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBotti, G. \u003cem\u003eet al.\u003c/em\u003e Impella RP for Patients with Acute Right Ventricular Failure and Cardiogenic Shock: A Subanalysis from the IMP-IT Registry. \u003cem\u003eJ Pers Med\u003c/em\u003e 12, (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQureshi, A. M. \u003cem\u003eet al.\u003c/em\u003e Percutaneous Impella RP use for refractory right heart failure in adolescents and young adults-A multicenter U.S. experience. \u003cem\u003eCatheter Cardiovasc Interv\u003c/em\u003e 96, 376\u0026ndash;381 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaddad, F., Couture, P., Tousignant, C. \u0026amp; Denault, A. Y. The right ventricle in cardiac surgery, a perioperative perspective: II. Pathophysiology, clinical importance, and management. \u003cem\u003eAnesth Analg\u003c/em\u003e 108, 422\u0026ndash;433 (2009).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eApostolakis, S. \u0026amp; Konstantinides, S. The right ventricle in health and disease: insights into physiology, pathophysiology and diagnostic management. \u003cem\u003eCardiology\u003c/em\u003e 121, 263\u0026ndash;273 (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMehta, S. R. \u003cem\u003eet al.\u003c/em\u003e Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction. \u003cem\u003eJ Am Coll Cardiol\u003c/em\u003e 37, 37\u0026ndash;43 (2001).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBasir, M. B. \u003cem\u003eet al.\u003c/em\u003e Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock. \u003cem\u003eAm J Cardiol\u003c/em\u003e 119, 845\u0026ndash;851 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHelgestad, O. K. L. \u003cem\u003eet al.\u003c/em\u003e Contemporary trends in use of mechanical circulatory support in patients with acute MI and cardiogenic shock. \u003cem\u003eOpen Heart\u003c/em\u003e 7, e001214 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhama, J. K. \u003cem\u003eet al.\u003c/em\u003e Clinical experience with temporary right ventricular mechanical circulatory support. \u003cem\u003eJ Thorac Cardiovasc Surg\u003c/em\u003e 156, 1885\u0026ndash;1891 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKapur, N. K. \u003cem\u003eet al.\u003c/em\u003e Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure. \u003cem\u003eThe Journal of Heart and Lung Transplantation\u003c/em\u003e 30, 1360\u0026ndash;1367 (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGramegna, M. \u003cem\u003eet al.\u003c/em\u003e Impella RP support in refractory right ventricular failure complicating acute myocardial infarction with unsuccessful right coronary artery revascularization. \u003cem\u003eInt J Cardiol\u003c/em\u003e 302, 135\u0026ndash;137 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEuropean Parliament. \u003cem\u003eRegulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation)\u003c/em\u003e. \u003cem\u003eEUR-Lex Access to European Union Law\u003c/em\u003e (2016).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3053944/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3053944/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eRight ventricular failure (RVF) after cardiac surgery is associated with an in-hospital mortality rate of up to 75%. Axial flow pumps are one of the mechanical circulatory support (MCS) options available for the treatment of RVF, however the specifics of timing and indication for MCS, as well as predictors for survival, remain unclear due to a dearth published data. We evaluated the clinical outcome of patients treated with Impella RP for predictors of mortality and the hemodynamic effects of the pump. This is a single-center retrospective observational study involving adult patients who underwent cardiac surgery with cardiopulmonary bypass between January 2019 and December 2020 in cardiac surgery and required therapeutic management of RVF with an Impella RP. Overall, 18 patients were included and analyzed for factors that could be associated with mortality, or that could be predictors of patient outcomes for this population. Treatment of RVF with Impella-RP improved the patient hemodynamics significantly and had a survival rate of 61% within 30 days. Patients with isolated CABG or better liver function before implantation had a better survival rate, which may indicate that underlying disease and timing of implantation are significant for successful treatment of RVF.\u003c/p\u003e","manuscriptTitle":"Outcome of right ventricular microaxial pump support in patients undergoing cardiac surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-06-28 20:32:39","doi":"10.21203/rs.3.rs-3053944/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-01-29T12:25:19+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-12-20T19:02:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"fad99f84-ec49-4879-b8dd-3ec3fa3d7fa5","date":"2023-12-20T04:06:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-12-15T08:11:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"fe37530c-1ad7-434d-a5d5-df3511d51ad0","date":"2023-12-14T16:53:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-10-30T18:19:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4c666a28-098b-4072-853f-b59644b4a7f5","date":"2023-10-19T18:13:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-09-19T07:31:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-06-23T13:12:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-06-23T12:07:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-06-23T11:59:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2023-06-12T14:38:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3dfa2920-96aa-43bf-9373-90666cd2cb7c","owner":[],"postedDate":"June 28th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":22666540,"name":"Health sciences/Cardiology/Cardiac device therapy"},{"id":22666541,"name":"Health sciences/Diseases/Cardiovascular diseases/Heart failure"}],"tags":[],"updatedAt":"2024-04-08T15:03:02+00:00","versionOfRecord":{"articleIdentity":"rs-3053944","link":"https://doi.org/10.1038/s41598-024-58602-w","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-04-06 15:00:53","publishedOnDateReadable":"April 6th, 2024"},"versionCreatedAt":"2023-06-28 20:32:39","video":"","vorDoi":"10.1038/s41598-024-58602-w","vorDoiUrl":"https://doi.org/10.1038/s41598-024-58602-w","workflowStages":[]},"version":"v1","identity":"rs-3053944","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3053944","identity":"rs-3053944","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}