Left Ventricle Unloading And Valvular Integrity Following Microaxial Mechanical Circulatory Support: A Two Year Follow-Up Study

Abstract Background Although the use of mechanical circulatory support (MCS) systems may improve the outcome of patients with cardiogenic shock (CS) due to myocardial infarction, little is known about its effect on the long-term structural integrity of left-ventricular (LV) valves as well as on the development of LV- architecture. Methods 84 consecutive patients were monitored over 2 years having received microaxillar MCS device (ImpellaTM CP or 2.5) for complete coronary revascularization followed by optimal medical treatment. Results 62 patients were treated for severe cardiogenic shock and compared with 22 patients receiving short-term microaxillar MCS for high risk percutaneous coronary interventions (PCI). 24 patients of the total population received Impella CP (14F motor pump) and the remaining 60 patients received Impella 2.5 (12F motor pump). Beside a significant increase in LV-ejection fraction after 2 years (p≤0.03 vs. pre implantation) in total cohort, we observed a statistically significant decrease in LV-dilation (p<0.001) and the severity of mitral valve regurgitation (p=0.007) in the 2 year follow-up period suggesting an improved LV-architecture. Neither the duration of support, nor the size of the MCS device or the indication for its use revealed any devastating impact on aortic or mitral valve integrity. Conclusions These findings indicate that beside complete revascularization and optimal medical treatment, microaxillar transvalvular MCS device supports the restoration of LV-architecture without detrimental long-term effects on the structural integrity of LV valves regardless of the size of the device or the duration of support. Funding Acknowledgement Type of funding source: None