Background: Percutaneous right ventricular assist device support with the Impella RP device (Abiomed) has been reported in adults, but a multicentre experience in children has yet to be reported.
Hypothesis: We hypothesised that the Impella RP can play an important role in the treatment of refractory right heart failure in children and young adults.
Methods: We included patients <21 years of age who underwent implantation of an Impella RP device for refractory right heart failure from June 2016 April 2018 at nine US (seven adult and two paediatric) centres. A total of 12 adolescents with a median age of 18 years (14–21 years), and median weight of 74.4 kg (49–112.4 kg) underwent Impella RP implantation.
Results: The underlying diagnosis was post-heart transplant rejection in five patients, primary myocarditis in three, cardiogenic shock in two, cardiomyopathy in one and arrhythmogenic right ventricular dysplasia in one (INTERMACS profile: cardiogenic shock in nine and slow progressive decline in three patients). The central venous pressure decreased significantly from a median of 20 mmHg (16–35 mmHg) to 12 mmHg (7–17 mmHg) post-Impella RP implantation (p=0.001). One patient was supported with an intra-aortic balloon pump (IABP) and the rest were concomitantly supported with a percutaneous or surgically placed left ventricular assist device. There were two procedural adverse events: one patient suffered a retroperitoneal haemorrhage from simultaneous Impella CP implantation and one patient underwent leg amputation due to arterial thrombosis from an IABP. There was one adverse event related to the Impella RP device (thrombosis resulting in explant). The average support duration was 6.5 days (4.8 hours to 18.4 days), and survival to hospital discharge was 83%. At a median follow-up of 11 months (5 days to 2.5 years), eight of 12 (67%) patients are alive with complete recovery.
Conclusion: In this multicentre experience, the use of the Impella RP device was found to be efficacious and safe when used in adolescents. The Impella RP device should be considered as a treatment modality in select adolescents with severe right heart failure refractory to medical therapy. Further studies are warranted to identify suitable candidates for Impella RP therapy for right heart failure.