TCT CONNECT-185 Early Impella RP Support Improves Outcomes for Acute Right Ventricular Failure Complicated by Cardiogenic Shock

Background: The RECOVER RIGHT trials established the safety and efficacy of Impella RP for acute right ventricular failure (RVF) management. We now explored real-world performance of the Impella RP for RVF.Methods: This is a prospective, multicenter study of Impella RP support for RVF after durable left ventricular assist device (LVAD) implantation, acute myocardial infarction, or open cardiac surgery. We compared patients who would have met the RECOVER RIGHT trial enrollment criteria (RECOVER RIGHT–like group) to those who did not (salvage group). The primary endpoint was survival to 30 days after device explant or at hospital discharge (whichever was longer), or to induction of anesthesia to for durable LVAD or cardiac transplantation.Results: Sixty-six patients (mean age 65 ± 12 years, 71% male) were included. Patients received an average of 3.5 ± 1.4 inotropes and/or vasopressors and 53% had mechanical circulatory support pre-Impella. The salvage group had more hemodynamic instability and longer duration of shock pre–Impella RP. More patients in the RECOVER RIGHT–like group reached the primary endpoint than the salvage group (72.7% vs. 15.9%, p < 0.001). A ≥48-h delay to Impella RP support was an independent predictor of mortality (relative risk: 1.65, 95% confidence interval: 1.19 to 2.3).Conclusion: RECOVER RIGHT–like patients had higher survival than salvage patients, which may reflect shorter time form shock onset to initiation of Impella RP support. Early identification of patients requiring right-heart support may be critical to improve clinical outcomes for RVF.