Left Ventricular Dysfunction
Conditions
Keywords
High-risk Cardiac Surgery, Low pre-operative left ventricular ejection fraction, Cardiopulmonary bypass (CPB), Temporary Mechanical Circulatory System (MCS)
Brief summary
The purpose of this Trial is to demonstrate the safety and effectiveness of the use of Impella 5.5 in high-risk cardiac surgery patients, with the overall aim to evaluate if using Impella 5.5 with SmartAssist (Impella 5.5) peri-operatively improves early hemodynamics, end-organ function and clinical outcomes in patients with severely reduced LV function undergoing cardiac surgery.
Detailed description
This is a prospective single-armed Trial to demonstrate the safety and effectiveness of the use of Impella 5.5 in high-risk cardiac surgery patients. A concurrent Registry will also be performed to collect information on patients meeting Exclusion Criteria and those not approached for enrollment. The overall aim is to evaluate if using Impella 5.5 peri-operatively improves early hemodynamics, end-organ function and subsequent clinical outcomes in patients with severely reduced LV function undergoing cardiac surgery.
Interventions
DEVICEImpella 5.5 with SmartAssist
For subjects enrolled in the Trial, the Impella 5.5 will be placed intra-operatively during the index cardiac surgical procedure
Sponsors
Abiomed Inc.
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Hemodynamically stable patients undergoing one of the following cardiac surgery procedures on CPB including aortic cross-clamping and cardioplegic arrest: * Isolated CABG * Isolated mitral valve repair or mitral valve replacement (MVR) * Isolated biological aortic valve replacement (AVR) * At least two of the following: CABG, MVR, AVR, or tricuspid valve repair or replacement (TVR) * Additional concomitant procedures permitted: 1. Atrial septal defect (ASD) or patent foramen ovale (PFO) repair or closure 2. Atrial fibrillation ablation procedures 3. Left atrial ablation (all forms including complete left/right side Cox Maze) 4. Coronary endarterectomy 2. LVEF within 30 days before surgery of either: * ≤25% measured by echocardiogram or cardiac MRI, OR * LVEF ≤35%, measured as above, for patients with significant mitral regurgitation (MR 3+ or 4+) and planned corrective mitral valve surgery (including MV replacement or repair) * Any subject with EF \<20% must have viability assessment performed to assess CABG candidacy (MRI preferred) 3. Age 18 years or older 4. Subject (or subject's LAR, if allowed by IRB) has signed Informed Consent Form
Exclusion criteria
1. Salvage operation (cardiac arrest within 24 hours prior to index surgery) 2. Unresponsive state within 24 hours of the time of surgery 3. Any inotrope within 72 hours of surgery 4. Any MCS device (such as IABP, ECMO, Impella®, CentriMag™ or TandemHeart®) in place at time of informed consent and less than 24 hours prior to index study procedure 5. RV dysfunction requiring mechanical or inotropic support pre-operatively and/or likely to be needed post-operatively 6. Index procedures requiring total circulatory arrest (TCA), such as aortic arch replacement, planned durable LVAD, durable RVAD, planned right-sided temporary mechanical support of any kind, total artificial heart (TAH), cardiac transplantation, pericardiectomy, pulmonary thromboendarterectomy and septal myectomy 7. Restrictive or obstructive cardiomyopathy, constrictive pericarditis, restrictive pericarditis, pericardial tamponade or other conditions in which cardiac output is dependent on venous return 8. Ventricular septal defect (VSD) 9. Stroke within 30 days of the index cardiac surgical procedure 10. Prior mantle field chest irradiation 11. Prior solid organ or hematologic transplantation (heart, kidney, liver, lung, pancreas, bone marrow) or durable LVAD 12. History of chronic dialysis 13. Pre-existing liver dysfunction defined as: Child-Pugh Class B or C 14. Pre-existing pulmonary disease requiring home oxygen or "severe pulmonary disease" determined by enrolling Investigator 15. Systemic active infection or evidence of systemic bacterial, fungal or viral infection within 72 hours before surgery (blood culture positive with leukocytosis) 16. Confirmed COVID-19 infection within two weeks prior to operation 17. Suspected or known pregnancy 18. Participation in the active treatment or follow-up phase of another interventional clinical trial of an investigational drug or device which has not reached its primary endpoint 19. Known contraindication to heparin; History of bleeding diathesis or known coagulopathy or will refuse blood transfusions 20. Inability to perform aortic cross-clamp, such as due to porcelain aorta 21. Any contraindication or inability to place Impella 5.5 (per the IFU), including LV thrombus and/or presence of a mechanical aortic valve 22. Any organ condition, concomitant disease (e.g., psychiatric illness, current severe alcoholism or current drug abuse, cancer, hepatic or kidney disease), with life expectancy of ≤2 years or other abnormality that itself or the treatment of which could interfere with the conduct of the trial or that, in the opinion of the investigator and/or Sponsor's medical monitor, would pose an unacceptable risk to the patient in the trial. 23. Patient has other medical, social or psychological problems that, in the opinion of the Investigator, compromises the subject's ability to give written informed consent and/or to comply with trial procedures 24. Patient belongs to a vulnerable population \[Vulnerable patient populations are defined as individuals with mental disability, persons in nursing homes, children, impoverished persons, homeless persons, nomads, refugees and those permanently incapable of giving informed consent. Vulnerable populations also may include members of a group with a hierarchical structure such as university students, subordinate hospital and laboratory personnel, employees of the Sponsor, members of the armed forces and persons kept in detention\]
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Stroke (as defined by STS) | 90 days | — |
| New requirement for Renal Replacement Therapy (RRT) | 90 days | — |
| Rate of Post-Cardiotomy Cardiac Failure | Hospital discharge, usually within 30 days | The rate of post-cardiotomy cardiac failure evaluated at hospital discharge. |
| Composite of All-Cause Mortality | 90 days | — |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Acute Kidney Injury | within 7 days or at ICU Discharge (usually within 30 days) | a modified KDIGO Stages 2-3 |
| Vasoactive-inotropic score (VIS) | ICU Discharge, usually within 30 days | — |
| Cardiovascular mortality | Hospital discharge, usually within 30 days | — |
| Major Hemolysis | Hospital Discharge, usually within 30 days | defined by MCS-ARC |
| Major Vascular Complications | Hospital Discharge, usually within 30 days | defined by MCS-ARC |
| Major Bleeding | Hospital Discharge, usually within 30 days | defined by STS |
| Length of ICU Stay | ICU Discharge, usually within 30 days | — |
| Length of Hospital Stay | Hospital Discharge, usually within 30 days | — |
| Quality of Life (QoL) assessed by KCCQ | 90 Days Post-Op | — |
| Technical Success | Intra-op, usually within 1 day | The successful use of the Impella 5.5 device will be assessed by the proportion of patients who undergo successful Impella implant, as well as the proportion of patients demonstrating successful wean off CPB. |
| Physical Activity | 90 Days Post-Op | Measured by (Katz Activities of Daily Living (ADL) and Lawton Instrumental ADL (IADL) |
| Number of attempts to wean from CPB | Intra-op, usually within 1 day | — |
| Duration of mechanical ventilation | ICU discharge, usually within 30 days | — |
| Duration and dosages of inotropes and vasopressors. Duration of mechanical circulatory support (Hours) | ICU Discharge, usually within 30 days | measured in number of hours of dosage |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORDaniel Goldstein, MD
Montefiore Medical Center
PRINCIPAL_INVESTIGATOREdward Soltesz, MD
The Cleveland Clinic
PRINCIPAL_INVESTIGATORHermann Reichenspurner, MD, PhD
University Heart & Vascular Center Hamburg
Outcome results
None listed