Statement from Abiomed on RP Notification
Abiomed is committed to proactively sharing data to inform the medical community of best practices for use of the Impella RP® heart pump and to continue to improve outcomes for patients.
The Impella RP is the only device with FDA PMA approval for right side support. FDA studies demonstrate that proper use and timely implantation of Impella RP increases survival with the potential for recovery of the right ventricle [i] [ii]. The data below was published in December, 2018:
Impella RP PMA Cohort Study Results (N=60)
| | |
| | Survival Rates |
PMA Subjects (RR + CAP + HDE PAS) – full cohort (N=60) Cohort A (N=31) Cohort B (N=29) | | 73% (44/60) 77% (24/31) 69% (20/29) |
Journal of Heart and Lung Transplant, December 2018(37)
On January 31, 2019, Abiomed proactively sent physicians who use Impella RP post-approval study (PAS) data that provides additional evidence of the benefits of following proper protocols for placement of Impella RP. The data is summarized in the table below and demonstrates the importance of early placement of Impella RP, and the importance of following proper inclusion and exclusion criteria when selecting patients for Impella RP.
The PMA cohort (n=60) had 73% survival and the PAS cohort (n=23) is currently at 17%. This PAS population has 70% (16/23) outside the recommended treatment protocol inclusion and exclusion criteria, and as a result survival rates are lower. These patients were critically ill and, in some cases, had been in profound shock for more than 48 hours. As such, these patients were statistically sicker and may not have been appropriate candidates to benefit from right side mechanical circulatory support.
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Characteristics | | Impella RP Pre-Market Application (PMA) Study (N=60 Patients) | | | Impella RP Post-Market Approval (PMS) Report (N=23 Patients) | | | P-Value | |
Age | | | | | | | | | | | | |
Mean±SD(N) | | | 58.58±15.12(60) | | | | 65.61±13.72(23) | | | | 0.056 | |
Did the patient experience anin-hospital cardiac arrest prior to Impella implant | | | 0.00% (0/60) | | | | 56.52% (13/23) | | | | <.001 | |
At the time of Impella implant did the patient receive CPR/ACLS | | | 0.05% (3/60) | | | | 30.43% (7/23) | | | | <.001 | |
Was there evidence of hypoxicischemic brain injury prior to Impella implant | | | 0.00% (0/60) | | | | 14.29% (3/21) | | | | 0.016 | |
Was the patient supported with inotrope or vasopressors prior to Impella implant | | | 98.33% (59/60) | | | | 86.96% (20/23) | | | | 0.063 | |
If yes, Indicate total number of inotrope or vasopressors | | | | | | | | | | | | |
Mean±SD(N) | | | 3.37±1.24(59) | | | | 4.38±1.56(13) | | | | 0.014 | |
Median | | | 3.00 | | | | 4.00 | | | | | |
Range (Min, Max) | | | (1.00,6.00) | | | | (2.00,8.00) | | | | | |
Patients in shock >=48 hours | | | 0.00% (0/34) | | | | 26.09% (6/23) | | | | <.001 | |
IABP used prior to Impella implant | | | 0.00% (0/60) | | | | 30.43% (7/23) | | | | <.001 | |
Abiomed encourages all clinicians to review proper inclusion and exclusion criteria for Impella RP. To help physicians determine if Impella RP is right for their patients, Abiomed has created anFDA-approved checklist to guide treatment decisions and encourages the use of physician guidelines such as the National Cardiogenic Shock Initiative (https://www.henryford.com/cardiogenicshock/protocol) and the Shock Care Pathway Algorithms (http://www.onlinejacc.org/content/72/16/1972). The checklist is available athttps://www.protectedpci.com/resources/. Right side failure remains a more difficult diagnosis than left side failure based on clinical experience and lower occurrence in clinical practice.
As a leader in post-market surveillance to improve patient outcomes, Abiomed tracks outcomes on nearly 100% of its Impella RP patients. The manufacturers of other technologies for right side support are cleared for less than 6 hours of support (ECMO, TandemLife®) and as a result, do not have regulatory responsibility to track and publically report a post approval study (PAS) on their patient outcomes. Abiomed will