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Tehrani BN, Sherwood MW, Rosner C, Truesdell AG, Ben Lee S, Damluji AA, Desai M, Desai S, Epps KC, Flanagan MC, Howard E, Ibrahim N, Kennedy J, Moukhachen H, Psotka M, Raja A, Saeed I, Shah P, Singh R, Sinha SS, Tang D, Welch T, Young K, deFilippi CR, Speir A, O'Connor CM, Batchelor WB. A Standardized and Regionalized Network of Care for Cardiogenic Shock. JACC. HEART FAILURE 2022; 10:768-781. [PMID: 36175063 PMCID: PMC10404382 DOI: 10.1016/j.jchf.2022.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/31/2022] [Accepted: 04/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The benefits of standardized care for cardiogenic shock (CS) across regional care networks are poorly understood. OBJECTIVES The authors compared the management and outcomes of CS patients initially presenting to hub versus spoke hospitals within a regional care network. METHODS The authors stratified consecutive patients enrolled in their CS registry (January 2017 to December 2019) by presentation to a spoke versus the hub hospital. The primary endpoint was 30-day mortality. Secondary endpoints included bleeding, stroke, or major adverse cardiovascular and cerebrovascular events. RESULTS Of 520 CS patients, 286 (55%) initially presented to 34 spoke hospitals. No difference in mean age (62 years vs 61 years; P = 0.38), sex (25% vs 32% women; P = 0.10), and race (54% vs 52% white; P = 0.82) between spoke and hub patients was noted. Spoke patients more often presented with acute myocardial infarction (50% vs 32%; P < 0.01), received vasopressors (74% vs 66%; P = 0.04), and intra-aortic balloon pumps (88% vs 37%; P < 0.01). Hub patients were more often supported with percutaneous ventricular assist devices (44% vs 11%; P < 0.01) and veno-arterial extracorporeal membrane oxygenation (13% vs 0%; P < 0.01). Initial presentation to a spoke was not associated with increased risk-adjusted 30-day mortality (adjusted OR: 0.87 [95% CI: 0.49-1.55]; P = 0.64), bleeding (adjusted OR: 0.89 [95% CI: 0.49-1.62]; P = 0.70), stroke (adjusted OR: 0.74 [95% CI: 0.31-1.75]; P = 0.49), or major adverse cardiovascular and cerebrovascular events (adjusted OR 0.83 [95% CI: 0.50-1.35]; P = 0.44). CONCLUSIONS Spoke and hub patients experienced similar short-term outcomes within a regionalized CS network. The optimal strategy to promote standardized care and improved outcomes across regional CS networks merits further investigation.
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Affiliation(s)
- Behnam N Tehrani
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA.
| | | | - Carolyn Rosner
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Alexander G Truesdell
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA; Virginia Heart, Falls Church, Virginia, USA
| | | | | | - Mehul Desai
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Shashank Desai
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Kelly C Epps
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | | | - Edward Howard
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA; Virginia Heart, Falls Church, Virginia, USA
| | - Nasrien Ibrahim
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Jamie Kennedy
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Hala Moukhachen
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Mitchell Psotka
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Anika Raja
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Ibrahim Saeed
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA; Virginia Heart, Falls Church, Virginia, USA
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Ramesh Singh
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | | | - Daniel Tang
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Timothy Welch
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Karl Young
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | | | - Alan Speir
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
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Kapur NK, Kanwar M, Sinha SS, Thayer KL, Garan AR, Hernandez-Montfort J, Zhang Y, Li B, Baca P, Dieng F, Harwani NM, Abraham J, Hickey G, Nathan S, Wencker D, Hall S, Schwartzman A, Khalife W, Li S, Mahr C, Kim JH, Vorovich E, Whitehead EH, Blumer V, Burkhoff D. Criteria for Defining Stages of Cardiogenic Shock Severity. J Am Coll Cardiol 2022; 80:185-198. [PMID: 35835491 DOI: 10.1016/j.jacc.2022.04.049] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/01/2022] [Accepted: 04/14/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Risk-stratifying patients with cardiogenic shock (CS) is a major unmet need. The recently proposed Society for Cardiovascular Angiography and Interventions (SCAI) staging system for CS severity lacks uniform criteria defining each stage. OBJECTIVES The purpose of this study was to test parameters that define SCAI stages and explore their utility as predictors of in-hospital mortality in CS. METHODS The CS Working Group registry includes patients from 17 hospitals enrolled between 2016 and 2021 and was used to define clinical profiles for CS. We selected parameters of hypotension and hypoperfusion and treatment intensity, confirmed their association with mortality, then defined formal criteria for each stage and tested the association between both baseline and maximum Stage and mortality. RESULTS Of 3,455 patients, CS was caused by heart failure (52%) or myocardial infarction (32%). Mortality was 35% for the total cohort and higher among patients with myocardial infarction, out-of-hospital cardiac arrest, and treatment with increasing numbers of drugs and devices. Systolic blood pressure, lactate level, alanine transaminase level, and systemic pH were significantly associated with mortality and used to define each stage. Using these criteria, baseline and maximum stages were significantly associated with mortality (n = 1,890). Lower baseline stage was associated with a higher incidence of stage escalation and a shorter duration of time to reach maximum stage. CONCLUSIONS We report a novel approach to define SCAI stages and identify a significant association between baseline and maximum stage and mortality. This approach may improve clinical application of the staging system and provides new insight into the trajectory of hospitalized CS patients. (Cardiogenic Shock Working Group Registry [CSWG]; NCT04682483).
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Affiliation(s)
- Navin K Kapur
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
| | - Manreet Kanwar
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Campus, Falls Church, Virginia, USA
| | - Katherine L Thayer
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - A Reshad Garan
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Yijing Zhang
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Borui Li
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Paulina Baca
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Fatou Dieng
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Neil M Harwani
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jacob Abraham
- Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Providence Research Network, Portland, Oregon, USA
| | - Gavin Hickey
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Detlef Wencker
- Baylor Scott and White Advanced Heart Failure Clinic, Dallas, Texas, USA
| | - Shelley Hall
- Baylor Scott and White Advanced Heart Failure Clinic, Dallas, Texas, USA
| | | | - Wissam Khalife
- University of Texas Medical Branch, Galveston, Texas, USA
| | - Song Li
- University of Washington Medical Center, Seattle, Washington, USA
| | - Claudius Mahr
- University of Washington Medical Center, Seattle, Washington, USA
| | - Ju H Kim
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | | | | | - Vanessa Blumer
- Duke University Medical Center, Durham, North Carolina, USA
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62
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Sinha SS, Rosner CM, Tehrani BN, Maini A, Truesdell AG, Lee SB, Bagchi P, Cameron J, Damluji AA, Desai M, Desai SS, Epps KC, deFilippi C, Flanagan MC, Genovese L, Moukhachen H, Park JJ, Psotka MA, Raja A, Shah P, Sherwood MW, Singh R, Tang D, Young KD, Welch T, O'Connor CM, Batchelor WB. Cardiogenic Shock From Heart Failure Versus Acute Myocardial Infarction: Clinical Characteristics, Hospital Course, and 1-Year Outcomes. Circ Heart Fail 2022; 15:e009279. [PMID: 35510546 DOI: 10.1161/circheartfailure.121.009279] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about clinical characteristics, hospital course, and longitudinal outcomes of patients with cardiogenic shock (CS) related to heart failure (HF-CS) compared to acute myocardial infarction (AMI; CS related to AMI [AMI-CS]). METHODS We examined in-hospital and 1-year outcomes of 520 (219 AMI-CS, 301 HF-CS) consecutive patients with CS (January 3, 2017-December 31, 2019) in a single-center registry. RESULTS Mean age was 61.5±13.5 years, 71% were male, 22% were Black patients, and 63% had chronic kidney disease. The HF-CS cohort was younger (58.5 versus 65.6 years, P<0.001), had fewer cardiac arrests (15.9% versus 35.2%, P<0.001), less vasopressor utilization (61.8% versus 82.2%, P<0.001), higher pulmonary artery pulsatility index (2.14 versus 1.51, P<0.01), lower cardiac power output (0.64 versus 0.77 W, P<0.01) and higher pulmonary capillary wedge pressure (25.4 versus 22.2 mm Hg, P<0.001) than patients with AMI-CS. Patients with HF-CS received less temporary mechanical circulatory support (34.9% versus 76.3% P<0.001) and experienced lower rates of major bleeding (17.3% versus 26.0%, P=0.02) and in-hospital mortality (23.9% versus 39.3%, P<0.001). Postdischarge, 133 AMI-CS and 229 patients with HF-CS experienced similar rates of 30-day readmission (19.5% versus 24.5%, P=0.30) and major adverse cardiac and cerebrovascular events (23.3% versus 28.8%, P=0.45). Patients with HF-CS had lower 1-year mortality (n=123, 42.6%) compared to the patients with AMI-CS (n=110, 52.9%, P=0.03). Cumulative 1-year mortality was also lower in patients with HF-CS (log-rank test, P=0.04). CONCLUSIONS Patients with HF-CS were younger, and despite lower cardiac power output and higher pulmonary capillary wedge pressure, less likely to receive vasopressors or temporary mechanical circulatory support. Although patients with HF-CS had lower in-hospital and 1-year mortality, both cohorts experienced similarly high rates of postdischarge major adverse cardiovascular and cerebrovascular events and 30-day readmission, highlighting that both cohorts warrant careful long-term follow-up. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03378739.
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Affiliation(s)
- Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Carolyn M Rosner
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Behnam N Tehrani
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Aneel Maini
- Georgetown University Medical School' Washington' DC (A.M.)
| | - Alexander G Truesdell
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.).,Virginia Heart, Falls Church (A.G.T., T.W.)
| | - Seiyon Ben Lee
- Department of Statistics, George Mason University' Fairfax' VA (S.B.L., P.B., J.C.)
| | - Pramita Bagchi
- Department of Statistics, George Mason University' Fairfax' VA (S.B.L., P.B., J.C.)
| | - James Cameron
- Department of Statistics, George Mason University' Fairfax' VA (S.B.L., P.B., J.C.)
| | - Abdulla A Damluji
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Mehul Desai
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Shashank S Desai
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Kelly C Epps
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Christopher deFilippi
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - M Casey Flanagan
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Leonard Genovese
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Hala Moukhachen
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - James J Park
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Mitchell A Psotka
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Anika Raja
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Palak Shah
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Matthew W Sherwood
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Ramesh Singh
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Daniel Tang
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Karl D Young
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Timothy Welch
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.).,Virginia Heart, Falls Church (A.G.T., T.W.)
| | - Christopher M O'Connor
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
| | - Wayne B Batchelor
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA (S.S.S., C.M.R., B.N.T., A.G.T., A.A.D., M.D., S.S.D., K.C.E., C.d., M.C.F., L.G., H.M., J.J.P., M.A.P., A.R., P.S., M.W.S., R.S., D.T., K.D.Y., T.W., C.M.O., W.B.B.)
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64
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Morici N, Marini C, Sacco A, Tavazzi G, Saia F, Palazzini M, Oliva F, De Ferrari GM, Colombo PC, Kapur NK, Garan AR, Pappalardo F. Intra-aortic balloon pump for acute-on-chronic heart failure complicated by cardiogenic shock. J Card Fail 2021; 28:1202-1216. [PMID: 34774745 DOI: 10.1016/j.cardfail.2021.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 12/22/2022]
Abstract
The Intra-aortic balloon pump (IABP) is widely implanted as temporary mechanical circulatory support for cardiogenic shock (CS). However, its use is declining following the results of the IABP-SHOCK II trial, which failed to show a clinical benefit of IABP in acute coronary syndrome (ACS) related CS. Acute-on-chronic heart failure has become an increasingly recognized, distinct etiology of CS (HF-CS). The pathophysiology of HF-CS differs from ACS-CS, as it typically represents the progression from a state of congestion (with relatively preserved cardiac output) to a low output state with hypoperfusion. The IABP is a "volume displacement pump" that promotes forward flow from a high-capacitance reservoir to low-capacitance vessels, improving peripheral perfusion and decreasing left ventricular afterload in the setting of high filling pressures. The IABP can improve ventricular-vascular coupling and, therefore, myocardial energetics. Additionally, many HF-CS patients are candidates for cardiac replacement therapies (left ventricular assist device or heart transplantation), and, therefore, may benefit from a "bridge" strategy that stabilizes the hemodynamics and end-organ function in preparation for more durable therapies. Notably, the new United Network for Organ Sharing donor heart allocation system has recently prioritized patients on IABP support. This review describes the role of IABP for the treatment of HF-CS. It also briefly discusses new strategies for vascular access as well as a fully implantable versions for a longer duration of support.
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Affiliation(s)
- Nuccia Morici
- Cardiac Intensive Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy..
| | - Claudia Marini
- S.C. Cardiologia, Polo San Carlo Borromeo, ASST Santi Paolo e Carlo, Milano; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alice Sacco
- Cardiac Intensive Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia Italy; Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Anestesia e Rianimazione I, Pavia, Italy; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Matteo Palazzini
- Cardiac Intensive Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; School of Medicine and Surgery, Università degli Studi Milano-Bicocca, Milan, Italy; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabrizio Oliva
- Cardiac Intensive Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gaetano Maria De Ferrari
- Dept of Cardiology OU Città della Salute e della Scienza di Torino, Dept of Medical Sciences, University of Torino, Torino, Italy; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University Medical Center-New York Presbyterian, NewYork, USA; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Navin K Kapur
- Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, USA; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Arthur Reshad Garan
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Federico Pappalardo
- School of Medicine and Surgery, Università degli Studi Milano-Bicocca, Milan, Italy; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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