1
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Sorolla-Romero JA, Navarrete-Navarro J, Martinez-Sole J, Garcia HMG, Diez-Gil JL, Martinez-Dolz L, Sanz-Sanchez J. Pharmacological Considerations during Percutaneous Treatment of Heart Failure. Curr Pharm Des 2024; 30:565-577. [PMID: 38477207 DOI: 10.2174/0113816128284131240209113009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/25/2024] [Indexed: 03/14/2024]
Abstract
Heart Failure (HF) remains a global health challenge, marked by its widespread prevalence and substantial resource utilization. Although the prognosis has improved in recent decades due to the treatments implemented, it continues to generate high morbidity and mortality in the medium to long term. Interventional cardiology has emerged as a crucial player in HF management, offering a diverse array of percutaneous treatments for both acute and chronic HF. This article aimed to provide a comprehensive review of the role of percutaneous interventions in HF patients, with a primary focus on key features, clinical effectiveness, and safety outcomes. Despite the growing utilization of these interventions, there remain critical gaps in the existing body of evidence. Consequently, the need for high-quality randomized clinical trials and extensive international registries is emphasized to shed light on the specific patient populations and clinical scenarios that stand to benefit most from these innovative devices.
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Affiliation(s)
- Jose Antonio Sorolla-Romero
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell 116, Valencia, Spain
| | - Javier Navarrete-Navarro
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell 116, Valencia, Spain
| | - Julia Martinez-Sole
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell 116, Valencia, Spain
| | - Hector M Garcia Garcia
- Department of Cardiology, MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC 20010, United States
| | - Jose Luis Diez-Gil
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell 116, Valencia, Spain
| | - Luis Martinez-Dolz
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell 116, Valencia, Spain
| | - Jorge Sanz-Sanchez
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell 116, Valencia, Spain
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2
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Esposito ML, Salama M, Jain P, Kapur NK. Left Atrial Unloading in the Setting of Mitral Stenosis and Left Atrial Appendage Thrombus. Circ Heart Fail 2021; 15:e008561. [DOI: 10.1161/circheartfailure.121.008561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Michael Salama
- The Cardiovascular Center, Tufts Medical Center, Boston, MA
| | - Pankaj Jain
- The Cardiovascular Center, Tufts Medical Center, Boston, MA
| | - Navin K. Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, MA
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3
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Cardiac intensive care management of high-risk percutaneous coronary intervention using the venoarterial ECMO support. Heart Fail Rev 2021; 25:833-846. [PMID: 31677013 DOI: 10.1007/s10741-019-09862-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The emerging concept of high-risk percutaneous coronary intervention (HR-PCI) has required the adoption of a multidisciplinary team approach. Venoarterial ECMO (VA-ECMO) has been introduced as a temporary mechanical circulatory support (MCS) for HR-PCI patients in order to provide an adequate systemic perfusion during the procedure. Both patient's complexity and technological evolutions have catalyzed the development of critical care cardiology; however, ECMO therapy faces several challenges. Indeed, the management of patients on ECMO remains complex; moreover, the lack of specific recommendation for HR-PCI patients further complicates the management of these patients. In this narrative review, we give a reappraisal for the management of HR-PCI patients supported with VA-ECMO according to the available data published in current literature.
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4
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Seliem A, Hall SA. The New Era of Cardiogenic Shock: Progress in Mechanical Circulatory Support. Curr Heart Fail Rep 2020; 17:325-332. [DOI: 10.1007/s11897-020-00490-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
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5
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Chandiramani R, Cao D, Nicolas J, Mehran R. Contrast-induced acute kidney injury. Cardiovasc Interv Ther 2020; 35:209-217. [PMID: 32253719 DOI: 10.1007/s12928-020-00660-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 01/26/2023]
Abstract
Although major advancements in the field of cardiology have allowed for an increasing number of patients to undergo minimally invasive imaging and interventional procedures, contrast-induced acute kidney injury (CI-AKI) continues to be a dreaded complication among patients receiving intravascular contrast media. CI-AKI is characterized by progressive decline in kidney function within a few days of contrast medium administration. Physiological changes resulting from the direct nephrotoxic effect of contrast media on tubular epithelial cells and release of vasoactive molecules have been implicated in creating a state of increased oxidative stress and subsequent ischemic renal cell injury. Over the last several years, preventive strategies involving intravenous hydration, pharmaceutical agents and renal replacement therapies have resulted in lower rates of CI-AKI. However, due to the evolving paradigm of diagnostic and therapeutic interventions, several unanswered questions remain. This review highlights the epidemiology, pathogenesis and preventive strategies of CI-AKI.
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Affiliation(s)
- Rishi Chandiramani
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA
| | - Davide Cao
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA
| | - Johny Nicolas
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA
| | - Roxana Mehran
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA.
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6
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Ly HQ, Noly PE, Nosair M, Lamarche Y. When the Complex Meets the High-Risk: Mechanical Cardiac Support Devices and Percutaneous Coronary Interventions in Severe Coronary Artery Disease. Can J Cardiol 2019; 36:270-279. [PMID: 32036868 DOI: 10.1016/j.cjca.2019.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 11/29/2022] Open
Abstract
Coronary artery disease (CAD) remains a leading cause of mortality and morbidity worldwide. Few practice guidelines directly address the issue of revascularization in patients with CAD at higher risk of periprocedural complications. It remains a challenge to appropriately identify the subset of patients with CAD who will require short-term use of mechanical cardiocirculatory support devices (MCSDs) when high-risk (HR) percutaneous coronary intervention (PCI) is required. Issues of the complexity (coronary anatomy and high burden of comorbidities) and risk status (hemodynamic precarity or compromise) need to be considered when considering revascularization in patients. This review will focus on the evolving concept of protected PCI in patients with CAD, and how a balanced, integrated heart-team approach remains the path to optimal patient-centred care in the setting of HR-PCI supported with MCSD.
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Affiliation(s)
- Hung Q Ly
- Interventional Cardiology Service, Department of Medicine, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
| | - Pierre-Emmanuel Noly
- Department of Cardiovascular Surgery, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Mohamed Nosair
- Interventional Cardiology Service, Department of Medicine, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Yoan Lamarche
- Department of Cardiovascular Surgery, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
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7
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Hetzer R, Javier MFDM, Javier Delmo EM. Pediatric ventricular assist devices: what are the key considerations and requirements? Expert Rev Med Devices 2019; 17:57-74. [PMID: 31779486 DOI: 10.1080/17434440.2020.1699404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: The development of ventricular assist devices (VADs) have enabled myocardial recovery and improved patient survival until heart transplantation. However, device options remain limited for children and lag in development.Areas covered: This review focuses on the evolution of pediatric VADs in becoming to be an accepted treatment option in advanced heart failure, discusses the classification of VADs available for children, i.e. types of pumps and duration of support, and defines implantation indications and explantation criteria, describes attendant complications and long-term outcome of VAD support. Furthermore, we emphasize the key considerations and requirements in the application of these devices in infants, children and adolescents.Expert opinion: Increasing use of VADs has facilitated a leading edge in management of advanced heart failure either as a bridge to transplantation or as a bridge to myocardial recovery. In newborns and small children, the EXCOR Pediatric VAD remains the only reliable option. In some patients ventricular unloading may lead to complete myocardial recovery. There is a strong need for pumps that are fully implantable, suitable for single ventricle physiology, such as the right ventricle.
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Affiliation(s)
- Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
| | | | - Eva Maria Javier Delmo
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
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8
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Shamekhi J, Pütz A, Zimmer S, Tiyerili V, Mellert F, Welz A, Fimmers R, Grube E, Nickenig G, Werner N, Sinning JM. Impact of Hemodynamic Support on Outcome in Patients Undergoing High-Risk Percutaneous Coronary Intervention. Am J Cardiol 2019; 124:20-30. [PMID: 31056109 DOI: 10.1016/j.amjcard.2019.03.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/10/2019] [Accepted: 03/15/2019] [Indexed: 10/27/2022]
Abstract
The use of left-ventricular (LV) hemodynamic support might facilitate high-risk percutaneous coronary interventions (PCI) in patients with complex coronary artery disease. The impact on outcome is a matter of ongoing debate. We assessed the outcome of high-risk patients who underwent protected PCI in comparison to patients who underwent unprotected high-risk PCI. One hundred and thirty nine patients underwent nonemergent high-risk PCI; 24 (17%) patients underwent protected PCI. To address selection bias, we performed a propensity score matched subanalysis. The primary end point was the occurrence of a major adverse cardiac event during the first year. Patients with protected PCI had a higher logistic EuroSCORE (logES) (protected PCI: 19% vs unprotected PCI: 12%; p = 0.01), a higher SYNTAX score (45 vs 36, p = 0.07), and significantly more often reduced LV function (40% vs 55%; p < 0.001). In protected PCI patients, complete revascularization was more often achieved (87% vs 58%, p = 0.007) without the occurrence of death at 30 days of follow-up (0% vs 4%, p = 0.31). After propensity score matching, patients who underwent protected PCI had a similar 1-year major adverse cardiac event rate compared with patients who underwent unprotected PCI (21% vs 17%, p = 0.67), despite significantly higher procedural complexity for example, more often complex left main bifurcation lesions (71% vs 29%; p = 0.004). In conclusion, 1-year outcome of patients who underwent protected PCI was not different from that in patients with less complex procedures without hemodynamic support, despite more complex coronary anatomy, a higher comorbidity burden, and more often reduced LV function.
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9
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Al‐khadra Y, Alraies MC, Darmoch F, Pacha HM, Soud M, Kaki A, Rab T, Grines CL, Meraj P, Alaswad K, Kwok CS, Mamas M, Kapadia S. Outcomes of nonemergent percutaneous coronary intervention requiring mechanical circulatory support in patients without cardiogenic shock. Catheter Cardiovasc Interv 2019; 95:503-512. [DOI: 10.1002/ccd.28383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/02/2019] [Accepted: 06/17/2019] [Indexed: 11/07/2022]
Affiliation(s)
| | - M. Chadi Alraies
- Wayne State University, Detroit Medical Center, Detroit Heart Hospital Detroit Michigan
| | - Fahed Darmoch
- Beth Israel Deaconess Medical Center/Harvard Medical School Boston Massachusetts
| | - Homam M. Pacha
- MedStar Washington Hospital Center Washington District of Columbia
| | - Mohamad Soud
- MedStar Washington Hospital Center Washington District of Columbia
| | - Amir Kaki
- St John Hospital and Medical Center Detroit Michigan
| | | | - Cindy L. Grines
- Zucker School of Medicine at Hofstra Northwell Health, Northshore University Hospital Manhasset New York
| | - Pewaiz Meraj
- Zucker School of Medicine at Hofstra Northwell Health, Northshore University Hospital Manhasset New York
| | | | - Chun S. Kwok
- Keele Cardiovascular Research Group, Keele University Stoke‐on‐Trent UK
- Royal Stoke University Hospital Stoke‐on‐Trent UK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Keele University Stoke‐on‐Trent UK
- Royal Stoke University Hospital Stoke‐on‐Trent UK
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10
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Craner RC, Carvajal T, Villablanca PA, Jahanyar J, Yang EH, Ramakrishna H. The Increasing Importance of Percutaneous Mechanical Circulatory Support in High-Risk Transcatheter Coronary Interventions: An Evidence-Based Analysis. J Cardiothorac Vasc Anesth 2018; 32:1507-1524. [DOI: 10.1053/j.jvca.2017.09.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Indexed: 12/18/2022]
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11
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Flaherty MP, Pant S, Patel SV, Kilgore T, Dassanayaka S, Loughran JH, Rawasia W, Dawn B, Cheng A, Bartoli CR. Hemodynamic Support With a Microaxial Percutaneous Left Ventricular Assist Device (Impella) Protects Against Acute Kidney Injury in Patients Undergoing High-Risk Percutaneous Coronary Intervention. Circ Res 2017; 120:692-700. [DOI: 10.1161/circresaha.116.309738] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 12/31/2016] [Accepted: 01/10/2017] [Indexed: 01/25/2023]
Abstract
Rationale:
Acute kidney injury (AKI) is common during high-risk percutaneous coronary intervention (PCI), particularly in those with severely reduced left ventricular ejection fraction. The impact of partial hemodynamic support with a microaxial percutaneous left ventricular assist device (pLVAD) on renal function after high-risk PCI remains unknown.
Objective:
We tested the hypothesis that partial hemodynamic support with the Impella 2.5 microaxial pLVAD during high-risk PCI protected against AKI.
Methods and Results:
In this retrospective, single-center study, we analyzed data from 230 patients (115 consecutive pLVAD-supported and 115 unsupported matched-controls) undergoing high-risk PCI with ejection fraction ≤35%. The primary outcome was incidence of in-hospital AKI according to AKI network criteria. Logistic regression analysis determined the predictors of AKI. Overall, 5.2% (6) of pLVAD-supported patients versus 27.8% (32) of unsupported control patients developed AKI (
P
<0.001). Similarly, 0.9% (1) versus 6.1% (7) required postprocedural hemodialysis (
P
<0.05). Microaxial pLVAD support during high-risk PCI was independently associated with a significant reduction in AKI (adjusted odds ratio, 0.13; 95% confidence intervals, 0.09–0.31;
P
<0.001). Despite preexisting CKD or a lower ejection fraction, pLVAD support protection against AKI persisted (adjusted odds ratio, 0.63; 95% confidence intervals, 0.25–0.83;
P
=0.04 and adjusted odds ratio, 0.16; 95% confidence intervals, 0.12–0.28;
P
<0.001, respectively).
Conclusions:
Impella 2.5 (pLVAD) support protected against AKI during high-risk PCI. This renal protective effect persisted despite the presence of underlying CKD and decreasing ejection fraction.
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Affiliation(s)
- Michael P. Flaherty
- From the Cardiovascular Medicine, University of Louisville School of Medicine, KY (M.P.F., S.P., T.K., S.D., J.H.L., W.R.); Internal Medicine, Sparks Regional Medical Center, Fort Smith, AR (S.V.P.); Cardiology, University of Kansas Medical Center, Kansas City (B.D.); Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (A.C.); and Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (C.R.B.)
| | - Sadip Pant
- From the Cardiovascular Medicine, University of Louisville School of Medicine, KY (M.P.F., S.P., T.K., S.D., J.H.L., W.R.); Internal Medicine, Sparks Regional Medical Center, Fort Smith, AR (S.V.P.); Cardiology, University of Kansas Medical Center, Kansas City (B.D.); Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (A.C.); and Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (C.R.B.)
| | - Samir V. Patel
- From the Cardiovascular Medicine, University of Louisville School of Medicine, KY (M.P.F., S.P., T.K., S.D., J.H.L., W.R.); Internal Medicine, Sparks Regional Medical Center, Fort Smith, AR (S.V.P.); Cardiology, University of Kansas Medical Center, Kansas City (B.D.); Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (A.C.); and Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (C.R.B.)
| | - Tyler Kilgore
- From the Cardiovascular Medicine, University of Louisville School of Medicine, KY (M.P.F., S.P., T.K., S.D., J.H.L., W.R.); Internal Medicine, Sparks Regional Medical Center, Fort Smith, AR (S.V.P.); Cardiology, University of Kansas Medical Center, Kansas City (B.D.); Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (A.C.); and Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (C.R.B.)
| | - Sujith Dassanayaka
- From the Cardiovascular Medicine, University of Louisville School of Medicine, KY (M.P.F., S.P., T.K., S.D., J.H.L., W.R.); Internal Medicine, Sparks Regional Medical Center, Fort Smith, AR (S.V.P.); Cardiology, University of Kansas Medical Center, Kansas City (B.D.); Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (A.C.); and Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (C.R.B.)
| | - John H. Loughran
- From the Cardiovascular Medicine, University of Louisville School of Medicine, KY (M.P.F., S.P., T.K., S.D., J.H.L., W.R.); Internal Medicine, Sparks Regional Medical Center, Fort Smith, AR (S.V.P.); Cardiology, University of Kansas Medical Center, Kansas City (B.D.); Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (A.C.); and Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (C.R.B.)
| | - Wasiq Rawasia
- From the Cardiovascular Medicine, University of Louisville School of Medicine, KY (M.P.F., S.P., T.K., S.D., J.H.L., W.R.); Internal Medicine, Sparks Regional Medical Center, Fort Smith, AR (S.V.P.); Cardiology, University of Kansas Medical Center, Kansas City (B.D.); Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (A.C.); and Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (C.R.B.)
| | - Buddhadeb Dawn
- From the Cardiovascular Medicine, University of Louisville School of Medicine, KY (M.P.F., S.P., T.K., S.D., J.H.L., W.R.); Internal Medicine, Sparks Regional Medical Center, Fort Smith, AR (S.V.P.); Cardiology, University of Kansas Medical Center, Kansas City (B.D.); Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (A.C.); and Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (C.R.B.)
| | - Allen Cheng
- From the Cardiovascular Medicine, University of Louisville School of Medicine, KY (M.P.F., S.P., T.K., S.D., J.H.L., W.R.); Internal Medicine, Sparks Regional Medical Center, Fort Smith, AR (S.V.P.); Cardiology, University of Kansas Medical Center, Kansas City (B.D.); Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (A.C.); and Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (C.R.B.)
| | - Carlo R. Bartoli
- From the Cardiovascular Medicine, University of Louisville School of Medicine, KY (M.P.F., S.P., T.K., S.D., J.H.L., W.R.); Internal Medicine, Sparks Regional Medical Center, Fort Smith, AR (S.V.P.); Cardiology, University of Kansas Medical Center, Kansas City (B.D.); Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (A.C.); and Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (C.R.B.)
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12
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Sandhu A, McCoy LA, Negi SI, Hameed I, Atri P, Al’Aref SJ, Curtis J, McNulty E, Anderson HV, Shroff A, Menegus M, Swaminathan RV, Gurm H, Messenger J, Wang T, Bradley SM. Use of Mechanical Circulatory Support in Patients Undergoing Percutaneous Coronary Intervention. Circulation 2015; 132:1243-51. [DOI: 10.1161/circulationaha.114.014451] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 07/17/2015] [Indexed: 11/16/2022]
Abstract
Background—
Little is known about the contemporary use of intra-aortic balloon pump (IABP) and other mechanical circulatory support (O-MCS) devices in patients undergoing percutaneous coronary intervention (PCI) in the setting of cardiogenic shock.
Methods and Results—
We identified 76 474 patients who underwent PCI in the setting of cardiogenic shock at one of 1429 National Cardiovascular Data Registry CathPCI participating hospitals from 2009 to 2013. Temporal trends and hospital-level variation in the use of IABP and O-MCS were evaluated. No mechanical circulatory support was used in 41 286 (54%) patients, 29 730 (39%) received IABP only, 2711 (3.5%) received O-MCS only, and 2747 (3.6%) received both IABP and O-MCS. At the start of the study period, 45% of patients undergoing PCI in the setting of cardiogenic shock received an IABP and 6.7% received O-MCS. The proportion of patients receiving IABP declined at an average rate of 0.3% per quarter, whereas the rate of O-MCS use was unchanged over the study period. The predicted probability of IABP use varied significantly by site (hospital median 42%, interquartile range 33% to 51%, range 8% to 85%). The probability of O-MCS use was <5% for half of hospitals and >20% in less than one-tenth of hospitals.
Conclusions—
In this large national registry, the use of IABP in the setting of PCI for cardiogenic shock decreased over time without a concurrent increase in O-MCS use. The probability of IABP and O-MCS use varied across hospitals, and the use of O-MCS was clustered at a small number of hospitals.
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Affiliation(s)
- Amneet Sandhu
- From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New
| | - Lisa A. McCoy
- From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New
| | - Smita I. Negi
- From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New
| | - Irfan Hameed
- From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New
| | - Prashant Atri
- From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New
| | - Subhi J. Al’Aref
- From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New
| | - Jeptha Curtis
- From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New
| | - Ed McNulty
- From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New
| | - H. Vernon Anderson
- From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New
| | - Adhir Shroff
- From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New
| | - Mark Menegus
- From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New
| | - Rajesh V. Swaminathan
- From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New
| | - Hitinder Gurm
- From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New
| | - John Messenger
- From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New
| | - Tracy Wang
- From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New
| | - Steven M. Bradley
- From Division of Cardiology, University of Colorado School of Medicine, Aurora (A.S., J.M., S.M.B.); Division of Cardiology, Duke University Medical Center, Durham, NC (L.A.M., T.W.); Division of Cardiology, Medstar Washington Hospital Center/Georgetown University, Washington, DC (S.I.N.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.H., M.M.); Division of Cardiology, Northwestern University, Chicago, IL (P.A.); Division of Cardiology, Weill Cornell Medical Center, New
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Spiro J, Doshi SN. Use of left ventricular support devices during acute coronary syndrome and percutaneous coronary intervention. Curr Cardiol Rep 2015; 16:544. [PMID: 25326728 DOI: 10.1007/s11886-014-0544-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In an effort to improve outcomes in percutaneous coronary intervention (PCI), percutaneous ventricular assist devices (PVADs) have been investigated in (1) high-risk PCI, (2) acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) and (3) in AMI without CS. PCI has become an increasing complex due to an ageing population with complex disease and the frequent presence of impaired LV function. Patients undergoing high-risk PCI in these circumstances are prone to acute cardiovascular collapse. Additionally, mortality in AMI complicated by CS remains high. Lastly, LV support during AMI may reduce infarct size and therefore preserve LV function. At present, four commercially available devices exist: intra-aortic balloon pump counterpulsation (IABP), Impella, TandemHeart and extracorporeal membrane oxygenation (ECMO). These devices are employed in an effort to increase cardiac output, mean arterial pressure (MAP) and coronary perfusion and to reduce pulmonary capillary wedge pressure (PCWP). The mechanism of action differs with each device, and there are advantages and disadvantages. In this update, we discuss recent data describing the use of PVADs to support patients with AMI with or without cardiogenic shock and during high-risk PCI. We focus on the unique features of each device, highlighting strengths, weaknesses and frequently encountered complications, which may be important when tailoring the most appropriate PVAD therapy to an individual patient's need.
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Affiliation(s)
- Jon Spiro
- Department of Cardiology, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
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Tomasello SD, Boukhris M, Ganyukov V, Galassi AR, Shukevich D, Haes B, Kochergin N, Tarasov R, Popov V, Barbarash L. Outcome of extracorporeal membrane oxygenation support for complex high-risk elective percutaneous coronary interventions: A single-center experience. Heart Lung 2015; 44:309-13. [DOI: 10.1016/j.hrtlng.2015.03.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 01/09/2023]
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15
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Gilotra NA, Stevens GR. Temporary mechanical circulatory support: a review of the options, indications, and outcomes. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 8:75-85. [PMID: 25674024 PMCID: PMC4317108 DOI: 10.4137/cmc.s15718] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 12/20/2022]
Abstract
Cardiogenic shock remains a challenging disease entity and is associated with significant morbidity and mortality. Temporary mechanical circulatory support (MCS) can be implemented in an acute setting to stabilize acutely ill patients with cardiomyopathy in a variety of clinical situations. Currently, several options exist for temporary MCS. We review the indications, contraindications, clinical applications, and evidences for a variety of temporary circulatory support options, including the intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO), CentriMag blood pump, and percutaneous ventricular assist devices (pVADs), specifically the TandemHeart and Impella.
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Affiliation(s)
- Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Gerin R Stevens
- Mechanical Circulatory Support Program, Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
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Abu Saleh WK, Jabbari OA, Guha A, Loebe M, Bruckner BA. Treatment strategies for patients with an INTERMACS I profile. Methodist Debakey Cardiovasc J 2015; 11:4-8. [PMID: 25793022 PMCID: PMC4362064 DOI: 10.14797/mdcj-11-1-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Treatment of patients with INTERMACS class I heart failure can be very challenging, and temporary long-term device support may be needed. In this article, we review the currently available temporary support devices in order to support these severely ill patients with decompensated heart failure. Strategies of using a temporary assist as a bridge to long-term device support are also discussed.
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Patel KD, Chiem DN. The preemptive use of extracorporeal membrane oxygenation to facilitate high risk percutaneous cardiac interventions: left main percutaneous coronary interventions and percutaneous balloon aortic valvuloplasty. ACTA ACUST UNITED AC 2014; 2:135-7. [PMID: 25612109 DOI: 10.1213/xaa.0000000000000029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As percutaneous cardiac interventions continue to evolve, high-risk procedures are being performed on patients deemed too ill for surgery. What were once considered lower-risk procedures compared with open cardiac interventions may no longer be so because of the complex nature of the interventions and the complex comorbidities of the patients on whom these are being performed. We present a case involving high-risk percutaneous cardiac interventions (left main coronary angioplasty and aortic balloon valvuloplasty), facilitated by the use of extracorporeal membrane oxygenation in a critically ill patient with severe aortic stenosis, left main coronary disease, and ischemic cardiomyopathy.
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Affiliation(s)
- Komal D Patel
- From the Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California
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Aggarwal S, Slaughter MS. Acute myocardial infarction complicated by cardiogenic shock: role of mechanical circulatory support. Expert Rev Cardiovasc Ther 2014; 6:1223-35. [DOI: 10.1586/14779072.6.9.1223] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Engström AE, Piek JJ, Henriques JPS. Percutaneous left ventricular assist devices for high-risk percutaneous coronary intervention. Expert Rev Cardiovasc Ther 2014; 8:1247-55. [DOI: 10.1586/erc.10.93] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Ohuchi K, Takatani S. Currently available ventricular-assist devices: capabilities, limitations and future perspectives. Expert Rev Med Devices 2014; 3:195-205. [PMID: 16515386 DOI: 10.1586/17434440.3.2.195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The continuous progress in ventricular-assist device (VAD) technology and the management of patients with VADs has broadened the treatment options for end-stage heart failure patients. The available line-up of clinical devices provides the current optimal therapies to meet the specific needs of each patient. The extended durability, safety, efficacy and improved quality of life of the patients provides sufficient proof for the VAD to be a likely alternative therapy to heart transplantation. The sequential progress from the first-, to the second- and to the third-generation VAD technology is expected to bring increasing benefits to clinical outcomes. This article reviews the current status, capabilities, limitations and future perspectives of currently available VADs by generally classifying them via support duration, alignment of pump devices and via pulsatile or nonpulsatile mode of perfusion. Furthermore, the future direction of research and development for next-generation VADs is presented based on the lessons learned from currently available VADs.
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Affiliation(s)
- Katsuhiro Ohuchi
- Institute of Biomaterials and Bioengineering, Department of Artificial Organs, Tokyo Medical and Dental University, Tokyo, Japan.
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Lemaire A, Anderson MB, Lee LY, Scholz P, Prendergast T, Goodman A, Lozano AM, Spotnitz A, Batsides G. The Impella device for acute mechanical circulatory support in patients in cardiogenic shock. Ann Thorac Surg 2013; 97:133-8. [PMID: 24090575 DOI: 10.1016/j.athoracsur.2013.07.053] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 07/02/2013] [Accepted: 07/16/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute cardiogenic shock is associated with high mortality rates. Mechanical circulatory devices have been increasingly used in this setting for hemodynamic support. The Impella device (Abiomed Inc, Danvers, MA) is a microaxial left ventricular assist device that can be inserted using a less invasive technique. This study was conducted to determine the outcome of patients who have undergone placement of the Impella device for acute cardiogenic shock in our institution. METHODS A retrospective record review of 47 patients who underwent placement of the Impella device was performed from January 1, 2006, to December 31, 2011. Records were evaluated for demographics, operative details, and postoperative outcomes. Operative mortality was defined as death within 30 days of the operation. RESULTS The patients (33 male) were an average age of 60.23 ± 13 years. The indication for placement of the Impella device included cardiogenic shock in 15 patients (32%) and postcardiotomy cardiogenic shock in 32 (68%). Of the 47 patients, 38 (80%) received the Impella 5.0 and the rest the 2.5 device. Ventricular function recovered in 34 of 47 patients (72%), and the device was removed, with 4 patients (8%) transitioned to long-term ventricular assist devices. The 30-day mortality was 25% (12 of 47 patients). Complications occurred in 14 patients (30%), consisting of device malfunction, high purge pressures, tube fracture, and groin hematoma. CONCLUSIONS This is one of the largest series of patients undergoing placement of the Impella device for acute cardiogenic shock. Our outcomes showed improved results compared with historical data. Myocardial recovery was accomplished in most patients. Finally, the 30-day mortality and complication rate was acceptable in these critical patients. These benefits were all achieved with the Impella device in a less invasive method.
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Affiliation(s)
- Anthony Lemaire
- Department of Cardiothoracic Surgery, Robert Wood Johnson University Hospital, The University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey; and Abiomed, Inc, Danvers, Massachusetts.
| | - Mark B Anderson
- Department of Cardiothoracic Surgery, Robert Wood Johnson University Hospital, The University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey; and Abiomed, Inc, Danvers, Massachusetts
| | - Leonard Y Lee
- Department of Cardiothoracic Surgery, Robert Wood Johnson University Hospital, The University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey; and Abiomed, Inc, Danvers, Massachusetts
| | - Peter Scholz
- Department of Cardiothoracic Surgery, Robert Wood Johnson University Hospital, The University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey; and Abiomed, Inc, Danvers, Massachusetts
| | - Thomas Prendergast
- Department of Cardiothoracic Surgery, Robert Wood Johnson University Hospital, The University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey; and Abiomed, Inc, Danvers, Massachusetts
| | - Andrew Goodman
- Department of Cardiothoracic Surgery, Robert Wood Johnson University Hospital, The University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey; and Abiomed, Inc, Danvers, Massachusetts
| | - Ann Marie Lozano
- Department of Cardiothoracic Surgery, Robert Wood Johnson University Hospital, The University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey; and Abiomed, Inc, Danvers, Massachusetts
| | - Alan Spotnitz
- Department of Cardiothoracic Surgery, Robert Wood Johnson University Hospital, The University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey; and Abiomed, Inc, Danvers, Massachusetts
| | - George Batsides
- Department of Cardiothoracic Surgery, Robert Wood Johnson University Hospital, The University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey; and Abiomed, Inc, Danvers, Massachusetts
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Usage of Percutaneous Left Ventricular Assist Devices in Clinical Practice and High-risk Percutaneous Coronary Intervention. Interv Cardiol Clin 2013; 2:417-428. [PMID: 28582103 DOI: 10.1016/j.iccl.2013.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients who require coronary revascularization and present with poor left ventricular function and complex coronary anatomy are at high risk for percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery. Some of these patients are poor surgical candidates because of previous cardiac surgery or significant comorbidities. The recent approval and availability of percutaneous left ventricular assist devices has created an opportunity for the highest risk patients. This article reviews currently available mechanical circulatory support systems and portable extracorporeal oxygenation, describing hemodynamic and physiologic rationales, indications, strategies, and available evidence for their use in high risk PCI.
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25
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Pollak P, Lim DS, Kern J. Management of severe aortic regurgitation in a patient with cardiogenic shock using a percutaneous left ventricular assist device and transcatheter occlusion of the failed aortic valve homograft as a bridge to surgical valve replacement. Catheter Cardiovasc Interv 2013; 83:E141-5. [DOI: 10.1002/ccd.24993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 04/08/2013] [Accepted: 04/28/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Peter Pollak
- Department of Internal Medicine; University of Virginia Health System; Rochester Minnesota
| | - D. Scott Lim
- Department of Pediatrics; University of Virginia Health System; Rochester Minnesota
| | - John Kern
- Department of Surgery; University of Virginia Health System; Rochester Minnesota
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26
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Mao H, Giuliani A, Blanca-Martos L, Kim JC, Nayak A, Virzi G, Brocca A, Scalzotto E, Neri M, Katz N, Ronco C. Effect of Percutaneous Ventricular Assist Devices on Renal Function. Blood Purif 2013; 35:119-26. [DOI: 10.1159/000346096] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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O'Neill WW, Kleiman NS, Moses J, Henriques JPS, Dixon S, Massaro J, Palacios I, Maini B, Mulukutla S, Dzavík V, Popma J, Douglas PS, Ohman M. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 2012; 126:1717-27. [PMID: 22935569 DOI: 10.1161/circulationaha.112.098194] [Citation(s) in RCA: 574] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although coronary artery bypass grafting is generally preferred in symptomatic patients with severe, complex multivessel, or left main disease, some patients present with clinical features that make coronary artery bypass grafting clinically unattractive. Percutaneous coronary intervention with hemodynamic support may be feasible for these patients. Currently, there is no systematic comparative evaluation of hemodynamic support devices for this indication. METHODS AND RESULTS We randomly assigned 452 symptomatic patients with complex 3-vessel disease or unprotected left main coronary artery disease and severely depressed left ventricular function to intra-aortic balloon pump (IABP) (n=226) or Impella 2.5 (n=226) support during nonemergent high-risk percutaneous coronary intervention. The primary end point was the 30-day incidence of major adverse events. A 90-day follow-up was required, as well, by protocol. Impella 2.5 provided superior hemodynamic support in comparison with IABP, with maximal decrease in cardiac power output from baseline of -0.04±0.24 W in comparison with -0.14±0.27 W for IABP (P=0.001). The primary end point (30-day major adverse events) was not statistically different between groups: 35.1% for Impella 2.5 versus 40.1% for IABP, P=0.227 in the intent-to-treat population and 34.3% versus 42.2%, P=0.092 in the per protocol population. At 90 days, a strong trend toward decreased major adverse events was observed in Impella 2.5-supported patients in comparison with IABP: 40.6% versus 49.3%, P=0.066 in the intent-to-treat population and 40.0% versus 51.0%, P=0.023 in the per protocol population, respectively. CONCLUSIONS The 30-day incidence of major adverse events was not different for patients with IABP or Impella 2.5 hemodynamic support. However, trends for improved outcomes were observed for Impella 2.5-supported patients at 90 days. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00562016.
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Affiliation(s)
- William W O'Neill
- Division of Cardiology, Department of Internal Medicine, Leonard M Miller School of Medicine, 1600 NW 10th Ave, Miami, FL 33156, USA.
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Alli OO, Singh IM, Holmes DR, Pulido JN, Park SJ, Rihal CS. Percutaneous left ventricular assist device with TandemHeart for high-risk percutaneous coronary intervention: The Mayo Clinic experience. Catheter Cardiovasc Interv 2012; 80:728-34. [DOI: 10.1002/ccd.23465] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 10/31/2011] [Indexed: 11/09/2022]
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Martinez CA, Badheka AO, O’Neill WW. Hemodynamic support in high-risk percutaneous coronary interventions and cardiogenic shock. Interv Cardiol 2012. [DOI: 10.2217/ica.11.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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30
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2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011; 58:e44-122. [PMID: 22070834 DOI: 10.1016/j.jacc.2011.08.007] [Citation(s) in RCA: 1724] [Impact Index Per Article: 132.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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31
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:e574-651. [PMID: 22064601 DOI: 10.1161/cir.0b013e31823ba622] [Citation(s) in RCA: 902] [Impact Index Per Article: 69.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Jacobs AK, Anderson JL, Albert N, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Catheter Cardiovasc Interv 2011; 82:E266-355. [DOI: 10.1002/ccd.23390] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shavelle DM, Clavijo L, Matthews RV. Percutaneous devices to support the left ventricle. Expert Rev Med Devices 2011; 8:681-94. [PMID: 22029466 DOI: 10.1586/erd.11.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article will summarize the current status of three percutaneous left ventricular assist devices, review technical details involving device components and device insertion, discuss the hemodynamic changes that occur with device implantation and summarize published and ongoing clinical trials evaluating these devices in patients undergoing high-risk percutaneous coronary intervention and those with cardiogenic shock.
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Affiliation(s)
- David M Shavelle
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, CA, USA.
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Arroyo D, Cook S. Percutaneous ventricular assist devices: new deus ex machina? Minim Invasive Surg 2011; 2011:604397. [PMID: 22091361 PMCID: PMC3197007 DOI: 10.1155/2011/604397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 05/22/2011] [Accepted: 05/25/2011] [Indexed: 11/26/2022] Open
Abstract
The development of ventricular assist devices has broadened the means with which one can treat acute heart failure. Percutaneous ventricular assist devices (pVAD) have risen from recent technological advances. They are smaller, easier, and faster to implant, all important qualities in the setting of acute heart failure. The present paper briefly describes the functioning and assets of the most common devices used today. It gives an overview of the current evidence and indications for left ventricular assist device use in cardiogenic shock and high-risk percutaneous coronary intervention. Finally, extracorporeal life support devices are dealt with in the setting of hemodynamic support.
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Affiliation(s)
- Diego Arroyo
- Cardiology Unit, University Medical Center, University of Fribourg, 1708 Fribourg, Switzerland
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35
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Froesch P, Martinelli M, Meier P, Cook S, Hullin R, Windecker S, Mohacsi P, Meier B. Clinical use of temporary percutaneous left ventricular assist devices. Catheter Cardiovasc Interv 2011; 78:304-13. [DOI: 10.1002/ccd.22948] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 12/18/2010] [Indexed: 11/05/2022]
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The role of percutaneous circulatory assist devices in acute myocardial infarction and high-risk percutaneous coronary intervention in the 21st century. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2011; 12:237-42. [DOI: 10.1016/j.carrev.2010.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 10/11/2010] [Indexed: 11/19/2022]
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Percutaneous left ventricular assist devices during cardiogenic shock and high-risk percutaneous coronary interventions. Curr Cardiol Rep 2010; 11:369-76. [PMID: 19709497 DOI: 10.1007/s11886-009-0051-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Left ventricular assist devices were developed to support the function of a failing left ventricle. Owing to recent technological improvements, ventricular assist devices can be placed by percutaneous implantation techniques, which offer the advantage of fast implantation in the setting of acute left ventricular failure. This article reviews the growing evidence supporting the clinical use of left ventricular assist devices. Specifically, we discuss the use of left ventricular assist devices in patients with cardiogenic shock, in patients with acute ST-elevation myocardial infarction without shock, and during high-risk percutaneous coronary interventions.
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Pulido JN, Park SJ, Rihal CS. Percutaneous Left Ventricular Assist Devices: Clinical Uses, Future Applications, and Anesthetic Considerations. J Cardiothorac Vasc Anesth 2010; 24:478-86. [DOI: 10.1053/j.jvca.2009.10.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Indexed: 11/11/2022]
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DE SOUZA CRISTIANOFREITAS, DE SOUZA BRITO FLAVIO, DE LIMA VALTERCORREIA, DE CAMARGO CARVALHO ANTONIOCARLOS. Percutaneous Mechanical Assistance for the Failing Heart. J Interv Cardiol 2010; 23:195-202. [DOI: 10.1111/j.1540-8183.2010.00536.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Sjauw KD, Konorza T, Erbel R, Danna PL, Viecca M, Minden HH, Butter C, Engstrøm T, Hassager C, Machado FP, Pedrazzini G, Wagner DR, Schamberger R, Kerber S, Mathey DG, Schofer J, Engström AE, Henriques JPS. Supported high-risk percutaneous coronary intervention with the Impella 2.5 device the Europella registry. J Am Coll Cardiol 2010; 54:2430-4. [PMID: 20082934 DOI: 10.1016/j.jacc.2009.09.018] [Citation(s) in RCA: 176] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 09/03/2009] [Accepted: 09/14/2009] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This retrospective multicenter registry evaluated the safety and feasibility of left ventricular (LV) support with the Impella 2.5 (Abiomed Europe GmbH, Aachen, Germany) during high-risk percutaneous coronary intervention (PCI). BACKGROUND Patients with complex or high-risk coronary lesions, such as last remaining vessel or left main lesions, are increasingly being treated with PCI. Because periprocedural hemodynamic compromise and complications might occur rapidly, many of these high-risk procedures are being performed with mechanical cardiac assistance, particularly in patients with poor LV function. The Impella 2.5, a percutaneous implantable LV assist device, might be a superior alternative to the traditionally used intra-aortic balloon pump. METHODS The Europella registry included 144 consecutive patients who underwent a high-risk PCI. Safety and feasibility end points included incidence of 30-day adverse events and successful device function. RESULTS Patients were older (62% >70 years of age), 54% had an LV ejection fraction < or = 30%, and the prevalence of comorbid conditions was high. Mean European System for Cardiac Operative Risk Evaluation score was 8.2 (SD 3.4), and 43% of the patients were refused for coronary artery bypass grafting. A PCI was considered high-risk due to left main disease, last remaining vessel disease, multivessel coronary artery disease, and low LV function in 53%, 17%, 81%, and 35% of the cases, respectively. Mortality at 30 days was 5.5%. Rates of myocardial infarction, stroke, bleeding requiring transfusion/surgery, and vascular complications at 30 days were 0%, 0.7%, 6.2%, and 4.0%, respectively. CONCLUSIONS This large multicenter registry supports the safety, feasibility, and potential usefulness of hemodynamic support with Impella 2.5 in high-risk PCI.
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Affiliation(s)
- Krischan D Sjauw
- Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
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Gregoric ID, Loyalka P, Radovancevic R, Jovic Z, Frazier OH, Kar B. TandemHeart as a rescue therapy for patients with critical aortic valve stenosis. Ann Thorac Surg 2010; 88:1822-6. [PMID: 19932242 DOI: 10.1016/j.athoracsur.2009.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 07/31/2009] [Accepted: 08/04/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND We analyzed our use of the TandemHeart Percutaneous Ventricular Assist Device (Cardiac Assist Inc, Pittsburgh, PA) as a rescue therapy for patients with cardiac arrest or severe refractory cardiogenic shock (SRCS) before or after aortic valve replacement (AVR) for critical aortic valve stenosis. METHODS We reviewed the records of 10 patients (6 men; 4 women), aged 62 +/- 12 years, who presented with cardiac arrest or SRCS. Eight patients, 5 undergoing cardiopulmonary resuscitation (CPR) and 3 with SRCS, received TandemHeart support in the catheterization laboratory and had AVR after undergoing hemodynamic stabilization. The other 2 patients went directly to the operating room while undergoing CPR, for emergency AVR and received the device for postcardiotomy cardiogenic shock. All 10 patients were intubated, on maximal vasopressor support, and 7 had an intraaortic balloon pump. The preoperative Society of Thoracic Surgeons mortality risk was 74.9% +/- 24.5%. RESULTS The 8 patients who received the TandemHeart in the catheterization laboratory were supported for 6.4 +/- 3.8 days and had significantly improved renal function before AVR. One patient died of sepsis 34 days after AVR, The other 7 were discharged home (ejection fraction, 0.42 +/- 0.14) and were alive 2 to 43 months later. The 2 patients who received the device in the operating room after AVR died on days 8 and 21, respectively. CONCLUSIONS Prompt placement of the TandemHeart in these critically ill patients yields the shortest "emergency department door to left ventricular unloading time," improves end-organ function, and allows AVR to be performed electively.
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Affiliation(s)
- Igor D Gregoric
- Center for Cardiac Support, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77225-0345, USA.
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Eichhöfer J, Osten M, Horlick E, Dzavík V. First Canadian experience with high-risk percutaneous coronary intervention with assistance of a percutaneously deployed left ventricular assist device. Can J Cardiol 2008; 24:e82-5. [PMID: 18987766 DOI: 10.1016/s0828-282x(08)70199-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Mechanical assist devices play an increasing role in high-risk percutaneous coronary intervention (PCI) in highly complex and critically ill patients. The Impella Recover LP 2.5 is a minimally invasive left ventricular assist device that is inserted percutaneously via a 13 Fr sheath. The device is engineered to provide a significant increase in cardiac output in patients with severe left ventricular impairment as well as in patients undergoing high-risk coronary intervention, and may provide substantive circulatory support when severe hemodynamic compromise occurs. It can potentially be maintained in situ for five to seven days. Canada's first implantations of an Impella device providing circulatory support in patients undergoing complex, high-risk PCI are reported. Larger studies will be required to identify whether a survival benefit or improvement in left ventricular function can be achieved when using the Impella device to support patients undergoing high-risk PCI or those in cardiogenic shock.
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Affiliation(s)
- Jonas Eichhöfer
- Division of Cardiology, University Health Network, University of Toronto, Ontario
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Percutaneous Impella Recover circulatory support in high-risk coronary angioplasty. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2008; 9:269-74. [DOI: 10.1016/j.carrev.2008.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 04/30/2008] [Indexed: 11/20/2022]
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Chandra D, Kar B, Idelchik G, Simpson L, Loyalka P, Gregoric ID, Delgado RM, Frazier OH. Usefulness of percutaneous left ventricular assist device as a bridge to recovery from myocarditis. Am J Cardiol 2007; 99:1755-6. [PMID: 17560889 DOI: 10.1016/j.amjcard.2007.01.067] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Revised: 01/17/2007] [Accepted: 01/17/2007] [Indexed: 11/30/2022]
Abstract
The TandemHeart percutaneous left ventricular assist device is a left atrial-to-femoral artery bypass system that can be implanted percutaneously within 30 minutes and provides active circulatory support. The TandemHeart has been used mainly for temporary hemodynamic assistance during high-risk coronary interventions and postcardiotomy heart failure. This report describes initial experience with this device as a successful bridge to cardiac recovery in 3 patients with acute myocarditis. All patients presented with severe cardiogenic shock (mean cardiac index 1.1 L/min/m2), and end-organ perfusion could not be maintained despite intra-aortic balloon counterpulsation and the maximal use of vasopressive agents. The patients were successfully bridged to myocardial recovery with the TandemHeart (mean duration of support 5 days, range 2 to 8). The only complication was a short episode of ventricular fibrillation during device placement in 1 patient, which did not result in any morbidity or mortality. All patients were discharged home (mean duration of stay 15 days). In conclusion, the TandemHeart proved to be a safe and effective bridge to myocardial recovery in these patients with acute myocarditis.
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Affiliation(s)
- Divay Chandra
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Abstract
Ventricular assist devices (VADs) play an increasingly important role in the care of cardiovascular patients. Developed initially for support of cardiothoracic surgery patients experiencing difficulty in weaning from cardiopulmonary bypass, these devices have been used extensively as a bridge to cardiac transplantation for patients who are failing on medical management. Research has demonstrated the effectiveness of a VAD as destination therapy, providing a permanent means of support for patients with advanced heart failure who are not eligible for heart transplantation. Applications for VADs are expanding and advances in technology occurring to support these new applications. This article provides an overview of current and emerging VADs and nursing management of the VAD patient.
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Giombolini C, Notaristefano S, Santucci S, Fortunati F, Savino K, Sindaco FD, Ragni T, Allegri M, Ambrosio G. Percutaneous left ventricular assist device, TandemHeart, for high-risk percutaneous coronary revascularization. A single centre experience. ACTA ACUST UNITED AC 2006; 8:35-40. [PMID: 16720426 DOI: 10.1080/14628840600621421] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Patients with severe depression of left ventricular ejection fraction and high-risk coronary lesions are at risk of developing complications during percutaneous coronary interventions (PCI). Intra-aortic balloon pump (IABP) is a support that helps the interventionalist in such hemodynamic complications during high-risk PCI, but it does not offer complete circulatory support. Instead, TandemHeart (Cardiac Assist, Pittsburg, PA, USA) is a percutaneous left ventricular assist device (pLVAD) that gives total left circulatory support and can be used for patients in cardiogenic shock or for elective PCI at high-risk. TandemHeart is a percutaneous transseptal ventricular assist device that allows a rapid percutaneous left ventricular support without the need for surgical implantation. Between November 2003 and April 2005, 6 patients admitted to our coronary care unit (CCU) underwent either emergency (n = 3) or elective (n = 3) placement of the TandemHeart device before a high-risk procedure. From our initial experience we conclude that the percutaneous transseptal ventricular assist device, TandemHeart, can be easily and rapidly deployed either in emergency or in elective high-risk PCI to achieve complete cardiac assistance.
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Affiliation(s)
- Claudio Giombolini
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy.
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Abstract
Patients undergoing percutaneous coronary intervention (PCI) who have severely compromised left ventricular systolic function and complex coronary lesions including multivessel disease, left main disease, or bypass graft disease are at higher risk of adverse outcomes from hemodynamic collapse. The TandemHeart percutaneous left ventricular assist device and the Impella Recover LP 2.5 System may provide rapid circulatory support in high-risk PCI patients and in those who have cardiogenic shock. Identification of patients who are at high risk for severe hemodynamic compromise and most likely to benefit from mechanical circulatory support is crucial to derive the most benefit from this therapy. Multicenter randomized clinical trials are needed to clearly define the role of these two devices in providing circulatory support in a variety of clinical settings.
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Affiliation(s)
- Michael S Lee
- Cardiovascular Intervention Center, Cedars-Sinai Medical Center, School of Medicine, University of California-Los Angeles, 8631 West Third Street, Los Angeles, CA 90048, USA
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Henriques JPS, Remmelink M, Baan J, van der Schaaf RJ, Vis MM, Koch KT, Scholten EW, de Mol BAJM, Tijssen JGP, Piek JJ, de Winter RJ. Safety and feasibility of elective high-risk percutaneous coronary intervention procedures with left ventricular support of the Impella Recover LP 2.5. Am J Cardiol 2006; 97:990-2. [PMID: 16563902 DOI: 10.1016/j.amjcard.2005.10.037] [Citation(s) in RCA: 177] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Revised: 10/06/2005] [Accepted: 10/06/2005] [Indexed: 12/01/2022]
Abstract
Currently, the most used left ventricular (LV) support device is intra-aortic balloon counterpulsation. The percutaneous implantable Impella Recover LP 2.5 system is a novel LV (unloading) assist device. We studied the feasibility and safety of LV support with the percutaneous implantable Impella Recover LP 2.5 system in 19 consecutive high-risk patients with percutaneous coronary intervention. Procedural success using the device and percutaneous coronary intervention was achieved in all 19 patients, who were very poor candidates for surgery. The patients were elderly (84% were >60 years of age), 74% had previous myocardial infarction, 63% had LV ejection fractions of < or =25%, and all had LV ejection fractions of < or =40%. There were no procedural deaths and 2 device-unrelated in-hospital late deaths. Mean decrease in hemoglobin level was 0.7 +/- 0.4 mmol/L. The device did not induce or increase aortic valve regurgitation. There were no important device-related adverse events during LV support with the Impella Recover LP 2.5 system. However, these encouraging findings must be confirmed by larger studies, longer assist times, and in other patient categories.
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Affiliation(s)
- José P S Henriques
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
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Minden HH, Lehmann H, Meyhöfer J, Butter C. Transradial unprotected left main coronary stenting supported by percutaneous Impella® Recover LP 2.5 assist device. Clin Res Cardiol 2006; 95:301-6. [PMID: 16598397 DOI: 10.1007/s00392-006-0371-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Accepted: 01/23/2006] [Indexed: 10/24/2022]
Abstract
Percutaneous coronary intervention (PCI) has been increasingly applied to patients with severely depressed left ventricular function and complex coronary lesions. The availability of hemodynamic support devices offers a promising option to reduce PCI-related complications in high-risk procedures. We report the case of a 79-year-old man who suffered from unstable angina. The coronary angiogram revealed multivessel disease including a significant distal left main (LM) stenosis. Additionally, the patient had a history of chronic lymphatic leukemia with immune hemolysis. Therefore, the patient was considered to be at exceptionally high mortality risk in case of cardiac surgery. We decided to perform a percutaneous revascularization of the LM supported by the Impella Recover LP 2.5 assist device. This case report discusses the principles of indications, technique and complications of this new addition to interventional cardiology.
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Affiliation(s)
- H H Minden
- Immanuel Diakonie Group, Heart Center Brandenburg in Bernau, Department of Cardiology, Bernau, Germany.
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