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Masiero G, Arturi F, Panza A, Tarantini G. Mechanical Circulatory Support with Impella: Principles, Evidence, and Daily Practice. J Clin Med 2024; 13:4586. [PMID: 39200728 PMCID: PMC11354798 DOI: 10.3390/jcm13164586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/23/2024] [Accepted: 08/03/2024] [Indexed: 09/02/2024] Open
Abstract
The Impella (Abiomed, Danvers, MA, USA) microaxial pump is a percutaneous mechanical circulatory support (MCS) that has been shown to increase coronary perfusion, reduce myocardial oxygen demand, and improve peripheral organ perfusion. Therefore, indications for the Impella device include emergency use for cardiogenic shock (CS) and pre-emptive implantation during high-risk percutaneous coronary intervention (HR-PCI). However, despite their exponential use in cardiovascular practice over the past decade, there is limited randomized evidence to support the benefits of this therapy and growing concern regarding complication rates. In this review, we summarize the principles, evidence, and practical considerations of the most widely used Impella CP percutaneous left ventricular support in both CS and HR-PCI settings, moving from the historical background to current issues and future expectations for this device.
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Affiliation(s)
| | | | | | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, 35128 Padua, Italy; (G.M.); (F.A.); (A.P.)
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2
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Meani P, Todaro S, Veronese G, Kowalewski M, Montisci A, Protti I, Marchese G, Meuwese C, Lorusso R, Pappalardo F. Science of left ventricular unloading. Perfusion 2024:2676591241268389. [PMID: 39058419 DOI: 10.1177/02676591241268389] [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: 07/28/2024]
Abstract
The concept of left ventricular unloading has its foundation in heart physiology. In fact, the left ventricular mechanics and energetics represent the cornerstone of this approach. The novel sophisticated therapies for acute heart failure, particularly mechanical circulatory supports, strongly impact on the mechanical functioning and energy consuption of the heart, ultimately affecting left ventricle loading. Notably, extracorporeal circulatory life support which is implemented for life-threatening conditions, may even overload the left heart, requiring additional unloading strategies. As a consequence, the understanding of ventricular overload, and the associated potential unloading strategies, founds its utility in several aspects of day-by-day clinical practice. Emerging clinical and pre-clinical research on left ventricular unloading and its benefits in heart failure and recovery has been conducted, providing meaningful insights for therapeutical interventions. Here, we review the current knowledge on left ventricular unloading, from physiology and molecular biology to its application in heart failure and recovery.
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Affiliation(s)
- Paolo Meani
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
- Thoracic Research Center, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Serena Todaro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giacomo Veronese
- Anesthesia and Cardiovascular Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariusz Kowalewski
- Thoracic Research Center, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Andrea Montisci
- Cardiothoracic Department, Division of Cardiothoracic Intensive Care, ASST Spedali Civili, Brescia, Italy
| | - Ilaria Protti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Marchese
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Christiaan Meuwese
- Department of Intensive Care and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
| | - Federico Pappalardo
- Cardiothoracic and Vascular Anesthesia and Intensive Care, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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3
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Geppert A, Mashayekhi K, Huber K. The use of mechanical circulatory support in elective high-risk percutaneous coronary interventions: a literature-based review. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae007. [PMID: 38511148 PMCID: PMC10954236 DOI: 10.1093/ehjopen/oeae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/28/2024] [Accepted: 02/02/2024] [Indexed: 03/22/2024]
Abstract
Contemporary medical practices allow complete percutaneous coronary intervention (PCI) in a considerable number of patients who previously would have been considered too 'high-risk' for such procedures. The use of mechanical circulatory support (MCS) devices during these high-risk PCIs (HR-PCIs) is thought to reduce the potential risk for major adverse events during and after revascularization. The intra-aortic balloon pump (IABP), veno-arterial extracorporeal membrane oxygenation (V-A ECMO), and the Impella are the most common MCS devices in use. This review aims to summarize the clinical evidence for each of these devices and the potential mechanisms for the improvement in patient outcomes in HR-PCI. The IABP use has rapidly declined in recent years due to no evidence of benefit in HR-PCI and cardiogenic shock. The V-A ECMO results in low rates of major adverse cardiac and cerebrovascular events (MACCEs) but higher rates of acute kidney injury and increased need for transfusions. In initial studies, Impella resulted in a reduced need for repeat interventions and reduced rates of hypotension, but no benefit in mortality. However, MACCE rates with Impella have gradually declined over the last 10 years, reflecting increased operator experience and technical improvements. Thus, a large, randomized trial is needed to assess the efficacy of Impella in HR-PCI with contemporary standards of care. There is currently no individual parameter that can identify patients who would benefit from MCS use in elective HR-PCI. To address this gap, we propose an algorithm that combines anatomical complexity, comorbidities, and clinical presentation to accurately identify candidates for MCS-assisted HR-PCI.
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Affiliation(s)
- Alexander Geppert
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Clinic Ottakring, Montleartstrasse 37, A-1160 Vienna, Austria
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg—Bad Krozingen, Südring 15, D-79189 Bad Krozingen, Faculty of Medicine of the University, Freiburg, Germany
- Clinic of Internal Medicine and Cardiology, Heart Center Lahr, Hohbergweg 2, D-77933 Lahr/Schwarzwald, Germany
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Clinic Ottakring, Montleartstrasse 37, A-1160 Vienna, Austria
- Medical Faculty, Sigmund Freud University, Freudplatz 1+3, A-1020 Vienna, Austria
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4
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Min S, Basir MB, Lemor A, Zhou Z, Abu-Much A, Redfors B, Thompson JB, Truesdell AG, Bharadwaj AS, Li Y, Kaki A, Brott BC, Wohns DH, Meraj PM, Daggubati R, Grines CL, O'Neill WW, Moses JW. Clinical characteristics and outcomes of patients requiring prolonged mechanical circulatory support after high-risk percutaneous coronary intervention. EUROINTERVENTION 2024; 20:e135-e145. [PMID: 38224254 PMCID: PMC10786176 DOI: 10.4244/eij-d-23-00512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/12/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND There are limited data on the clinical characteristics and outcomes of patients who require prolonged mechanical circulatory support (MCS) after Impella-supported high-risk percutaneous coronary intervention (HR-PCI). AIMS The aim of this study is to describe the contemporary clinical characteristics, outcomes, and predictors associated with prolonged MCS support after assisted HR-PCI. METHODS Patients enrolled in the prospective, multicentre, clinical endpoint-adjudicated PROTECT III study who had undergone HR-PCI using Impella were evaluated. Patient and procedural characteristics and outcomes for those who received prolonged MCS beyond the duration of their index procedure were compared to those in whom MCS was successfully weaned and explanted at the conclusion of the index PCI. RESULTS Among 1,155 patients who underwent HR-PCI with Impella between 2017 and 2020 and had sufficient data to confirm the duration of Impella support, 16.5% received prolonged MCS (mean duration 25.2±31.1 hours compared with 1.8±5.8 hours for those who only received intraprocedural MCS). Patients receiving prolonged support presented with more urgent indications (e.g., acute coronary syndromes [ACS], lower ejection fraction [EF], elevated baseline heart rate and lower systolic blood pressure). Use of the Impella CP, intraprocedural complications, periprocedural complications and in-hospital mortality were all more common amongst the prolonged MCS group. Prolonged MCS was associated with increased rates of major adverse cardiovascular and cerebrovascular events, cardiovascular death, and all-cause mortality at 90-day follow-up. CONCLUSIONS Patients receiving prolonged MCS after Impella-supported HR-PCI presented with more ACS, reduced EF and less favourable haemodynamics. Additionally, they were more likely to experience intraprocedural and periprocedural complications as well as increased in-hospital and post-discharge mortality.
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Affiliation(s)
- Sugi Min
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Mir Babar Basir
- Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - Alejandro Lemor
- Department of Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Zhipeng Zhou
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Arsalan Abu-Much
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Julia B Thompson
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Alexander G Truesdell
- Virginia Heart, Falls Church, VA, USA
- INOVA Heart and Vascular Institute, Falls Church, VA, USA
| | - Aditya S Bharadwaj
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Yanru Li
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Amir Kaki
- Interventional Cardiology Department, Ascension St. John Hospital and Center, Detroit, MI, USA
| | - Brigitta C Brott
- Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - David H Wohns
- Spectrum Health, Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA
| | - Perwaiz M Meraj
- Department of Cardiology, Zucker School of Medicine, Northwell Health, Manhasset, New York, NY, USA
| | - Ramesh Daggubati
- Division of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Cindy L Grines
- Medical College of Georgia, Augusta, GA, USA
- Northside Hospital Cardiovascular Institute, Atlanta, GA, USA
| | - William W O'Neill
- Center for Structural Heart Disease, Department of Cardiology, Henry Ford Health Care System, Detroit, MI, USA
| | - Jeffrey W Moses
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- St. Francis Heart Center, Roslyn, NY, USA
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5
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Sicke M, Modi S, Hong Y, Bashline M, Klass W, Horn E, Hansra BS, Ramanan R, Fowler J, Sumzin N, Rivosecchi RM, Chaudhary R, Ziegler LA, Hess NR, Agrawal N, Kaczorowski DJ, Hickey GW. Cardiogenic shock etiology and exit strategy impact survival in patients with Impella 5.5. Int J Artif Organs 2024; 47:8-16. [PMID: 38053245 PMCID: PMC10824236 DOI: 10.1177/03913988231214180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Despite historical differences in cardiogenic shock (CS) outcomes by etiology, outcomes by CS etiology have yet to be described in patients supported by temporary mechanical circulatory support (MCS) with Impella 5.5. OBJECTIVES This study aims to identify differences in survival and post-support destination for these patients in acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF) CS at a high-volume, tertiary, transplant center. METHODS A retrospective review of patients who received Impella 5.5 at our center from November 2020 to June 2022 was conducted. RESULTS Sixty-seven patients underwent Impella 5.5 implantation for CS; 23 (34%) for AMI and 44 (66%) for ADHF. AMI patients presented with higher SCAI stage, pre-implant lactate, and rate of prior MCS devices, and fewer days from admission to implantation. Survival was lower for AMI patients at 30 days, 90 days, and discharge. No difference in time to all-cause mortality was found when excluding patients receiving transplant. There was no significant difference in complication rates between groups. CONCLUSIONS ADHF-CS patients with Impella 5.5 support have a significantly higher rate of survival than patients with AMI-CS. ADHF patients were successfully bridged to heart transplant more often than AMI patients, contributing to increased survival.
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Affiliation(s)
- McKenzie Sicke
- University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Shan Modi
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yeahwa Hong
- Department of Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
| | - Michael Bashline
- Division of Cardiology Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Wyatt Klass
- Division of Cardiology Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ed Horn
- Department of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Barinder S Hansra
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Division of Cardiology Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Raj Ramanan
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeffrey Fowler
- Division of Cardiology Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nikita Sumzin
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ryan M Rivosecchi
- Department of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rahul Chaudhary
- Division of Cardiology Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Luke A Ziegler
- Division of Cardiology Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nicholas R Hess
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Nishant Agrawal
- University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David J Kaczorowski
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Gavin W Hickey
- Division of Cardiology Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Suzuki T, Sugiura R. Improvement of persistent anuria in severe myocardial infarction: the potential role of Impella 5.5 as a bridge to decision. BMJ Case Rep 2023; 16:e255462. [PMID: 38129092 DOI: 10.1136/bcr-2023-255462] [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] [Indexed: 12/23/2023] Open
Abstract
A man in his 40s with ST-segment elevation myocardial infarction complicating cardiogenic shock was transferred to our hospital. Emergent percutaneous coronary intervention for the left anterior descending and left circumflex arteries supported with Impella CP was performed. However, his cardiac function was severely impaired, and anuria developed, necessitating continuous renal replacement therapy (CRRT). After Impella CP was removed on day 6, the patient remained dependent on inotropes and CRRT. Following volume reduction to manage pulmonary congestion, symptoms of low perfusion appeared. Then, Impella 5.5 was inserted on day 38 as a bridge to decision. On day 52, the urine volume reached >2000 mL/day, and CRRT was discontinued. On day 56, the patient was transferred to a certified facility for left ventricular assist device implantation or heart transplantation. This case suggests the potential of Impella 5.5 as a bridge to decision in patients with organ failure caused by low cardiac output.
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Affiliation(s)
- Toshiaki Suzuki
- Cardiovascular Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Ryo Sugiura
- Cardiovascular Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
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7
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Liu Y, Tan N, Huo Y, Chen SQ, Liu J, Wang Y, Li L, Tao JH, Su X, Zhang L, Li QX, Zhang JY, Guo YS, Du ZM, Zhou YP, Fang ZF, Xu GM, Liang Y, Tao L, Chen H, Ji Z, Han B, Chen PY, Ge JB, Han YL, Chen JY. Simplified Rapid Hydration Prevents Contrast-Associated Acute Kidney Injury Among CKD Patients Undergoing Coronary Angiography. JACC Cardiovasc Interv 2023; 16:1503-1513. [PMID: 37380233 DOI: 10.1016/j.jcin.2023.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) undergoing coronary angiography (CAG) are at high risk of contrast-associated acute kidney injury (CA-AKI) and mortality. Therefore, there is a clinical need to explore safe, convenient, and effective strategies for preventing CA-AKI. OBJECTIVES This study sought to assess whether simplified rapid hydration is noninferior to standard hydration for CA-AKI prevention in patients with CKD. METHODS This multicenter, open-label, randomized controlled study was conducted across 21 teaching hospitals and included 1,002 patients with CKD. Patients were randomized to either simplified hydration (SH) (SH group, with normal saline from 1 hour before to 4 hours after CAG at a rate of 3 mL/kg/h) or standard hydration (control group, with normal saline 12 hours before and 12 hours after CAG at a rate of 1 mL/kg/h). The primary endpoint of CA-AKI was a ≥25% or 0.5-mg/dL rise in serum creatinine from baseline within 48 to 72 hours. RESULTS CA-AKI occurred in 29 of 466 (6.2%) patients in the SH group and in 38 of 455 (8.4%) patients in the control group (relative risk: 0.8; 95% CI: 0.5-1.2; P = 0.216). In addition, the risk of acute heart failure and 1-year major adverse cardiovascular events did not differ significantly between the groups. However, the median hydration duration was significantly shorter in the SH group than in the control group (6 vs 25 hours; P < 0.001). CONCLUSIONS In CKD patients undergoing CAG, SH is noninferior to standard hydration in preventing CA-AKI with a shorter hydration duration.
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Affiliation(s)
- Yong Liu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Ning Tan
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Shi-Qun Chen
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yan Wang
- Xiamen Key Laboratory of Cardiovascular Disease, Xiamen Cardiovascular Hospital Xiamen University, Xiamen, China
| | - Lang Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Jian-Hong Tao
- Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xi Su
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Li Zhang
- Department of Cardiology, West China Hospital, Sichuan University, China
| | - Qing-Xian Li
- Department of Cardiology, Affiliated Hospital, Jining Medical College, Shandong, China
| | - Jin-Ying Zhang
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan-Song Guo
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Zhi-Min Du
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Department of Heart Brain and Vessel Diseases, Dongguan Tungwah Hospital, Dongguan, China
| | - Yin-Pin Zhou
- Department of Cardiology, ChongQing FuLing Central Hospital, Chong Qing, China
| | - Zhen-Fei Fang
- Department of Cardiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Guang-Ma Xu
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Province, China
| | - Yan Liang
- Department of Cardiology, Maoming People's Hospital, Maoming, China
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Air Force Military Medical University, Shaanxi, China
| | - Hui Chen
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Ji
- Department of Cardiology, Tangshan Gongren Hospital, Hebei, China
| | - Bing Han
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, China
| | - Ping-Yan Chen
- Department of Biostatistics, Southern Medical University, Guangzhou, China
| | - Jun-Bo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Ya-Ling Han
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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8
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Prasad A, Palevsky PM, Bansal S, Chertow GM, Kaufman J, Kashani K, Kim ES, Sridharan L, Amin AP, Bangalore S, Briguori C, Charytan DM, Eng M, Jneid H, Brown JR, Mehran R, Sarnak MJ, Solomon R, Thakar CV, Fowler K, Weisbord S. Management of Patients With Kidney Disease in Need of Cardiovascular Catheterization: A Scientific Workshop Cosponsored by the National Kidney Foundation and the Society for Cardiovascular Angiography and Interventions. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100445. [PMID: 39132354 PMCID: PMC11307971 DOI: 10.1016/j.jscai.2022.100445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 08/13/2024]
Abstract
Patients with chronic kidney disease (CKD) are at an increased risk of developing cardiovascular disease (CVD), whereas those with established CVD are at risk of incident or progressive CKD. Compared with individuals with normal or near normal kidney function, there are fewer data to guide the management of patients with CVD and CKD. As a joint effort between the National Kidney Foundation and the Society for Cardiovascular Angiography and Interventions, a workshop and subsequent review of the published literature was held. The present document summarizes the best practice recommendations of the working group and highlights areas for further investigation.
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Affiliation(s)
- Anand Prasad
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, Texas
| | - Paul M. Palevsky
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine and Kidney Medicine Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Shweta Bansal
- Department of Medicine, Division of Nephrology, UT Health San Antonio, San Antonio, Texas
| | - Glenn M. Chertow
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, California
| | - James Kaufman
- Department of Medicine, Division of Nephrology, NYU Grossman School of Medicine, New York, New York
- VA New York Harbor Healthcare System, New York, New York
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Esther S.H. Kim
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lakshmi Sridharan
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia
| | - Amit P. Amin
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Sripal Bangalore
- Department of Medicine, Division of Cardiology, New York University Grossman School of Medicine, New York, New York
| | - Carlo Briguori
- Laboratory of Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - David M. Charytan
- Department of Medicine, Division of Nephrology, NYU Grossman School of Medicine, New York, New York
| | - Marvin Eng
- Banner University Medical Center, Phoenix, Arizona
| | - Hani Jneid
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Jeremiah R. Brown
- Departments of Epidemiology, Biomedical Data Science, and Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute at Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark J. Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Richard Solomon
- Division of Nephrology and Hypertension, University of Vermont School of Medicine, Burlington, Vermont
| | | | - Kevin Fowler
- Principal, Voice of the Patient, Inc, St Louis, Missouri
| | - Steven Weisbord
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine and Kidney Medicine Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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9
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Randomized Trials of Percutaneous Microaxial Flow Pump Devices. J Am Coll Cardiol 2022; 80:2028-2049. [DOI: 10.1016/j.jacc.2022.08.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022]
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10
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Tayal R, Kalra S, Seth A, Chandra P, Sohal S, Punamiya K, Rao R, Rastogi V, Kapardhi PLN, Sharma S, Kumar P, Arneja J, Mathew R, Kumar D, Mahesh NK, Trehan V. Clinical expert consensus document on the use of percutaneous left ventricular assist devices during complex high-risk PCI in India using a standardised algorithm. ASIAINTERVENTION 2022; 8:75-85. [PMID: 36483283 PMCID: PMC9706744 DOI: 10.4244/aij-d-22-00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/12/2022] [Indexed: 06/17/2023]
Abstract
Over the past decade, percutaneous left ventricular assist devices (pLVAD), such as the Impella microaxial flow pump (Abiomed), have been increasingly used to provide haemodynamic support during complex and high-risk revascularisation procedures to reduce the risk of intraprocedural haemodynamic compromise and to facilitate complete and optimal revascularisation. A global consensus on patient selection for the use of pLVADs, however, is currently lacking. Access to these devices is different across the world, thus, individual health care environments need to create and refine patient selection paradigms to optimise the use of these devices. The Impella pLVAD has recently been introduced in India and is being used in several centres in the management of high-risk percutaneous coronary intervention (PCI) and cardiogenic shock. With this increasing utilisation, there is a need for a standardised evaluation protocol to guide Impella use that factors in the unique economic and infrastructural characteristics of India's health care system to ensure that the needs of patients are optimally managed. In this consensus document, we present an algorithm to guide Impella use in Indian patients: to establish a standardised patient selection and usage paradigm that will allow both optimal patient outcomes and ongoing data collection.
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Affiliation(s)
- Rajiv Tayal
- Interventional Cardiology Unit, The Valley Hospital, Ridgewood, NJ, USA
| | - Sanjog Kalra
- Interventional Cardiology Unit, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada
| | - Ashok Seth
- Interventional Cardiology Unit, Fortis Escorts Heart Institute, New Delhi, India
| | - Praveen Chandra
- Interventional Cardiology Unit, Medanta Heart Institute, Gurgaon, India
| | - Sumit Sohal
- Interventional Cardiology Unit, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Kirti Punamiya
- Interventional Cardiology Unit, Breach Candy Hospital, Mumbai, India
| | - Ravinder Rao
- Interventional Cardiology Unit, Rajasthan Hospital, Jaipur, India
| | - Vishal Rastogi
- Interventional Cardiology Unit, Fortis Escorts Heart Institute, New Delhi, India
| | - P L N Kapardhi
- Interventional Cardiology Unit, CARE Hospitals, Hyderabad, India
| | - Sanjeev Sharma
- Interventional Cardiology Unit, Eternal Hospital, Jaipur, India
| | - Prathap Kumar
- Interventional Cardiology Unit, Meditrina Group of Hospitals, Kollam, India
| | - Jaspal Arneja
- Interventional Cardiology Unit, Arneja Heart and Multispeciality Hospital, Nagpur, India
| | - Rony Mathew
- Interventional Cardiology Unit, Lisie Hospital, Ernakulam, India
| | - Dilip Kumar
- Interventional Cardiology Unit, Medica Superspecialty Hospital, Kolkata, India
| | - N K Mahesh
- Interventional Cardiology Unit, Apollo Adlux Hospital, Kochi, India
| | - Vijay Trehan
- Interventional Cardiology Unit, Govind Ballabh Pant Hospital, New Delhi, India
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11
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Isaac T, Gilani S, Kleiman NS. When Prevention is Truly Better than Cure: Contrast-Associated Acute Kidney Injury in Percutaneous Coronary Intervention. Methodist Debakey Cardiovasc J 2022; 18:73-85. [PMID: 36132584 PMCID: PMC9461685 DOI: 10.14797/mdcvj.1136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/01/2022] [Indexed: 11/08/2022] Open
Abstract
Contrast-associated acute kidney injury (CA-AKI) is a fairly frequent complication of cardiovascular angiography and percutaneous coronary intervention (PCI). The risk is significantly higher in patients with advanced chronic kidney disease (CKD). Prevention is the only option for avoiding the significant morbidity and mortality associated with CA-AKI. This review provides a concise and clinically directed appraisal of the latest pre-procedural and peri-procedural strategies to minimize the risk of CA-AKI in all patients undergoing PCI. By broadly implementing these evidence-based care bundles, we can dramatically improve outcomes in this vulnerable patient population.
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Affiliation(s)
- Tea Isaac
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Salima Gilani
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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12
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Prevention and Management of AKI in ACS Patients Undergoing Invasive Treatments. Curr Cardiol Rep 2022; 24:1299-1307. [PMID: 35925513 DOI: 10.1007/s11886-022-01742-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Management of patients presenting with acute coronary syndrome (ACS) includes invasive procedures that may increase the risk of acute kidney injury (AKI). AKI adversely affects the outcomes of such procedures and complicates the management of ACS. We have summarized several strategies for the prevention and management of AKI in this critical patient group including in the pre-procedural, intraprocedural, and post-procedural settings. RECENT FINDINGS Definitive prevention and management strategies for AKI in patients presenting with ACS requiring invasive management can be confounded by the variation in data outcomes. Pre-procedural hydration with normal saline when accounting for time to catheterization, radial artery access, contrast stewardship, and close monitoring of renal function after catheterization should be implemented.
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13
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Sharifi A, Bark D. Flow assessment as a function of pump timing of tubular pulsatile pump for use as a ventricular assist device in a left heart simulator. Artif Organs 2022; 46:1294-1304. [PMID: 35132629 DOI: 10.1111/aor.14196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/19/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although mechanical circulatory support saved many lives during the last decade, clinical observations have shown that the continuous flow pumps are associated with a much higher incidence of gastrointestinal bleeding and kidney problems, among others, compared with the earlier generation pulsatile pumps. However, the presence of several moving mechanical components made pulsatile pumps less durable, bulky, and prone to malfunction, ultimately leading to bias in favor of continuous flow designs. OBJECTIVE The aim of the current work is to create a prototype tubular pulsatile pump and to test the timing of the pump in a left heart simulator. METHODS A left heart simulator to mimic pumping from a failing heart was created. This was used to experimentally test the output of a prototype ventricular assist device relative to a failing heart in the form of flow and pressure. The effect of pulsation timing was quantified. RESULTS A failing heart was simulated with an average flow rate of 1.1 L/min and a systolic pressure of 47 mmHg. With the pump, the flow rate increases to 4.8 L/min and a systolic pressure of 110mmHg, in a copulsation mode, while activating for 300-400 ms. If the activation time is reduced, or increased, the pump becomes less effective. Load on the heart is reduced when the pump operates in a counterpulsation mode. CONCLUSION A pulsatile pump, like the one proposed, provides adequate output for mechanical circulatory support, while minimizing the number of moving parts that could otherwise lead to tribological wear.
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Affiliation(s)
- Alireza Sharifi
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - David Bark
- Department of Pediatrics, Division of Hematology and Oncology, Washington University in St. Louis, St. Louis, MO, USA.,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
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14
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Walther CP, Civitello AB, Liao KK, Navaneethan SD. Nephrology Considerations in the Management of Durable and Temporary Mechanical Circulatory Support. KIDNEY360 2022; 3:569-579. [PMID: 35582171 PMCID: PMC9034823 DOI: 10.34067/kid.0003382021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/04/2022] [Indexed: 01/10/2023]
Abstract
Durable and temporary mechanical circulatory support (MCS) use is growing for a range of cardiovascular indications. Kidney dysfunction is common in people evaluated for or receiving durable or temporary MCS and portends worse outcomes. This kidney dysfunction can be due to preexisting kidney chronic kidney disease (CKD), acute kidney injury (AKI) related to acute cardiovascular disease necessitating MCS, AKI due to cardiac procedures, and acute and chronic MCS effects and complications. Durable MCS, with implantable continuous flow pumps, is used for long-term support in advanced heart failure refractory to guideline-directed medical and device therapy, either permanently or as a bridge to heart transplantation. Temporary MCS-encompassing in this review intra-aortic balloon pumps (IABP), axial flow pumps, centrifugal flow pumps, and venoarterial ECMO-is used for diverse situations: high-risk percutaneous coronary interventions (PCI), acute decompensated heart failure, cardiogenic shock, and resuscitation after cardiac arrest. The wide adoption of MCS makes it imperative to improve understanding of the effects of MCS on kidney health/function and of kidney health/function on MCS outcomes. The complex structure and functions of the kidney, and the complex health states of individuals receiving MCS, makes investigations in this area challenging, and current knowledge is limited. Fortunately, the increasing nephrology toolbox of noninvasive kidney health/function assessments may enable development and testing of individualized management strategies and therapeutics in the future. We review technology, epidemiology, pathophysiology, clinical considerations, and future directions in MCS and nephrology.
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Affiliation(s)
- Carl P. Walther
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Andrew B. Civitello
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas,Advanced Heart Failure Center of Excellence, Baylor College of Medicine, Houston, Texas
| | - Kenneth K. Liao
- Division of Cardiothoracic Transplantation and Circulatory Support, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Sankar D. Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas,Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas,Institute of Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
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15
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Upadhyaya VD, Alshami A, Patel I, Douedi S, Quinlan A, Thomas T, Prentice J, Calderon D, Asif A, Sen S, Mehra A, Hossain MA. Outcomes of Renal Function in Cardiogenic Shock Patients With or Without Mechanical Circulatory Support. J Clin Med Res 2021; 13:283-292. [PMID: 34104280 PMCID: PMC8166292 DOI: 10.14740/jocmr4449] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/12/2021] [Indexed: 12/29/2022] Open
Abstract
Background The objective of the study was to compare the renal outcomes in patients presenting with all-cause cardiogenic shock who were supported by either Impella devices (Abiomed, Danvers, MA), intra-aortic balloon pump (IABP), or vasopressors alone. Outcomes of cardiogenic shock remain poor even with the advancement of early revascularization and circulatory supportive care. Percutaneous mechanical circulatory support (MCS) device has emerged as an effective strategy in protecting end organ function especially renal function during high risk percutaneous coronary intervention (PCI) and in patients with cardiogenic shock. Currently, comparative data amongst various MCS modalities and their association with improvement of renal function in cardiogenic shock patients have not been well characterized. Methods Data from New Jersey Cardiac Catheterization Data registry of cardiogenic shock patients from a single tertiary care institution that underwent cardiac catheterization and the modality used to treat were obtained, either with Impella devices, IABP, or treatment with vasopressors alone. Retrospective chart review was conducted to assess the incidence of acute kidney injury (AKI) on patients with cardiogenic shock prior to and after cardiac catheterization and renal function was evaluated over the course of 96 h after cardiac catheterization. Statistical analysis was performed to ascertain significant difference in creatinine and estimated glomerular filtration rate (eGFR) in patients who received Impella devices, IABP, or were treated with vasopressors alone. Results A total of 61 all-cause cardiogenic shock patients met the inclusion and exclusion criteria and were included in the study with 19 receiving IABPs, 15 receiving Impella devices, and 27 treated with vasopressors alone. Baseline characteristics among these three groups did not show any statistically significant difference. A total of 29 cardiogenic shock patients had experienced AKI prior to cardiac catheterization in which those receiving Impella devices showed statistically significant decrease in creatinine and increase in eGFR at 72 and 96 h (P < 0.05) compared to baseline. Within the same cohort, Impella group showed statistically significant lower creatinine at 96 h when compared to IABP. Patients that experienced AKI after cardiac catheterization did not show any statistically significant changes in renal function regardless of modality used. Conclusion The results of our study suggest that Impella devices improve renal function in all-cause cardiogenic shock patients who experience AKI prior to undergoing cardiac catheterization.
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Affiliation(s)
- Vandan D Upadhyaya
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Abbas Alshami
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Ishan Patel
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Steven Douedi
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Amy Quinlan
- Department of Cardiology, One Robert Wood Johnson Place, New Brunswick, NJ 08903, USA
| | - Tresy Thomas
- Department of Cardiology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Joni Prentice
- Department of Cardiology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Dawn Calderon
- Department of Cardiology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Arif Asif
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Shuvendu Sen
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Aditya Mehra
- Department of Cardiology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Mohammad A Hossain
- Department of Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ 07753, USA
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16
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Tarantini G, Masiero G, Burzotta F, Pazzanese V, Briguori C, Trani C, Piva T, De Marco F, Di Biasi M, Pagnotta P, Mojoli M, Casu G, Giustino G, Lorenzoni G, Montorfano M, Ancona MB, Pappalardo F, Chieffo A. Timing of Impella implantation and outcomes in cardiogenic shock or high-risk percutaneous coronary revascularization. Catheter Cardiovasc Interv 2021; 98:E222-E234. [PMID: 33793051 PMCID: PMC8451815 DOI: 10.1002/ccd.29674] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/19/2022]
Abstract
Objective To evaluate the role of the microaxial percutaneous mechanical circulatory support device (Impella® pump) implantation pre‐percutaneous coronary intervention (PCI) versus during/after PCI in cardiogenic shock (CS) and high‐risk PCI populations. Background A better understanding of the safety and effectiveness of the Impella and the role of timing of this support initiation in specific clinical settings is of utmost clinical relevance. Methods A total of 365 patients treated with Impella 2.5/CP in the 17 centers of the IMP‐IT Registry were included. Through propensity‐score weighting (PSW) analysis, 1‐year clinical outcomes were assessed separately in CS and HR‐PCI patients, stratified by timing of Impella support. Results Pre‐procedural insertion was associated with an improvement in 1‐year survival in patients with CS due to acute myocardial infarction (AMI) treated with PCI (p = .04 before PSW, p = .009 after PSW) and HR‐PCI (p < .01 both before and after PSW). Among patients undergoing HR‐PCI, early Impella support was also associated with a lower rate of the composite of mortality, re‐hospitalization for heart failure, and need for left‐ventricular assist device/heart transplantation at 1‐year (p = .04 before PSW, p = .01 after PSW). Furthermore, Impella use during/after PCI was associated with an increased in‐hospital life‐threatening and severe bleeding among patients with AMI‐CS receiving PCI (7 vs. 16%, p = .1) and HR‐PCI (1 vs. 9%, p = .02). Conclusions Our findings suggested a survival benefit and reduced rates of major bleeding when a pre‐PCI Impella implantation instead of during‐after procedure was used in the setting of HR‐PCI and AMI‐CS.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Science and Public Health, University of Padova, Padua, Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Science and Public Health, University of Padova, Padua, Italy
| | - Francesco Burzotta
- Division of cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vittorio Pazzanese
- Division of cardiology, Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Vita Salute University, Milan, Italy
| | - Carlo Briguori
- Division of cardiology, Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Carlo Trani
- Division of cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tommaso Piva
- Division of cardiology, Interventional Cardiology Unit, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Maurizio Di Biasi
- Division of cardiology, Interventional Cardiology Unit, Ospedale Luigi Sacco, Milan, Italy
| | - Paolo Pagnotta
- Division of cardiology, Cardiovascular Department, Humanitas Research Hospital, Milan, Italy
| | - Marco Mojoli
- Division of cardiology, Ospedale Santa Maria degli Angeli, Pordenone, Italy
| | - Gavino Casu
- Interventional Cardiology Unit, Ospedale San Francesco, Nuoro, Italy
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Matteo Montorfano
- Division of cardiology, Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Division of cardiology, Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Pappalardo
- Division of cardiology, Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Vita Salute University, Milan, Italy
| | - Alaide Chieffo
- Division of cardiology, Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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17
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Myocardial Injury Promotes Matrix Metalloproteinase-9 Activity in the Renal Cortex in Preclinical Models of Acute Myocardial Infarction. J Cardiovasc Transl Res 2021; 15:207-216. [PMID: 33782857 PMCID: PMC8983528 DOI: 10.1007/s12265-021-10114-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/24/2021] [Indexed: 11/02/2022]
Abstract
New mechanistic insight into how the kidney responds to cardiac injury during acute myocardial infarction (AMI) is required. We hypothesized that AMI promotes inflammation and matrix metalloproteinase-9 (MMP9) activity in the kidney and studied the effect of initiating an Impella CP or veno-arterial extracorporeal membrane oxygenation (VA-ECMO) before coronary reperfusion during AMI. Adult male swine were subjected to coronary occlusion and either reperfusion (ischemia-reperfusion; IR) or support with either Impella or VA-ECMO before reperfusion. IR and ECMO increased while Impella reduced levels of MMP-9 in the myocardial infarct zone, circulation, and renal cortex. Compared to IR, Impella reduced myocardial infarct size and urinary KIM-1 levels, but VA-ECMO did not. IR and VA-ECMO increased pro-fibrogenic signaling via transforming growth factor-beta and endoglin in the renal cortex, but Impella did not. These findings identify that AMI increases inflammatory activity in the kidney, which may be attenuated by Impella support.
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18
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Chandrasekar B. Mechanical circulatory support with Impella in percutaneous coronary intervention: current status. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2021; 1:100002. [PMID: 38560363 PMCID: PMC10976289 DOI: 10.1016/j.ahjo.2020.100002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/25/2020] [Accepted: 11/11/2020] [Indexed: 04/04/2024]
Abstract
In patients with, or at risk of, hemodynamic instability during percutaneous coronary intervention, maintaining perfusion of vital organs is crucial. The intra-aortic balloon pump and Impella are the two most commonly used percutaneous mechanical circulatory support devices. Intra-aortic balloon pump has been in widespread use for over three decades. Mechanical circulatory support with Impella is being used increasingly often in patients with acute myocardial infarction complicated by cardiogenic shock, and in those undergoing high-risk percutaneous coronary intervention. Besides improving cardiac output and coronary perfusion, Impella has potential myocardial protective effects. Three key measures that determine the clinical utility of a device are clinical outcome, device-related complications, and cost impact. In this review, the current data on use of Impella in patients with acute myocardial infarction complicated by cardiogenic shock, in left ventricular unloading in acute myocardial infarction, and in those undergoing high-risk percutaneous coronary intervention is analyzed.
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19
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Osman M, Syed M, Abdul Ghaffar Y, Patel B, Abugroun A, Kheiri B, Kawsara A, Kadiyala M, Balla S, Daggubati R. Gender-based outcomes of impeller pumps percutaneous ventricular assist devices. Catheter Cardiovasc Interv 2020; 97:E627-E635. [PMID: 33058477 DOI: 10.1002/ccd.29222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/08/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is paucity of data focusing on females' outcomes after the use of impeller pumps percutaneous ventricular assist devices (IPVADs). METHODS Patients who received IPVADs during the period of October 1st, 2015-December 31, 2017, were identified from the United States National Readmission Database. A 1:1 propensity score matching was used to compare the outcomes between females and males. RESULTS A total of 19,278 (Female = 5,456; Male = 13,822) patients were included in the current analysis. After propensity score matching and among all-comers who were treated with IPVADs, females had higher in-hospital major adverse events (MAEs) (38 vs. 32.6%, p < .01), mortality (31 vs. 28%, p < .01), vascular complications (3.3 vs. 2.1%, p < .01), major bleeding (7.8 vs. 4.8%, p < .01), nonhome discharges (21.6 vs. 16.3%; p < .01), and longer length of stay (7 days [IQR 2-12] vs. 6 days [IQR 2-12], p = .02) with higher 30-day readmission rate compared to males (20.5 vs.16.4%, p < .01). Furthermore, among patients who received the IPVADs for high-risk percutaneous coronary intervention (HRPCI), females continued to have worse MAEs, which was driven by high rates of major bleeding. However, among patients who received IPVADs for cardiogenic shock (CS) the outcomes of females and males were comparable. CONCLUSIONS Among all-comers who received IPVADs, females suffered higher morbidity and mortality compared to males. Higher morbidity driven mainly by higher rates of major bleeding was seen among females who received IPVADs for the hemodynamic support during HRPCI and comparable outcomes were observed when the IPVADs were used for CS.
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Affiliation(s)
- Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Moinuddin Syed
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Yasir Abdul Ghaffar
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Brijesh Patel
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Ashraf Abugroun
- Department of Internal medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Akram Kawsara
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Madhavi Kadiyala
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Ramesh Daggubati
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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Simonton C, Thompson C, Wollmuth JR, Morris DL, Dahle TG. The Role of Hemodynamic Support in High-risk Percutaneous Coronary Intervention. US CARDIOLOGY REVIEW 2020. [DOI: 10.15420/usc.2020.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Patients with advanced age, complex coronary anatomy, and multiple comorbidities are often unsuitable for surgical revascularization. In this setting, hemodynamic support devices are used as an adjunct to percutaneous coronary intervention to maintain hemodynamic stability and enable optimal revascularization. This article provides an overview of percutaneous hemodynamic support devices currently used in clinical practice for high-risk percutaneous coronary intervention. These include the intra-aortic balloon pump, centrifugal pumps (TandemHeart, venous arterial extracorporeal membrane oxygenation), and micro-axial Impella pump. The hemodynamic effects, clinical evidence supporting improved outcomes and recovery of heart function, and associated complications with these devices are highlighted, with a special focus on Impella pumps.
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Affiliation(s)
| | | | | | - D Lynn Morris
- East Carolina Heart Institute Brody School of Medicine, Greenville, NC
| | - Thom G Dahle
- Centracare Heart and Vascular Center, St Cloud, MN
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Masyuk M, Abel P, Hug M, Wernly B, Haneya A, Sack S, Sideris K, Langwieser N, Graf T, Fuernau G, Franz M, Westenfeld R, Kelm M, Felix SB, Jung C. Extracorporeal life support system during cardiovascular procedures: Insights from the German Lifebridge registry. Artif Organs 2020; 44:1259-1266. [PMID: 32592601 DOI: 10.1111/aor.13760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/13/2020] [Accepted: 06/17/2020] [Indexed: 12/13/2022]
Abstract
The frequency of mechanical circulatory support (MCS) device application has increased in recent years. Besides implantation in the emergency setting, such as circulatory arrest, MCS is also increasingly used electively to ensure hemodynamic stability in high-risk patients, for example, during percutaneous coronary interventions (PCI), valve interventions or off-pump coronary bypass surgery. Lifebridge (Zoll Medical GmbH, Germany) is a compact percutaneous MCS device widely used in daily clinical routine. The present study aimed to investigate the indications, feasibility, and outcomes after use of Lifebridge in cardiac interventions, evaluating a large-scale multicenter database. A total of 60 tertiary cardiovascular centers were questioned regarding application and short-term outcomes after the use of the Lifebridge system (n = 160 patients). Out of these 60 centers, eight consented to participate in the study (n = 39 patients), where detailed data were collected using standardized questionnaires. Demographic and clinical characteristics of the patient population, procedural as well as follow-up data were recorded and analyzed. In 60 interrogated centers, Lifebridge was used in 74% of emergency cases and 26% in the setting of planned interventions. The subcohort interrogated in detail displayed the same distribution of application scenarios, while the main cardiovascular procedure was high-risk PCI (82%). All patients were successfully weaned from the device and 92% (n = 36) of the patients studied in detail survived after 30 days. As assessed 30 days after insertion of the device, bleeding requiring red blood cell (RBC) transfusion constituted the main complication, occurring in 49% of cases. In our analysis of clinical data, the use of Lifebridge in cardiac intervention was shown to be feasible. Further prospective studies are warranted to identify patients who benefit from hemodynamic MCS support despite the increased rate of RBC transfusion due to challenges in access sites during cardiovascular procedures.
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Affiliation(s)
- Maryna Masyuk
- Department of Medicine, Division of Cardiology, Pulmonary Diseases and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Peter Abel
- Department of Internal Medicine B, Division of Cardiology, Pneumology and Critical Care Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Martin Hug
- Department of Cardiology, Pulmonology and Internal Intensive Care Medicine, Städtisches Klinikum München GmbH, Klinikum Neuperlach, Munich, Germany
| | - Bernhard Wernly
- Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Assad Haneya
- Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Stefan Sack
- Department of Cardiology, Pneumology, and Internal Intensive Care Medicine, Schwabing Hospital, Academic Municipal Hospital Munich, Munich, Germany
| | - Konstantinos Sideris
- Department of Cardiovascular Surgery, German Heart Center, Technische Universität München (TUM), Munich, Germany
| | - Nicolas Langwieser
- Medical Clinic I, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Graf
- Department of Cardiology, Angiology, Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Georg Fuernau
- Department of Cardiology, Angiology, Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Marcus Franz
- Department of Internal Medicine I, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
| | - Ralf Westenfeld
- Department of Medicine, Division of Cardiology, Pulmonary Diseases and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Department of Medicine, Division of Cardiology, Pulmonary Diseases and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.,CARID: Cardiovascular Research Institute Düsseldorf, Düsseldorf, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, Division of Cardiology, Pneumology and Critical Care Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Christian Jung
- Department of Medicine, Division of Cardiology, Pulmonary Diseases and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
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22
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Higuchi S, Kabeya Y, Nishina Y, Miura Y, Yoshino H. Feasibility and safety of noncontrast percutaneous coronary intervention in patients with complicated acute coronary syndrome. Catheter Cardiovasc Interv 2020; 96:E666-E673. [DOI: 10.1002/ccd.28958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/07/2020] [Accepted: 04/25/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Satoshi Higuchi
- Department of Cardiology Kyorin University School of Medicine Mitaka Japan
- Department of Emergency and General Medicine Kyorin University School of Medicine Mitaka Japan
| | - Yusuke Kabeya
- Division of General Internal Medicine, Department of Internal Medicine Tokai University Isehara Japan
- Department of Home Care Medicine Sowa Hospital Sagamihara Japan
| | - Yoshio Nishina
- Department of Cardiology Kyorin University School of Medicine Mitaka Japan
| | - Yusuke Miura
- Department of Cardiology Kyorin University School of Medicine Mitaka Japan
| | - Hideaki Yoshino
- Department of Cardiology Kyorin University School of Medicine Mitaka Japan
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23
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Bugani G, Ponticelli F, Giannini F, Gallo F, Gaudenzi E, Laricchia A, Fisicaro A, Cimaglia P, Mangieri A, Gardi I, Colombo A. Practical guide to prevention of contrast-induced acute kidney injury after percutaneous coronary intervention. Catheter Cardiovasc Interv 2020; 97:443-450. [PMID: 31967390 DOI: 10.1002/ccd.28740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/12/2019] [Accepted: 01/11/2020] [Indexed: 11/06/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) represents a common but serious complication of percutaneous coronary interventions (PCI)-and in general of all those examinations requiring iodinated contrast injection-which affects not only renal function but also long-term prognosis. While several prophylactic approaches were designed in order to prevent CI-AKI, most failed to demonstrate clear benefits in randomized trials, and their implementation is therefore discouraged in clinical practice. The most notorious examples include pre-procedural bicarbonate or N-acetylcysteine, and preprocedural withdrawal of ACE inhibitors/Angiotensin receptor blockers. Those strategies that were instead demonstrated effective include the appropriate use of preprocedural hydration, reduction in contrast volume utilization, adoption of techniques for zero- or ultra-low-contrast procedures, and pharmacological treatments with statins. In this brief review, we summarize the main preventive strategies into brief and pragmatic recommendations designed to improve everyday clinical practice.
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Affiliation(s)
- Giulia Bugani
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Francesco Ponticelli
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Gallo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy.,Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Eleonora Gaudenzi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Andrea Fisicaro
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Paolo Cimaglia
- Cardiology Department, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Ilja Gardi
- Cardiology Department, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.,Emo GVM Centro Cuore Columbus, Interventional Cardiology Unit, Milan, Italy
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