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Maitz T, Shah S, Gupta R, Goel A, Sreenivasan J, Hajra A, Vyas AV, Lavie CJ, Hawwa N, Lanier GM, Kapur NK. Pathophysiology, diagnosis and management of right ventricular failure: A state of the art review of mechanical support devices. Prog Cardiovasc Dis 2024; 85:103-113. [PMID: 38944261 DOI: 10.1016/j.pcad.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 06/26/2024] [Indexed: 07/01/2024]
Abstract
The function of the right ventricle (RV) is to drive the forward flow of blood to the pulmonary system for oxygenation before returning to the left ventricle. Due to the thin myocardium of the RV, its function is easily affected by decreased preload, contractile motion abnormalities, or increased afterload. While various etiologies can lead to changes in RV structure and function, sudden changes in RV afterload can cause acute RV failure which is associated with high mortality. Early detection and diagnosis of RV failure is imperative for guiding initial medical management. Echocardiographic findings of reduced tricuspid annular plane systolic excursion (<1.7) and RV wall motion (RV S' <10 cm/s) are quantitatively supportive of RV systolic dysfunction. Medical management commonly involves utilizing diuretics or fluids to optimize RV preload, while correcting the underlying insult to RV function. When medical management alone is insufficient, mechanical circulatory support (MCS) may be necessary. However, the utility of MCS for isolated RV failure remains poorly understood. This review outlines the differences in flow rates, effects on hemodynamics, and advantages/disadvantages of MCS devices such as intra-aortic balloon pump, Impella, centrifugal-flow right ventricular assist devices, extracorporeal membrane oxygenation, and includes a detailed review of the latest clinical trials and studies analyzing the effects of MCS devices in acute RV failure.
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Affiliation(s)
- Theresa Maitz
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Swara Shah
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Rahul Gupta
- Department of Cardiology, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA.
| | - Akshay Goel
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | | | - Adrija Hajra
- Department of Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Apurva V Vyas
- Department of Cardiology, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Oshner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Nael Hawwa
- Department of Cardiology, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA
| | - Gregg M Lanier
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Navin K Kapur
- Cardiovascular Center, Tufts Medical Center, Boston, MA, USA
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2
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Patel B, Davis RP, Saatee S. Mechanical Circulatory Support Devices in the Elderly. Anesthesiol Clin 2023; 41:583-594. [PMID: 37516496 DOI: 10.1016/j.anclin.2023.02.008] [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: 07/31/2023]
Abstract
As the field of mechanical circulatory support (MCS) continues to advance and resuscitation protocols are being refined, elderly patients previously not considered for MCS are now being supported. MCS devices can broadly be classified based on the duration of support into temporary or durable devices. Although mortality is higher in the elderly, carefully selected patients, MCS support can be valuable and lead to excellent recovery. Age itself should not preclude patients from being candidates for MCS because we must not restrict the progress of science in medicine for any age.
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Affiliation(s)
- Bhoumesh Patel
- Division of Cardiac Anesthesiology, Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, P.O. Box 208051, New Haven, CT 06520-8051, USA.
| | - Robert P Davis
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, 333 Cedar Street, P.O. Box 208051, New Haven, CT 06520-8051, USA
| | - Siavosh Saatee
- Department of Anesthesiology, Feinberg School of Medicine, 251 East Huron St., F5-704, Chicago, IL 60611, USA
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Aranda-Michel E, Toubat O, Brennan Z, Bhagat R, Siki M, Paluri S, Duda M, Han J, Komlo C, Blitzer D, Louis C, Pruitt E, Sultan I. A primer for students regarding advanced topics in cardiothoracic surgery, part 2: Primer 7 of 7. JTCVS OPEN 2023; 14:362-371. [PMID: 37425452 PMCID: PMC10329042 DOI: 10.1016/j.xjon.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/02/2023] [Accepted: 04/08/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Edgar Aranda-Michel
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Omar Toubat
- Department of Cardiac Surgery, Keck Medicine of University of Southern California, Los Angeles, Calif
| | - Zach Brennan
- Michigan State University College of Osteopathic Medicine, Michigan State University, East Lansing, Mich
| | - Rohun Bhagat
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Mary Siki
- Department of Cardiothoracic Surgery, Tulane University, New Orleans, La
| | - Sarin Paluri
- Department of Cardiothoracic Surgery, Chicago College of Osteopathic Medicine, Midwestern University, Chicago, Ill
| | - Matthew Duda
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Jason Han
- Department of Cardiac Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Caroline Komlo
- Department of Cardiothoracic Surgery, Yale University, New Haven, Conn
| | - David Blitzer
- Department of Cardiothoracic Surgery, Columbia University, New York, NY
| | - Clauden Louis
- Department of Cardiothoracic Surgery, Brigham and Women's Hospital, Harvard University, Boston, Mass
| | - Eric Pruitt
- Department of Cardiothoracic Surgery, University of Florida, Gainesville, Fla
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
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González LS, Grady M. Intra-aortic balloon pump counterpulsation: technical function, management, and clinical indications. Int Anesthesiol Clin 2022; 60:16-23. [PMID: 35975922 DOI: 10.1097/aia.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Laura S González
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Gallinoro E, Candreva A, Colaiori I, Kodeboina M, Fournier S, Nelis O, Di Gioia G, Sonck J, van 't Veer M, Pijls NH, Collet C, De Bruyne B. Thermodilution-derived volumetric resting coronary blood flow measurement in humans. EUROINTERVENTION 2021; 17:e672-e679. [PMID: 33528358 PMCID: PMC9724906 DOI: 10.4244/eij-d-20-01092] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Quantification of microvascular function requires the measurement of flow and resistance at rest and during hyperaemia. Continuous intracoronary thermodilution accurately measures coronary flow during hyperaemia. AIMS The aim of this study was to investigate whether continuous coronary thermodilution using lower infusion rates also enables volumetric coronary blood flow measurements (in mL/min) at rest. METHODS In 59 patients (88 arteries), the ratio of distal to proximal coronary pressure (Pd/Pa), as well as absolute blood flow (in mL/min) by continuous thermodilution, was recorded using a pressure/temperature guidewire. Saline was infused at rates of 10 and 20 mL/min. In 27 arteries, Doppler average peak velocity (APV) was measured simultaneously. Pd/Pa, APV, thermodilution-derived coronary flow reserve (CFRthermo) and coronary flow velocity reserve (CFVR) were assessed. In 10 arteries, simultaneous recordings were obtained at saline infusion rates of 6, 8, 10 and 20 mL/min. RESULTS Compared to baseline, saline infusion at 10 mL/min did not change Pd/Pa (0.95±0.05 versus 0.94±0.05, p=0.49) or APV (22±8 versus 23±8 cm/s, p=0.60); conversely, an infusion rate of 20 mL/min induced a decrease in Pd/Pa and an increase in APV. Stable thermodilution tracings were obtained during saline infusion at 8 and 10 mL/min, but not at 6 mL/min. Mean values of CFRthermo and CFVR were similar (2.78±0.91 versus 2.76±1.06, p=0.935) and their individual values correlated closely (r=0.89, 95% CI: 0.78-0.95, p<0.001). CONCLUSIONS In addition to hyperaemic flow, continuous thermodilution can quantify absolute resting coronary blood flow; therefore, it can be used to calculate coronary flow reserve and microvascular resistance reserve.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium,Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | - Monika Kodeboina
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium,Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Stephane Fournier
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy,Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Nelis
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Giuseppe Di Gioia
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium,Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium,Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Marcel van 't Veer
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Nico H.J. Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan 164, B-9300 Aalst, Belgium
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Abstract
Right ventricular dysfunction presents unique challenges in patients with cardiopulmonary disease. When optimal medical therapy fails, mechanical circulatory support is considered. Devices can by classified according to whether they are deployed percutaneously or surgically, whether the pump is axial or centrifugal, whether the right ventricle is bypassed directly or indirectly, and whether the support is short term or long term. Each device has advantages and disadvantages. Acute mechanical circulatory support is a suitable temporizing strategy in advanced heart failure. Future research in right ventricular mechanical circulatory support will optimize device management, refine patient selection, and ultimately improve clinical outcomes.
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Affiliation(s)
- Akbarshakh Akhmerov
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, Suite A3105, Los Angeles, CA 90048, USA
| | - Danny Ramzy
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, Suite A3105, Los Angeles, CA 90048, USA.
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7
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Daubenspeck D, González LS, Gerlach RM, Chaney MA. Unique Complications Associated With the Subclavian Intra-Aortic Balloon Pump. J Cardiothorac Vasc Anesth 2020; 35:2212-2222. [PMID: 33485757 DOI: 10.1053/j.jvca.2020.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/25/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Danisa Daubenspeck
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Laura S González
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Rebecca M Gerlach
- Department of Anesthesiology and Critical Care, Preoperative Anesthesia Clinic, University of New Mexico, Albuquerque, NM; Preoperative Anesthesia Clinic, University of New Mexico, Albuquerque, NM
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
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Karaganov KS, Lishuta AS, Belenkov YN. The Use of Enhanced External Counterpulsation in the Treatment of Patients with Coronary Artery Disease. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-08-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Enhanced external counterpulsation (EECP) is one of the most effective and safe non-invasive methods of treatment for patients with coronary artery disease (CAD), including complicated chronic heart failure (CHF). This method of therapeutic neoangiogenesis, used in conjunction with traditional drug therapy and myocardial revascularization, can significantly improve the quality of management of these patients.Aim. To study the effect of the EECP course on exercise tolerance, quality of life, structural and functional parameters of blood vessels in patients with verified stable CAD complicated by CHF.Material and methods. Patients (n=70) with verified stable CAD (angina pectoris class II-III) complicated by CHF class II-III (NYHA) were included in non-randomized uncontrolled study. Data from 67 patients (48 to 74 years old; 47 men and 20 women) were included in the final analysis. All patients had a course of EECP (35 one-hour procedures with a compression pressure of 220-280 mm Hg). All patients initially and 1.5 months after the EECP course had a 6-minute walk test (6MWT), an assessment of the clinical status, quality of life of patients (MLHFQ; Minnesota Living with Heart Failure Questionnaire). Computer nailfold video capillaroscopy, photoplethysmography with pulse wave recording and contour analysis, applanation tonometry to assess central aortic systolic pressure and radial augmentation index (RAI) were performed to assess the structural and functional state of large and microcirculatory vessels.Results. A statistically significant improvement in exercise tolerance (increase in distance in 6MWT from 212 [189; 273] to 308 [251; 336] m), improvement in the clinical status of patients (decrease in points on the rating scale of clinical state from 6.5±1.8 to 4.4±1,2), improvement in the quality of life according to the MLHFQ questionnaire (from 51.9±6.2 to 38.6±7.1), increase in the left ventricle ejection fraction (from 41.6 [36.6;47.1] to 44.8 [39.5;50.7]%) were found. A statistically significant improvement in endothelial function indices of both large vessels (phase shift: from 5.6 [2.4;7.2] to 6.8 [3.3;8] m/s) and microcirculatory vessels (occlusion index: from 1.5 [1.2;1.7] to 1.66 [1.3;1.9]), as well as a decrease in functional disorders of nailfold capillaries (percent of perfused capillaries, capillary network density in the reactive hyperemia test) also were found. But no statistically significant changes in the structural remodeling indices of both large and microcirculatory vessels were found.Conclusion. A positive effect of the EECP course both on the functional status with an increase in exercise tolerance and improvement in the quality of life, and on the functional state of large vessels and microvasculature was found in patients with stable CAD complicated by CHF.
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Affiliation(s)
- K. S. Karaganov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. S. Lishuta
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Y. N. Belenkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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9
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Intraaortic Balloon Pump Counterpulsation, Part I: History, Technical Aspects, Physiologic Effects, Contraindications, Medical Applications/Outcomes. Anesth Analg 2020; 131:776-791. [DOI: 10.1213/ane.0000000000004954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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10
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de Jong MMJ, Parise O, Matteucci F, Tetta C, Maessen JG, Gelsomino S. Superior mesenteric flow pattern during counterpulsation: is simply a shorter balloon the solution for visceral hypoperfusion? Interact Cardiovasc Thorac Surg 2020; 30:121-128. [PMID: 31578569 DOI: 10.1093/icvts/ivz230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/31/2019] [Accepted: 08/11/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We studied the flow pattern in the superior mesenteric artery (SMA) during intra-aortic balloon pump support, comparing 2 intra-aortic balloons of 2 different lengths. METHODS Sixteen Landrace pigs (mean weight 84.0 kg ± 6.0) were used in this study. The animals were randomly assigned to 2 groups: group 1 received an 8-Fr, 40-ml standard balloon; group 2 received an 8-Fr, 40-ml short balloon. SMA flow was measured during early, mid- and telediastole. RESULTS The standard balloon led to a reduction in SMA flow in early diastole (P < 0.001), a negative flow in mid-diastole (P < 0.001) and a reincrease in telediastole (P < 0.001). In contrast, in early diastole a significant reduction was observed with the short balloon (P < 0.001), followed by another drop in mid-diastole (P < 0.001), without reaching negative values and by a telediastolic increase (P < 0.001). SMA flows were comparable between balloons during early diastole (P = 0.66), whereas they were higher with the short balloon during mid (P < 0.001) and telediastole (P = 0.02). Overall, the diastolic area was significantly larger when the short balloon was used (P < 0.001). Finally, during counterpulsation, mesenteric resistances increased significantly (P < 0.001), although, with the short balloon, they were lower than with the standard balloon (P = 0.01). CONCLUSIONS Despite better overall mean mesenteric diastolic flow, the short balloon leads to early- and mid-diastolic flow reduction, although to a lesser extent than the standard intra-aortic balloon pump balloon. Our data are a call for improvement in the design of the short balloon.
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Affiliation(s)
- Monique M J de Jong
- Department of Cardiothoracic Surgery, CARIM-School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
| | - Orlando Parise
- Department of Cardiothoracic Surgery, CARIM-School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
| | - Francesco Matteucci
- Department of Cardiothoracic Surgery, CARIM-School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
| | - Cecilia Tetta
- Department of Cardiothoracic Surgery, CARIM-School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, CARIM-School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, CARIM-School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
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11
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Jansen JRC, B Bastos M, Hanlon P, Van Mieghem NM, Alfieri O, Schreuder JJ. Determination of cardiac output from pulse pressure contour during intra-aortic balloon pumping in patients with low ejection fraction. J Clin Monit Comput 2020; 34:233-243. [PMID: 31089844 PMCID: PMC7080671 DOI: 10.1007/s10877-019-00320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
Evaluation of a new Windkessel model based pulse contour method (WKflow) to calculate stroke volume in patients undergoing intra-aortic balloon pumping (IABP). Preload changes were induced by vena cava occlusions (VCO) in twelve patients undergoing cardiac surgery to vary stroke volume (SV), which was measured by left ventricular conductance volume method (SVlv) and WKflow (SVwf). Twelve VCO series were carried out during IABP assist at a 1:2 ratio and seven VCO series were performed with IABP switched off. Additionally, SVwf was evaluated during nine episodes of severe arrhythmia. VCO's produced marked changes in SV over 10-20 beats. 198 paired data sets of SVlv and SVwf were obtained. Bland-Altman analysis for the difference between SVlv and SVwf during IABP in 1:2 mode showed a bias (accuracy) of 1.04 ± 3.99 ml, precision 10.9% and limits of agreement (LOA) of - 6.94 to 9.02 ml. Without IABP bias was 0.48 ± 4.36 ml, precision 11.6% and LOA of - 8.24 to 9.20 ml. After one thermodilution calibration of SVwf per patient, during IABP the accuracy improved to 0.14 ± 3.07 ml, precision to 8.3% and LOA to - 6.00 to + 6.28 ml. Without IABP the accuracy improved to 0.01 ± 2.71 ml, precision to 7.5% and LOA to - 5.41 to + 5.43 ml. Changes in SVlv and SVwf were directionally concordant in response to VCO's and during severe arrhythmia. (R2 = 0.868). The SVwf and SVlv methods are interchangeable with respect to measuring absolute stroke volume as well as tracking changes in stroke volume. The precision of the non-calibrated WKflow method is about 10% which improved to 7.5% after one calibration per patient.
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Affiliation(s)
- Jos R C Jansen
- Department of Intensive Care Medicine, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Marcelo B Bastos
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Pat Hanlon
- Teleflex Medical/Arrow, Interventional, 16 Elizabeth Dr, Chelmsford, MA, 01824, USA
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - Jan J Schreuder
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132, Milan, Italy
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12
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Kaneko D, Takahashi M, Fukutomi M, Funayama H, Kario K. Additional Use of a 6-Fr Intra-Aortic Balloon Pump on Extracorporeal Membrane Oxygenation Was Effective in a Patient with Cardiogenic Shock with Low Pulse Pressure. Int Heart J 2019; 60:1184-1188. [PMID: 31484860 DOI: 10.1536/ihj.18-643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report the case of a 79-year-old man with acute myocardial infarction caused by left main trunk lesion, who experienced cardiogenic shock during percutaneous coronary intervention (PCI). To reverse the cardiogenic shock, we initiated veno-arterial extra corporeal membrane oxygenation (VA-ECMO) without an intra-aortic balloon pump (IABP) due to the severe tortuosity of the left external iliac artery. Although PCI was successful, arterial pressure monitoring revealed that the pulse pressure was too low to recover from the cardiogenic shock of decreased cardiac contraction function (the left ventricular ejection fraction was 30%). Thus, we decided to use IABP from the brachial artery to improve the hemodynamics. Immediately after the deployment of a 6-Fr IABP system (Takumi) from the left brachial artery, the pulse pressure was restored and finally VA-ECMO was withdrawn from the patient without complications. Although using IABP in combination with VA-ECMO is a reasonable strategy for cardiogenic shock, the effectiveness of this combination remains controversial. In this case, IABP added to VA-ECMO clearly achieved an improvement of pulse pressure and vital signs. Based on this result, monitoring of the pulse waveform is an effective tool to determine whether the concomitant use of IABP with VA-ECMO is indicated. Moreover, when it is difficult to insert IABP from the femoral arteries, the use of a 6-Fr IABP system (Takumi) approaching from the brachial artery should be considered.
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Affiliation(s)
- Daisuke Kaneko
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | - Masao Takahashi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | - Motoki Fukutomi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | - Hiroshi Funayama
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
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13
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van Nunen LX, van 't Veer M, Zimmermann FM, Wijnbergen I, Brueren GRG, Tonino PAL, Aarnoudse WA, Pijls NHJ. Intra-aortic balloon pump counterpulsation in extensive myocardial infarction with persistent ischemia: The SEMPER FI pilot study. Catheter Cardiovasc Interv 2019; 95:128-135. [PMID: 31020797 DOI: 10.1002/ccd.28289] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/25/2019] [Accepted: 04/04/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study aimed to prospectively investigate intra-aortic balloon pump counterpulsation (IABP) support in large myocardial infarction complicated by persistent ischemia after primary percutaneous coronary intervention (PCI). BACKGROUND Use of IABP is suggested to be effective by increasing diastolic aortic pressure, thereby improving coronary blood flow. This can only be expected with exhausted coronary autoregulation, typical in acute myocardial infarction complicated by persistent ischemia. In this situation, augmented diastolic pressure is expected to increase myocardial oxygenation. METHODS One hundred patients with large STEMI complicated by persistent ischemia after primary PCI were randomized to treatment with or without IABP therapy on top of standard care. IABP support was initiated following primary PCI, immediately after inclusion. Primary end point was all-cause mortality, need for (additional) mechanical hemodynamic support, or readmission for heart failure within 6 months. RESULTS Mean age was 63 ± 10 years, 76% were male. Mean systolic and diastolic blood pressure were 120 ± 25 mmHg and 73 ± 17 mmHg. Mean heart rate was 75 ± 18 mmHg. Before PCI, mean summed ST-deviation was 21 ± 8 mm with only minimal ST-resolution after PCI. One patient in the IABP group reached the primary end point versus four patients in the control group (2% vs. 8%; p = 0.16). After primary PCI, resolution of ST-deviation was significantly more pronounced in the IABP group (73 ± 17%) compared to the control group (56 ± 26%; p < 0.01). CONCLUSIONS In this pilot study, in patients with large STEMI and persistent ischemia after primary PCI, use of IABP showed a nonsignificant decrease in mortality, necessity for (additional) mechanical hemodynamic support or readmission for heart failure at 6 months, and resulted in more rapid ST-resolution.
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Affiliation(s)
- Lokien X van Nunen
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marcel van 't Veer
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Frederik M Zimmermann
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Inge Wijnbergen
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Guus R G Brueren
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Wilbert A Aarnoudse
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Intra-aortic Balloon Counterpulsation for High-Risk Percutaneous Coronary Intervention: Defining Coronary Responders. J Cardiovasc Transl Res 2019; 12:299-309. [PMID: 30877563 PMCID: PMC6708049 DOI: 10.1007/s12265-019-09871-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 02/06/2019] [Indexed: 01/09/2023]
Abstract
The effect of intra-aortic balloon counterpulsation (IABC) varies, and it is unknown whether this is due to a heterogeneous coronary physiological response. This study aimed to characterise the coronary and left ventricular (LV) effects of IABC and define responders in terms of their invasive physiology. Twenty-seven patients (LVEF 31 ± 9%) underwent coronary pressure and Doppler flow measurements in the target vessel and acquisition of LV pressure volume loops after IABC supported PCI, with and without IABC assistance. Through coronary wave intensity analysis, perfusion efficiency (PE) was calculated as the proportion of total wave energy comprised of accelerating waves, with responders defined as those with an increase in PE with IABC. The myocardial supply/demand ratio was defined as the ratio between coronary flow and LV pressure volume area (PVA). Responders (44.4%) were more likely to have undergone complex PCI (p = 0.03) with a higher pre-PCI disease burden (p = 0.02) and had lower unassisted mean arterial (87.4 ± 11.0 vs. 77.8 ± 11.6 mmHg, p = 0.04) and distal coronary pressures (88.0 ± 11.0 vs. 71.6 ± 12.4 mmHg, p < 0.001). There was no effect overall of IABC on the myocardial supply/demand ratio (p = 0.34). IABC has minimal effect on demand, but there is marked heterogeneity in the coronary response to IABC, with the greatest response observed in those patients with the most disordered autoregulation.
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15
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Jannati M, Attar A. Intra-aortic balloon pump postcardiac surgery: A literature review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:6. [PMID: 30815019 PMCID: PMC6383337 DOI: 10.4103/jrms.jrms_199_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/05/2018] [Accepted: 10/24/2018] [Indexed: 12/31/2022]
Abstract
Intra-aortic balloon pump (IABP) has been the most commonly used mechanical assist circulatory device in many postcardiotomy low output disorders for decades. Mechanism of IABP is based on its inflation in time of the diastolic pressure in the aortic root resulting increase in the blood and oxygen amount of the coronary artery and its deflation in left ventricular afterload during the systolic period. Prophylactic and postoperative application of IABP has been suggested by researchers, which has been commonly used in high-risk patients undertaking coronary artery bypass grafting surgery or percutaneous coronary intervention. Other researchers put forward the idea of the percutaneous IABP insertion throughout the left axillary artery as a reliable and relatively well-tolerated approach and also as a recovery tool to bridge patients with end-stage heart failure to heart transplantation. The current review was aimed to give further insight into routine IABP application by presenting the basic principles and trends in the incidence, management, role of IABP recovery, and long-lasting mortality outcomes in patients with cardiovascular disorders and discussing previous and current evidence.
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Affiliation(s)
- Mansour Jannati
- Department of Cardiovascular Surgery, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Attar
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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16
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Imamura T, Juricek C, Song T, Ota T, Onsager D, Sarswat N, Kim G, Raikhelkar J, Kalantari S, Sayer G, Burkhoff D, Jeevanandam V, Uriel N. Improvement in Biventricular Cardiac Function After Ambulatory Counterpulsation. J Card Fail 2019; 25:20-26. [DOI: 10.1016/j.cardfail.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 10/29/2018] [Accepted: 11/05/2018] [Indexed: 02/04/2023]
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17
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Zainab A, Tuazon D, Uddin F, Ratnani I. How New Support Devices Change Critical Care Delivery. Methodist Debakey Cardiovasc J 2018; 14:101-109. [PMID: 29977466 DOI: 10.14797/mdcj-14-2-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Mechanical support devices are used to support failing cardiac, respiratory, or both systems. Since Gibbon developed the cardiopulmonary bypass in 1953, collaborative efforts by medical centers, bioengineers, industry, and the National Institutes of Health have led to development of mechanical devices to support heart, lung, or both. These devices are used as a temporary or long-term measures for acute collapse of circulatory system and/or respiratory failure. Patients are managed on these support devices as a bridge to recovery, bridge to long term devices, or bridge to transplant. The progress in development of these devices has improved mortality and quality of life in select groups of patients. Care of these patients requires a multidisciplinary team approach, which includes cardiac surgeons, critical care physicians, cardiologists, pulmonologists, nursing staff, and perfusionists. Using a team approach improves outcomes in these patients.
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Hawranek M, Gierlotka M, Pres D, Zembala M, Gąsior M. Nonroutine Use of Intra-Aortic Balloon Pump in Cardiogenic Shock Complicating Myocardial Infarction With Successful and Unsuccessful Primary Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2018; 11:1885-1893. [DOI: 10.1016/j.jcin.2018.07.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 06/28/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
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19
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Wray S, Lascano E, Negroni J, Cabrera Fischer E. Assessment of Intra-Aortic Counterpulsation in an Animal Model of Heart Failure and Myocardial Ischemia. Artif Organs 2018; 43:E28-E40. [PMID: 30062681 DOI: 10.1111/aor.13340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/25/2018] [Accepted: 07/27/2018] [Indexed: 11/27/2022]
Abstract
The effectiveness of intra-aortic balloon pumping (IABP) is currently evaluated using indirect indexes. The diastolic pressure augmentation is quantified using the subendocardial viability ratio (SEVR) and the DABAC/SABAC index (areas beneath the aortic pressure-time signals during the diastolic and systolic periods, respectively). The SEVR requires invasive recordings of left ventricular pressure; the DABAC/SABAC index may represent an alternative, since it only requires an aortic pressure signal. Nonetheless, it has never been used in an animal model of counterpulsated heart failure and ischemia-reperfusion episode. The aims of this work were: (i) to develop an animal model of heart failure, with a myocardial ischemia-reperfusion episode, treated with IABP during the reperfusion period; (ii) to evaluate the effects of the IABP using the SEVR and DABAC/SABAC indices; and (iii) to assess the relationship between both ratios. Cardiovascular parameters were obtained in anesthetized sheep, in which induced heart failure and ischemia-reperfusion episodes were monitored with and without IABP 1:2. Systolic and diastolic blood pressure signals were assessed in the aorta and in the left ventricle. Values of cardiac output and left ventricular wall thickness signals were obtained. Induction of ischemia and heart failure determined decreases in SEVR and DABAC/SABAC indices with respect to their basal stage (0.807 ± 0.118 vs. 0.601 ± 0.107, P < 0.05 and 1.062 ± 0.136 vs. 0.902 ± 0.161, P < 0.05, respectively). Counterpulsated animals whose myocardial reperfusion was accompanied by heart failure showed a significant improvement of wall thickening fraction along time (R2 = 0.7627, P < 0.001). During counterpulsated heart failure accompanied by myocardial reperfusion, the SEVR was positively correlated with DABAC/SABAC index.
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Affiliation(s)
- Sandra Wray
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería, Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Elena Lascano
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería, Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Jorge Negroni
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería, Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Edmundo Cabrera Fischer
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería, Universidad Favaloro-CONICET, Buenos Aires, Argentina
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20
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Desai SR, Hwang NC. Advances in Left Ventricular Assist Devices and Mechanical Circulatory Support. J Cardiothorac Vasc Anesth 2018. [DOI: 10.1053/j.jvca.2018.01.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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21
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Fernando RJ, Johnson SD, Augoustides JG, Patel PA, Gutsche JT, Ha B, Feinman JW, Weiss SJ, Cheruku S, McCartney SL, Dave N, Fabbro M, Morris BN. The Hostile Thoracic Aorta: Management Considerations for Severe Aortic Atheroma in a Challenging Case of Coronary Artery Bypass Grafting and Mitral Valve Replacement. J Cardiothorac Vasc Anesth 2018; 33:223-231. [PMID: 29685800 DOI: 10.1053/j.jvca.2018.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Sean D Johnson
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bao Ha
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sreekanth Cheruku
- Divisions of Cardiothoracic and Critical Care Anesthesiology, Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Sharon L McCartney
- Divisions of Cardiothoracic and Critical Care Anesthesiology, Department of Anesthesiology, Duke University, Durham, NC
| | - Nisha Dave
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Michael Fabbro
- Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Benjamin N Morris
- Cardiothoracic and Critical Care Sections, Department of Anesthesiology, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
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22
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Esposito M, Bader Y, Pedicini R, Breton C, Mullin A, Kapur NK. The role of acute circulatory support in ST-segment elevation myocardial infarction complicated by cardiogenic shock. Indian Heart J 2017; 69:668-674. [PMID: 29054200 PMCID: PMC5650570 DOI: 10.1016/j.ihj.2017.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 05/05/2017] [Accepted: 05/12/2017] [Indexed: 01/05/2023] Open
Abstract
In the setting of ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock, three primary treatment objectives include providing circulatory support, ventricular unloading, and restoring myocardial perfusion. In addition to primary percutaneous coronary intervention, each of these three objectives can be achieved with appropriate use of an acute mechanical circulatory support (AMCS) pump. Over the past decade, utilization of percutaneously-delivered AMCS devices including the Impella axial-flow catheter, TandemHeart left atrial-to-femoral artery bypass system, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has grown exponentially. In this review, we will discuss the hemodynamic impact of each AMCS device and clinical data surrounding their use in the setting of STEMI complicated by cardiogenic shock.
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Affiliation(s)
- Michele Esposito
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
| | - Yousef Bader
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
| | - Robert Pedicini
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
| | - Catalina Breton
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
| | - Andrew Mullin
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
| | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, United States.
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Affiliation(s)
- Sebastian Nuding
- Department of Medicine III, University Hospital Halle (Saale) of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Karl Werdan
- Department of Medicine III, University Hospital Halle (Saale) of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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24
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MacKay EJ, Patel PA, Gutsche JT, Weiss SJ, Augoustides JG. Contemporary Clinical Niche for Intra-Aortic Balloon Counterpulsation in Perioperative Cardiovascular Practice: An Evidence-Based Review for the Cardiovascular Anesthesiologist. J Cardiothorac Vasc Anesth 2017; 31:309-320. [DOI: 10.1053/j.jvca.2016.07.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Indexed: 01/10/2023]
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25
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Efficacy of Subcutaneous Electrocardiogram Leads for Synchronous Timing During Chronic Counterpulsation Therapy. ASAIO J 2016; 63:134-138. [PMID: 27984317 DOI: 10.1097/mat.0000000000000498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Counterpulsation devices (CPDs) require an accurate, reliable electrocardiogram (ECG) waveform for triggering inflation and deflation. Surface electrodes are for short-term use, and transvenous/epicardial leads require invasive implant procedure. A subcutaneous ECG lead configuration was developed as an alternative approach for long-term use with timing mechanical circulatory support (MCS) devices. In this study, efficacy testing was completed by simultaneously recording ECG waveforms from clinical-grade epicardial (control) and subcutaneous (test) leads in chronic ischemic heart failure calves implanted with CPD for up to 30 days. Sensitivity and specificity of CPD triggering by R-wave detection was quantified for each lead configuration. The subcutaneous leads provided 98.9% positive predictive value and 98.9% sensitivity compared to the epicardial ECG leads. Lead migration (n = 1) and fracture (n = 1) were observed in only 2 of 40 implanted leads, without adversely impacting triggering efficacy due to lead redundancy. These findings demonstrate the efficacy of subcutaneous ECG leads for long-term CPD timing and potential use as an alternative method for MCS device timing.
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26
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The Effect of Intraaortic Balloon Pumping Under Venoarterial Extracorporeal Membrane Oxygenation on Mortality of Cardiogenic Patients. Crit Care Med 2016; 44:1974-1979. [DOI: 10.1097/ccm.0000000000001828] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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27
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Briceno N, Kapur NK, Perera D. Percutaneous mechanical circulatory support: current concepts and future directions. Heart 2016; 102:1494-507. [DOI: 10.1136/heartjnl-2015-308562] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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28
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Tian G, Xiong L, Lin W, Han J, Chen X, Leung TWH, Soo YOY, Wong LKS. External Counterpulsation Reduces Beat-to-Beat Blood Pressure Variability When Augmenting Blood Pressure and Cerebral Blood Flow in Ischemic Stroke. J Clin Neurol 2016; 12:308-15. [PMID: 27095525 PMCID: PMC4960215 DOI: 10.3988/jcn.2016.12.3.308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE External counterpulsation (ECP) is a noninvasive method used to enhance cerebral perfusion by elevating the blood pressure in ischemic stroke. However, the response of the beat-to-beat blood pressure variability (BPV) in ischemic stroke patients during ECP remains unknown. METHODS We enrolled recent ischemic stroke patients and healthy controls. Changes in the blood flow velocities in bilateral middle cerebral arteries and the continuous beat-to-beat blood pressure before, during, and after ECP were monitored. Power spectral analysis revealed that the BPV included oscillations at very low frequency (VLF; <0.04 Hz), low frequency (LF; 0.04-0.15 Hz), and high frequency (HF; 0.15-0.40 Hz), and the total power spectral density (TP; <0.40 Hz) and LF/HF ratio were calculated. RESULTS We found that ECP significantly increased the systolic and diastolic blood pressures in both stroke patients and controls. ECP decreased markedly the systolic and diastolic BPVs at VLF and LF and the TP, and the diastolic BPV at HF when compared with baseline. The decreases in diastolic and systolic BPV reached 37.56% and 23.20%, respectively, at VLF, 21.15% and 12.19% at LF, 8.76% and 16.59% at HF, and 31.92% and 23.62% for the total TP in stroke patients, which did not differ from those in healthy controls. The change in flow velocity on the contralateral side was positively correlated with the total TP systolic BPV change induced by ECP (r=0.312, p=0.035). CONCLUSIONS ECP reduces the beat-to-beat BPV when increasing the blood pressure and cerebral blood flow velocity in ischemic stroke patients. ECP might be able to improve the clinical outcome by decreasing the beat-to-beat BPV in stroke patients, and this should be explored further in future studies.
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Affiliation(s)
- Ge Tian
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Li Xiong
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Wenhua Lin
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jinghao Han
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiangyan Chen
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Wai Hong Leung
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yannie Oi Yan Soo
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Lawrence Ka Sing Wong
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
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Aso S, Matsui H, Fushimi K, Yasunaga H. In-hospital mortality and successful weaning from venoarterial extracorporeal membrane oxygenation: analysis of 5,263 patients using a national inpatient database in Japan. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:80. [PMID: 27044572 PMCID: PMC4820970 DOI: 10.1186/s13054-016-1261-1] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 03/08/2016] [Indexed: 12/05/2022]
Abstract
Background The mortality rate of severely ill patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains unknown because of differences in patient background, clinical settings, and sample sizes between studies. We determined the in-hospital mortality of VA-ECMO patients and the proportion weaned from VA-ECMO using a national inpatient database in Japan. Methods Patients aged ≥19 years who received VA-ECMO during hospitalization for cardiogenic shock, pulmonary embolism, hypothermia, poisoning, or trauma between 1 July 2010 and 31 March 2013 were identified, using The Japanese Diagnosis Procedure Combination national inpatient database. Results The primary outcome was in-hospital mortality and the secondary outcome was the proportion weaned from VA-ECMO. A total of 5263 patients received VA-ECMO during the study period. The majority of patients had cardiogenic shock (n = 4,658). The number of patients weaned from VA-ECMO was 3389 (64.4 %) and in-hospital mortality after weaning from VA-ECMO was 1994 (37.9 %). In-hospital mortality without cardiac arrest in the cardiogenic shock group was significantly lower than that in patients with cardiac arrest (70.5 % vs. 77.1 %, p <0.001). In the multivariable logistic regression including multiple imputation, higher age and greater or smaller body mass index were significantly associated with in-hospital mortality, whereas hospital volume was not associated with such mortality. Conclusions The present nationwide study showed high mortality rates in patients who received VA-ECMO, and in particular in patients with cardiogenic shock and in patients with cardiac arrest. Weaning from VA-ECMO did not necessarily result in survival. Further studies are warranted to clarify risk-adjusted mortality of VA-ECMO using more detailed data on patient background.
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Affiliation(s)
- Shotaro Aso
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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30
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Usefulness of Intra-aortic Balloon Pump Counterpulsation. Am J Cardiol 2016; 117:469-76. [PMID: 26708637 DOI: 10.1016/j.amjcard.2015.10.063] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/30/2015] [Accepted: 10/30/2015] [Indexed: 11/20/2022]
Abstract
Intra-aortic balloon pump (IABP) counterpulsation is the most widely used mechanical circulatory support device because of its ease of use, low complication rate, and fast manner of insertion. Its benefit is still subject of debate, and a considerable gap exists between guidelines and clinical practice. Retrospective nonrandomized studies and animal experiments show benefits of IABP therapy. However, recent large randomized trials do not show benefit of IABP therapy, which has led to a downgrading in the guidelines. In our view, this dichotomy between trials and practice might be the result of insufficient understanding of the prerequisites needed for effective IABP therapy, that is, exhausted autoregulation, and of not including the right patient population in trials. The population included in recent large randomized trials has been heterogeneous, also including patients in whom benefit of IABP could not be expected. The clinical condition in which most benefit is expected, that is persistent ischemia in acute ST-elevation myocardial infarction, is discussed in this review. In conclusion, this review aims to explain the physiological principles needed for effective IABP therapy, to reflect critically on the large randomized trials, and to solve some of the controversies in this field.
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31
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Doll JA, Ohman EM, Patel MR, Milano CA, Rogers JG, Wohns DH, Kapur NK, Rao SV. A team-based approach to patients in cardiogenic shock. Catheter Cardiovasc Interv 2015; 88:424-33. [DOI: 10.1002/ccd.26297] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 10/02/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Jacob A. Doll
- Duke University Medical Center; Durham North Carolina
- the Duke Clinical Research Institute; Durham North Carolina
| | - E. Magnus Ohman
- Duke University Medical Center; Durham North Carolina
- the Duke Clinical Research Institute; Durham North Carolina
| | - Manesh R. Patel
- Duke University Medical Center; Durham North Carolina
- the Duke Clinical Research Institute; Durham North Carolina
| | | | | | | | | | - Sunil V. Rao
- Duke University Medical Center; Durham North Carolina
- the Duke Clinical Research Institute; Durham North Carolina
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32
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Zhang C, Liu X, Wang X, Wang Q, Zhang Y, Ge Z. Efficacy of Enhanced External Counterpulsation in Patients With Chronic Refractory Angina on Canadian Cardiovascular Society (CCS) Angina Class: An Updated Meta-Analysis. Medicine (Baltimore) 2015; 94:e2002. [PMID: 26632696 PMCID: PMC5058965 DOI: 10.1097/md.0000000000002002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A growing number of patients with chronic artery disease suffer from angina, despite the optimal medical management (ie, β-blockers, calcium channel blockers, and long-acting nitrates) and revascularization. Currently, enhanced external counterpulsation (EECP) therapy has been verified as a noninvasive, safe therapy for refractory angina. The study was designed to evaluate the efficacy of EECP in patients with chronic refractory angina according to Canadian Cardiovascular Society (CCS) angina class.We identified systematic literature through MEDLINE, EMBASE, the Cochrane Clinical Trials Register Database, and the ClinicalTrials. gov Website from 1990 to 2015. Studies were considered eligible if they were prospective and reported data on CCS class before and after EECP treatment. Meta-analysis was performed to assess the efficacy of EECP therapy by at least 1 CCS angina class improvement, and proportion along with the 95% confidence interval (CI) was calculated. Statistical heterogeneity was calculated by I statistic and the Q statistic. Sensitivity analysis was addressed to test the influence of trials on the overall pooled results. Subgroup analysis was applied to explore potential reasons for heterogeneity.Eighteen studies were enrolled in our meta-analysis. Pooled analysis showed 85% of patients underwent EECP had a reduction by at least one CCS class (95%CI 0.81-0.88, I = 58.5%, P < 0.001). The proportion of patients enrolled at primarily different studies with chronic heart failure (CHF) improved by at least 1 CCS class was about 84% after EECP (95%CI 0.81-0.88, I = 32.7%, P = 0.1668). After 3 large studies were excluded, the pooled proportion was 82% (95%CI 0.79-0.86, I = 18%, P = 0.2528). Funnel plot indicated that some asymmetry while the Begg and Egger bias statistic showed no publication bias (P = 0.1495 and 0.2859, respectively).Our study confirmed that EECP provided an effective treatment for patients who were unresponsive to medical management and/or invasive therapy. However, the long-term benefits of EECP therapy needed further studies to evaluate in the management of chronic refractory angina.
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Affiliation(s)
- Chunmei Zhang
- From the Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Qilu Hospital of Shandong University, Jinan, Shandong, China
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van Nunen LX, van ’t Veer M, Schampaert S, Rutten MC, van de Vosse FN, Patel MR, Pijls NH. Intra-aortic balloon counterpulsation reduces mortality in large anterior myocardial infarction complicated by persistent ischaemia: a CRISP-AMI substudy. EUROINTERVENTION 2015; 11:286-92. [DOI: 10.4244/eijy14m09_10] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Schampaert S, van Nunen LX, Pijls NHJ, Rutten MCM, van Tuijl S, van de Vosse FN, van ‘t Veer M. Intra-Aortic Balloon Pump Support in the Isolated Beating Porcine Heart in Nonischemic and Ischemic Pump Failure. Artif Organs 2015; 39:931-8. [DOI: 10.1111/aor.12470] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Stéphanie Schampaert
- Department of Biomedical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
- Department of Cardiology; Catharina Hospital Eindhoven; Eindhoven The Netherlands
| | - Lokien X. van Nunen
- Department of Biomedical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
- Department of Cardiology; Catharina Hospital Eindhoven; Eindhoven The Netherlands
| | - Nico H. J. Pijls
- Department of Biomedical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
- Department of Cardiology; Catharina Hospital Eindhoven; Eindhoven The Netherlands
| | - Marcel C. M. Rutten
- Department of Biomedical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
| | | | - Frans N. van de Vosse
- Department of Biomedical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
| | - Marcel van ‘t Veer
- Department of Biomedical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
- Department of Cardiology; Catharina Hospital Eindhoven; Eindhoven The Netherlands
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Kapur NK, Esposito M. Hemodynamic Support with Percutaneous Devices in Patients with Heart Failure. Heart Fail Clin 2015; 11:215-30. [DOI: 10.1016/j.hfc.2014.12.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Diabetic patient with three-vessel disease and left main involvement. Surgery yes, but not always. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2014.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Myat A, Patel N, Tehrani S, Banning AP, Redwood SR, Bhatt DL. Percutaneous Circulatory Assist Devices for High-Risk Coronary Intervention. JACC Cardiovasc Interv 2015; 8:229-244. [DOI: 10.1016/j.jcin.2014.07.030] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/17/2014] [Indexed: 10/24/2022]
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Control of acute phase intestinal bleeding after percutaneous coronary intervention by discontinuing dual antiplatelet therapy and implementing intra-aortic balloon pumping. J Cardiol Cases 2015; 11:113-116. [PMID: 30546544 DOI: 10.1016/j.jccase.2014.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/02/2014] [Accepted: 12/19/2014] [Indexed: 11/20/2022] Open
Abstract
Aspirin's efficacy for the prevention of secondary vascular disease is well supported. However, more attention should be given to its side effects, especially gastrointestinal injury. A 62-year-old man suffered acute myocardial infarction of the left main trunk. Although a percutaneous coronary intervention, using a bare metal stent, was successful, intractable in-bowel bleeding developed. To control the bleeding, we discontinued dual antiplatelet therapy during the acute phase, and used intra-aortic balloon pumping to provide sufficient coronary flow to prevent stent thrombosis. This strategy controlled intestinal bleeding without any thrombotic complications, indicating that intra-aortic balloon pumping is effective for preventing stent thrombosis. <Learning objective: Aspirin often causes bleeding complications, especially in the gastrointestinal tract. We experienced a case with severe intestinal bleeding of unknown origin during the acute phase after percutaneous coronary intervention for acute myocardial infarction. The dual antiplatelet therapy was necessarily stopped, which could have resulted in stent thrombosis. We used intra-aortic balloon pumping to prevent the stent thrombosis through coronary flow augmentation.>.
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39
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Willerson JT, Ferguson JJ, Patel DD. Medical Treatment of Stable Angina. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_17] [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: 11/28/2022]
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40
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White JM, Ruygrok PN. Intra-aortic balloon counterpulsation in contemporary practice - where are we? Heart Lung Circ 2014; 24:335-41. [PMID: 25616681 DOI: 10.1016/j.hlc.2014.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/03/2014] [Accepted: 12/05/2014] [Indexed: 11/18/2022]
Abstract
The intra-aortic balloon pump (IABP) remains the most widely used form of mechanical circulatory support in current clinical practice. This article will review the current evidence to guide IABP use, focussing on large registry and prospective, randomised data, and seek to establish appropriate roles for the IABP in contemporary practice. Despite a paucity of clinical evidence, the IABP remains a useful clinical tool in selected settings, although its routine, up-front use in relatively unselected MI populations is not supported by data. Although current evidence no longer supports routine use in certain high-risk groups, further studies of appropriately selected high-risk patients may yet demonstrate benefit in patients with moderate-severe degrees of shock.
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Affiliation(s)
- Jonathon M White
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Peter N Ruygrok
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; University of Auckland School of Medicine, Auckland, New Zealand.
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41
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Patterson T, Perera D, Redwood SR. Intra-Aortic Balloon Pump for High-Risk Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2014; 7:712-20. [DOI: 10.1161/circinterventions.114.001258] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Tiffany Patterson
- From the Cardiovascular Division, Rayne Institute, British Heart Foundation Centre of Research Excellence, Kings College London, St Thomas’ Hospital, London, UK
| | - Divaka Perera
- From the Cardiovascular Division, Rayne Institute, British Heart Foundation Centre of Research Excellence, Kings College London, St Thomas’ Hospital, London, UK
| | - Simon R. Redwood
- From the Cardiovascular Division, Rayne Institute, British Heart Foundation Centre of Research Excellence, Kings College London, St Thomas’ Hospital, London, UK
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42
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Impact of intra-aortic balloon pump on long-term mortality of unselected patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 10:175-80. [PMID: 25489303 PMCID: PMC4252308 DOI: 10.5114/pwki.2014.45144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 06/17/2014] [Accepted: 07/14/2014] [Indexed: 12/22/2022] Open
Abstract
Introduction A large, randomised trial (IABP-SHOCK II) confirmed no benefit of intra-aortic balloon pump (IABP) on clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock. However, the ‘sickest’ patients are often excluded from randomised clinical trials, so it is difficult to generalise expected outcomes from randomized clinical trials to the real life setting. Aim We sought to evaluate the impact of IABP on 1-year mortality of unselected patients with STEMI presenting in cardiogenic shock. Material and methods Data were gathered for 1,650 consecutive patients with STEMI transferred for primary angioplasty from hospital networks in 7 countries in Europe from November 2005 to January 2007 (the EUROTRANSFER registry population). Of them, 51 patients with cardiogenic shock on admission were identified and stratified based on the use of IABP. Outcome results were adjusted for age and sex, to control possible selection bias. Results At the discretion of the operators, IABP was applied in 30 patients (58.8%, IABP group). The remaining 21 patients were treated without IABP (no-IABP group). The use of IABP was more frequent among males, younger patients, and patients with STEMI of the anterior wall. There was no difference in 30-day mortality in patients with and without IABP (no-IABP vs. IABP: 38.1% vs. 33.3%; adjusted OR 1.79 (95% CI 0.43–7.52); p = 0.43). Similarly, IABP had no impact on 1-year mortality (42.9% vs. 33.3%; adjusted OR 1.27 (95% CI 0.32–5.09); p = 0.74). One-year mortality was comparable among patients who survived hospitalisation (14.3% vs. 13%; p = 0.64). Conclusions We observed no benefit of IABP on short – and long-term mortality of unselected patients with STEMI complicated by cardiogenic shock.
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Rognoni A, Cavallino C, Lupi A, Veia A, Rosso R, Rametta F, Bongo AS. Aortic counterpulsation in cardiogenic shock during acute myocardial infarction. Expert Rev Cardiovasc Ther 2014; 12:913-7. [DOI: 10.1586/14779072.2014.921116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Altayyar S, Rochwerg B, Alnasser S, Al-Omari A, Baw B, Fox-Robichaud A, Alhazzani W. Intra-aortic balloon pump in patients with cardiogenic shock complicating myocardial infarction: a systematic review and meta-analysis of randomized trials (protocol). Syst Rev 2014; 3:24. [PMID: 24620783 PMCID: PMC4008254 DOI: 10.1186/2046-4053-3-24] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 02/25/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cardiogenic shock is the leading cause of death in patients with acute myocardial infarction. Despite significant advancements in health technology and research, hospital mortality approaches 50%. The intra-aortic balloon pump is a mechanical hemodynamic assist device that has been used for over 40 years in the management of patients with cardiogenic shock. A recent randomized trial suggests that the use of intra-aortic balloon pumps does not reduce mortality in patients with ischemic cardiogenic shock. METHODS We plan to search MEDLINE, EMBASE, and the Cochrane Trial Registry for potentially eligible randomized trials that compare the use of intra-aortic balloon pump with no mechanical device support in patients with cardiogenic shock. No date, language or journal limitations will be applied. Two reviewers will independently screen and identify eligible studies using predefined eligibility criteria. Data abstraction will be done independently and in duplicate. We plan to use RevMan software to generate pooled estimates across included studies, using the previously published method of DerSimonian and Laird. We will report pooled estimates as risk ratios with 95% confidence intervals for binary outcomes, and as mean differences with 95% confidence intervals for continuous outcomes. We will assess the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. DISCUSSION The aim of this systematic review and meta-analysis is to summarize the available evidence on the efficacy of the intra-aortic balloon pump in cardiogenic shock. Systematic review registration: PROSPERO CRD42014007056.
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Affiliation(s)
| | | | | | | | | | | | - Waleed Alhazzani
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada.
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Solanki P. Aortic counterpulsation: C-pulse and other devices for cardiac support. J Cardiovasc Transl Res 2014; 7:292-300. [PMID: 24554288 DOI: 10.1007/s12265-014-9548-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 02/04/2014] [Indexed: 01/28/2023]
Abstract
Heart failure is the leading cause of hospitalization in the USA. Despite major advances in the medical and device-related therapy including chronic resynchronization therapy for management of heart failure, significant number of patients eventually require advanced cardiac therapy including mechanical circulatory support or heart transplant. Heart transplant is a gold standard for end-stage heart failure but is limited by the donor heart shortage creating a definite need for alternative effective therapies. The earliest and most common form of mechanical circulatory support is counterpulsation therapy. Annually, more than 150,000 patients worldwide receive counterpulsation therapy for various indications including cardiogenic shock or severe left ventricular dysfunction (Nanas and Moulopoulos in Cardiology, 84:156-167, 1994) and many thousands of lives are saved each year (65 % survival) (Torchiana et al. in Journal of Thoracic and Cardiovascular Surgery, 113(4):758-764, 1997). There are different types of aortic counterpulsation devices. Here, we will give an overview of different counterpulsation devices with focus on C-Pulse device. Extra-aortic balloon counterpulsation, C-Pulse (Sunshine Heart Inc., Eden Prairie, MN), is an important and novel approach in the management of patients with advanced heart failure who remain symptomatic despite optimum medical and device-based therapy. C-Pulse is designed to provide permanent, long-term, continuous partial circulatory support for New York Heart Association class III and ambulatory class IV heart failure patients. C-Pulse is a nonblood-contacting counterpulsation using an inflatable cuff around the ascending aorta, extra-aortic balloon (EAB) counterpulsation device. A pivotal, multicenter US study to assess the safety and efficacy of C- Pulse in patient with Stage C and NYHA Class III or ambulatory Class IV heart failure is in progress.
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Affiliation(s)
- Pallavi Solanki
- Division of Cardiology, Rutgers-New Jersey Medical School, 185 S. Orange Avenue, Newark, NJ, 07103, USA,
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46
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Intra-aortic balloon counterpulsation in acute myocardial infarction: old and emerging indications. Neth Heart J 2013; 21:554-60. [PMID: 24170231 PMCID: PMC3833909 DOI: 10.1007/s12471-013-0485-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Recent evidence questions the role of intra-aortic balloon counterpulsation (IABP) in the treatment of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). An area of increasing interest is the use of IABP for persistent ischaemia (PI). We analysed the use of IABP in patients with AMI complicated by CS or PI. Methods From 2008 to 2010, a total of 4076 patients were admitted to our hospital for primary percutaneous coronary intervention (PCI) for AMI. Out of those, 239 patients received an IABP either because of CS or because of PI. Characteristics and outcome of those patients are investigated. Results The mean age of the study population was 64 ± 11 years; 75 % were male patients. Of the patients, 63 % had CS and 37 % had PI. Patients with CS had a 30-day mortality rate of 36 %; 1-year mortality was 41 %. Patients with PI had a 30-day mortality rate of 7 %; 1-year mortality was 11 %. Conclusions Mortality in patients admitted for primary PCI because of AMI complicated by CS is high despite IABP use. Outcome in patients treated with IABP for PI is favourable and mandates further prospective studies.
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Abstract
Despite advances in coronary revascularization and widespread use of primary percutaneous interventions, cardiogenic shock complicating an acute ST-elevation myocardial infarction (CSMI) remains a clinical challenge with high mortality rates. Conservative management with catecholamines is associated with serious limitations, including arrhythmias, increased myocardial oxygen consumption, and inadequate circulatory support. Clinicians have therefore turned to mechanical means of circulatory support. Circulatory assist systems for CSMI can be distinguished by the method of placement (i.e. percutaneous vs. surgical), the type of circulatory support (i.e. left ventricular, right ventricular, or biventricular pressure and/or volume unloading), and whether they are combined with extracorporal membrane oxygenation (ECMO). The percutaneous assist systems most commonly used in CSMI are the intra-aortic balloon pump (IABP), venoarterial ECMO, the Impella pump, and the TandemHeart. Decades of clinical studies and experience demonstrated haemodynamic improvement, including elevation of diastolic perfusion pressure and cardiac output. Recently, the large randomized IABP-Shock II Trial did not show a significant reduction in 30-day mortality in CSMI with IABP insertion. There are no randomized study data available for ECMO use in CSMI. Both the Impella pump and the TandemHeart did not reduce 30-day mortality when compared with IABP in small randomized controlled trials (RCTs). In conclusion, despite the need for effective mechanical circulatory support in CSMI, current devices, as tested, have not been demonstrated to improve short- or long-term survival rates. RCTs testing the optimal timing of device therapy and optimal device design are needed to improve outcomes in CSMI.
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Affiliation(s)
- Karl Werdan
- Department of Internal Medicine III, Heart Center, Martin-Luther-University Halle-Wittenberg, University Hospital Halle/Saale, Ernst-Grube-Str. 40, Halle/Saale 06120, Germany
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Chen S, Yin Y, Ling Z, Krucoff MW. Short and long term effect of adjunctive intra-aortic balloon pump use for patients undergoing high risk reperfusion therapy: a meta-analysis of 10 international randomised trials. Heart 2013; 100:303-10. [PMID: 23886602 DOI: 10.1136/heartjnl-2013-304198] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Shaojie Chen
- Department of Cardiology, Evidence Based Medicine, The Second Affiliated Hospital of Chongqing Medical University, , Chongqing, China
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Khir AW, Bruti G. Intra-aortic balloon shape change: effects on volume displacement during inflation and deflation. Artif Organs 2013; 37:E88-95. [PMID: 23647572 DOI: 10.1111/aor.12090] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
It has been observed that operating the intra-aortic balloon at an angle to the horizontal resulted in a reduction of the volume displaced toward the coronary arteries and compromised afterload reduction. Therefore, the aim of this work is to examine whether changing the current balloon shape, which has not been altered for 40 years, could compensate for the negative hemodynamic effects due to angulation. We tested two tapered balloons, increasing diameter (TID) and decreasing diameter (TDD), and compared the results with those obtained from a standard cylindrical balloon. The balloons were tested in vitro at 60 beats/min and a static pressure of 90 mm Hg. The balloons were operated at four angles (0°, 20°, 30°, 45°), and the pressure at three locations along the balloon (base, middle, and tip) was also measured. Flow rate upstream of the tip of the balloon was also measured to indicate the flow displaced toward the coronary circulation. The relative volume displaced toward (VUTVi) and suctioned away from (VUTVd) the simulated ascending aorta, during inflation and deflation, respectively, is reduced when a standard cylindrical balloon is operated at an angle to the horizontal. The TDD provided the greatest VUTVi and also produced the largest pulse pressure during deflation. Although the TID provided less VUTVi and VUTVd at smaller angles, it was not markedly affected by the change of angle. According to these results, different balloon shapes analyzed, with comparable volume to that of a cylindrical balloon, produced greater inflation and deflation benefits, at the horizontal and at a range of angles to the horizontal. Further investigations are required to optimize the shape of the tapered balloons to fit into the available physiological space.
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Affiliation(s)
- Ashraf William Khir
- Brunel Institute for Bioengineering, Brunel University, Uxbridge, Middlesex, UK.
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Perera D, Stables R, Clayton T, De Silva K, Lumley M, Clack L, Thomas M, Redwood S. Long-Term Mortality Data From the Balloon Pump–Assisted Coronary Intervention Study (BCIS-1). Circulation 2013; 127:207-12. [DOI: 10.1161/circulationaha.112.132209] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Divaka Perera
- From the Cardiovascular Division, Kings College London, London (D.P., K.D.S., M.L., L.C., M.T., S.R.); Liverpool Heart and Chest Hospital, Liverpool (R.S.); and London School of Hygiene and Tropical Medicine, London (T.C.), UK
| | - Rod Stables
- From the Cardiovascular Division, Kings College London, London (D.P., K.D.S., M.L., L.C., M.T., S.R.); Liverpool Heart and Chest Hospital, Liverpool (R.S.); and London School of Hygiene and Tropical Medicine, London (T.C.), UK
| | - Tim Clayton
- From the Cardiovascular Division, Kings College London, London (D.P., K.D.S., M.L., L.C., M.T., S.R.); Liverpool Heart and Chest Hospital, Liverpool (R.S.); and London School of Hygiene and Tropical Medicine, London (T.C.), UK
| | - Kalpa De Silva
- From the Cardiovascular Division, Kings College London, London (D.P., K.D.S., M.L., L.C., M.T., S.R.); Liverpool Heart and Chest Hospital, Liverpool (R.S.); and London School of Hygiene and Tropical Medicine, London (T.C.), UK
| | - Matthew Lumley
- From the Cardiovascular Division, Kings College London, London (D.P., K.D.S., M.L., L.C., M.T., S.R.); Liverpool Heart and Chest Hospital, Liverpool (R.S.); and London School of Hygiene and Tropical Medicine, London (T.C.), UK
| | - Lucy Clack
- From the Cardiovascular Division, Kings College London, London (D.P., K.D.S., M.L., L.C., M.T., S.R.); Liverpool Heart and Chest Hospital, Liverpool (R.S.); and London School of Hygiene and Tropical Medicine, London (T.C.), UK
| | - Martyn Thomas
- From the Cardiovascular Division, Kings College London, London (D.P., K.D.S., M.L., L.C., M.T., S.R.); Liverpool Heart and Chest Hospital, Liverpool (R.S.); and London School of Hygiene and Tropical Medicine, London (T.C.), UK
| | - Simon Redwood
- From the Cardiovascular Division, Kings College London, London (D.P., K.D.S., M.L., L.C., M.T., S.R.); Liverpool Heart and Chest Hospital, Liverpool (R.S.); and London School of Hygiene and Tropical Medicine, London (T.C.), UK
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