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Vlachakis PK, Theofilis P, Leontsinis I, Drakopoulou M, Karakasis P, Oikonomou E, Chrysohoou C, Tsioufis K, Tousoulis D. Bridge to Life: Current Landscape of Temporary Mechanical Circulatory Support in Heart-Failure-Related Cardiogenic Shock. J Clin Med 2024; 13:4120. [PMID: 39064160 PMCID: PMC11277937 DOI: 10.3390/jcm13144120] [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: 06/01/2024] [Revised: 07/02/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Acute heart failure (HF) presents a significant mortality burden, necessitating continuous therapeutic advancements. Temporary mechanical circulatory support (MCS) is crucial in managing cardiogenic shock (CS) secondary to acute HF, serving as a bridge to recovery or durable support. Currently, MCS options include the Intra-Aortic Balloon Pump (IABP), TandemHeart (TH), Impella, and Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO), each offering unique benefits and risks tailored to patient-specific factors and clinical scenarios. This review examines the clinical implications of recent advancements in temporary MCS, identifies knowledge gaps, and explores promising avenues for future research and clinical application. Understanding each device's unique attributes is crucial for their efficient implementation in various clinical scenarios, ultimately advancing towards intelligent, personalized support strategies.
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Affiliation(s)
- Panayotis K. Vlachakis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.V.); (I.L.); (M.D.); (C.C.); (K.T.); (D.T.)
| | - Panagiotis Theofilis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.V.); (I.L.); (M.D.); (C.C.); (K.T.); (D.T.)
| | - Ioannis Leontsinis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.V.); (I.L.); (M.D.); (C.C.); (K.T.); (D.T.)
| | - Maria Drakopoulou
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.V.); (I.L.); (M.D.); (C.C.); (K.T.); (D.T.)
| | - Paschalis Karakasis
- 2nd Department of Cardiology, “Hippokration” General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Christina Chrysohoou
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.V.); (I.L.); (M.D.); (C.C.); (K.T.); (D.T.)
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.V.); (I.L.); (M.D.); (C.C.); (K.T.); (D.T.)
| | - Dimitris Tousoulis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.V.); (I.L.); (M.D.); (C.C.); (K.T.); (D.T.)
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2
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Inglis SS, Kanwar A, Bonilla HG, Singh S, Pearson JY, Abbas M, Folkens LA, Ou NN, Spencer PJ, Villavicencio MA, Clavell AL, Frantz RP, Rosenbaum AN, Behfar A. Reduction in Balloon Pump Size Reduces Axillary Intraaortic Balloon Pump Failure Risk. ASAIO J 2024:00002480-990000000-00521. [PMID: 38976860 DOI: 10.1097/mat.0000000000002268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
Axillary artery intra-aortic balloon pump (axIABP) placement has been implemented as a bridging solution before heart transplantation. This study evaluates complications associated with axIABP support and describes an approach to minimize adverse events. We previously described a percutaneous approach for axIABP placement. However, patients receiving axIABP between September 1, 2017, and September 26, 2019 (n = 32) demonstrated a high rate of balloon pump malfunction (8/32; 25%) and other complications (totaling 15/32; 47%). Sixty-four patients were sequentially treated under a revised protocol. Compared to the initial cohort, no significant differences in demographics were noted. A significant reduction in rate of balloon malfunction (8/32, 25% vs. 1/64, 2%; p < 0.001) and total complications (15/32, 47% vs. 10/64, 16%; p = 0.0025) during the period of support were noted after intervention. Subsequent analysis of total complications per device size (40 vs. ≤ 34 ml balloon) revealed significantly reduced complications in patients with smaller devices (40% vs. 13%, respectively; p = 0.0022). This study provides guidelines to limit complications in patients supported with axIABP, facilitating a protracted period of bridging support.
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Affiliation(s)
- Sara S Inglis
- From the Department of Cardiovascular Medicine, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, Minnesota
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ardaas Kanwar
- From the Department of Cardiovascular Medicine, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, Minnesota
| | | | - Swaiman Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Mohsin Abbas
- From the Department of Cardiovascular Medicine, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, Minnesota
| | - Lori A Folkens
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Narith N Ou
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Department of Pharmacy Operations, Rochester, Minnesota
| | - Philip J Spencer
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Alfredo L Clavell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robert P Frantz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrew N Rosenbaum
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Adamopoulos S, Bonios M, Ben Gal T, Gustafsson F, Abdelhamid M, Adamo M, Bayes-Genis A, Böhm M, Chioncel O, Cohen-Solal A, Damman K, Di Nora C, Hashmani S, Hill L, Jaarsma T, Jankowska E, Lopatin Y, Masetti M, Mehra MR, Milicic D, Moura B, Mullens W, Nalbantgil S, Panagiotou C, Piepoli M, Rakisheva A, Ristic A, Rivinius R, Savarese G, Thum T, Tocchetti CG, Tops LF, Van Laake LW, Volterrani M, Seferovic P, Coats A, Metra M, Rosano G. Right heart failure with left ventricular assist devices: Preoperative, perioperative and postoperative management strategies. A clinical consensus statement of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2024. [PMID: 38853659 DOI: 10.1002/ejhf.3323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/11/2024] [Accepted: 05/20/2024] [Indexed: 06/11/2024] Open
Abstract
Right heart failure (RHF) following implantation of a left ventricular assist device (LVAD) is a common and potentially serious condition with a wide spectrum of clinical presentations with an unfavourable effect on patient outcomes. Clinical scores that predict the occurrence of right ventricular (RV) failure have included multiple clinical, biochemical, imaging and haemodynamic parameters. However, unless the right ventricle is overtly dysfunctional with end-organ involvement, prediction of RHF post-LVAD implantation is, in most cases, difficult and inaccurate. For these reasons optimization of RV function in every patient is a reasonable practice aiming at preparing the right ventricle for a new and challenging haemodynamic environment after LVAD implantation. To this end, the institution of diuretics, inotropes and even temporary mechanical circulatory support may improve RV function, thereby preparing it for a better adaptation post-LVAD implantation. Furthermore, meticulous management of patients during the perioperative and immediate postoperative period should facilitate identification of RV failure refractory to medication. When RHF occurs late during chronic LVAD support, this is associated with worse long-term outcomes. Careful monitoring of RV function and characterization of the origination deficit should therefore continue throughout the patient's entire follow-up. Despite the useful information provided by the echocardiogram with respect to RV function, right heart catheterization frequently offers additional support for the assessment and optimization of RV function in LVAD-supported patients. In any patient candidate for LVAD therapy, evaluation and treatment of RV function and failure should be assessed in a multidimensional and multidisciplinary manner.
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Affiliation(s)
- Stamatis Adamopoulos
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | - Michael Bonios
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Magdy Abdelhamid
- Faculty of Medicine, Department of Cardiology, Cairo University, Giza, Egypt
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Bayes-Genis
- Heart Failure and Cardiac Regeneration Research Program, Health Sciences Research Institute Germans Trias i Pujol, Barcelona, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Cardiology Service, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Michael Böhm
- Clinic for Internal Medicine III (Cardiology, Intensive Care Medicine and Angiology), Saarland University Medical Center, Homburg, Germany
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof C.C. Iliescu', Bucharest, Romania
- University of Medicine Carol Davila, Bucharest, Romania
| | | | - Kevin Damman
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Concetta Di Nora
- Cardiovascular Department, University of Trieste, Trieste, Italy
| | - Shahrukh Hashmani
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Loreena Hill
- School of Nursing & Midwifery, Queen's University, Belfast, UK
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linköping, Sweden
| | - Ewa Jankowska
- Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland
| | - Yury Lopatin
- Volgograd State Medical University, Regional Cardiology Centre, Volgograd, Russian Federation
| | - Marco Masetti
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mandeep R Mehra
- Center for Advanced Heart Disease, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Davor Milicic
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine & University Hospital Centre Zagreb, Zagreb, Croatia
| | - Brenda Moura
- Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Sanem Nalbantgil
- Cardiology Department, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Chrysoula Panagiotou
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | - Massimo Piepoli
- IRCCS Policlinico San Donato, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Amina Rakisheva
- Scientific Research Institute of Cardiology and Internal Medicine, Almaty, Kazakhstan
| | - Arsen Ristic
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Rasmus Rivinius
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Heidelberg, Germany
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS) and Rebirth Center for Translational Regenerative Therapies, Hannover Medical School, Hannover, Germany
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda W Van Laake
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Serbia Academy of Sciences and Arts, Belgrade, Serbia
| | | | - Marco Metra
- Cardiology. ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe Rosano
- St. George's Hospitals NHS Trust University of London, London, UK
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Kodack E, Patel R, Bonner C, Pantin E. A complication of an axillary intra-aortic balloon pump. J Surg Case Rep 2024; 2024:rjae092. [PMID: 38455981 PMCID: PMC10915356 DOI: 10.1093/jscr/rjae092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/04/2024] [Indexed: 03/09/2024] Open
Abstract
Intra-aortic balloon pumps (IABPs) are used to mechanically temporize a failing heart by decreasing afterload while increasing coronary perfusion pressure of the heart while more definitive treatment is sought. We report a case of a 65-year-old male with nonischemic cardiomyopathy, atrial fibrillation, thyroiditis, and non-Hodgkin lymphoma who presented with worsening heart failure. He underwent a percutaneous placement of a left axillary IABP with seemingly no complications. Approximately 3 weeks post-placement, the patient was taken for a heart transplant when an intraoperative transesophageal echo showed that the IABP was in the aortic arch and ascending aorta, instead of its proper placement in the descending aorta. The patient's arterial line showed waveforms appropriate for an IABP patient, and the patient showed no signs indicative of improper placement. This erroneous placement carried the potential to affect the aortic valve function, injure the aortic intima and/or occlude the aortic arch vessels. .
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Affiliation(s)
- Eileen Kodack
- Department of Anesthesiology and Perioperative Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
| | - Riya Patel
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, United States
| | - Carain Bonner
- Department of Anesthesiology and Perioperative Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
| | - Enrique Pantin
- Department of Anesthesiology and Perioperative Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
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Antonopoulos M, Bonios MJ, Dimopoulos S, Leontiadis E, Gouziouta A, Kogerakis N, Koliopoulou A, Elaiopoulos D, Vlahodimitris I, Chronaki M, Chamogeorgakis T, Drakos SG, Adamopoulos S. Advanced Heart Failure: Therapeutic Options and Challenges in the Evolving Field of Left Ventricular Assist Devices. J Cardiovasc Dev Dis 2024; 11:61. [PMID: 38392275 PMCID: PMC10888700 DOI: 10.3390/jcdd11020061] [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: 01/05/2024] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
Heart Failure is a chronic and progressively deteriorating syndrome that has reached epidemic proportions worldwide. Improved outcomes have been achieved with novel drugs and devices. However, the number of patients refractory to conventional medical therapy is growing. These advanced heart failure patients suffer from severe symptoms and frequent hospitalizations and have a dismal prognosis, with a significant socioeconomic burden in health care systems. Patients in this group may be eligible for advanced heart failure therapies, including heart transplantation and chronic mechanical circulatory support with left ventricular assist devices (LVADs). Heart transplantation remains the treatment of choice for eligible candidates, but the number of transplants worldwide has reached a plateau and is limited by the shortage of donor organs and prolonged wait times. Therefore, LVADs have emerged as an effective and durable form of therapy, and they are currently being used as a bridge to heart transplant, destination lifetime therapy, and cardiac recovery in selected patients. Although this field is evolving rapidly, LVADs are not free of complications, making appropriate patient selection and management by experienced centers imperative for successful therapy. Here, we review current LVAD technology, indications for durable MCS therapy, and strategies for timely referral to advanced heart failure centers before irreversible end-organ abnormalities.
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Affiliation(s)
- Michael Antonopoulos
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Michael J Bonios
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Stavros Dimopoulos
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Evangelos Leontiadis
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Aggeliki Gouziouta
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Nektarios Kogerakis
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Antigone Koliopoulou
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Dimitris Elaiopoulos
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Ioannis Vlahodimitris
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Maria Chronaki
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Themistocles Chamogeorgakis
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Stavros G Drakos
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Stamatis Adamopoulos
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
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Bertolone DT, Paolisso P, Gallinoro E, Belmonte M, Bermpeis K, De Colle C, Esposito G, Caglioni S, Fabbricatore D, Leone A, Valeriano C, Shumkova M, Storozhenko T, Viscusi MM, Botti G, Verstreken S, Morisco C, Barbato E, Bartunek J, Vanderheyden M. Innovative Device-Based Strategies for Managing Acute Decompensated Heart Failure. Curr Probl Cardiol 2023; 48:102023. [PMID: 37553060 DOI: 10.1016/j.cpcardiol.2023.102023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 08/10/2023]
Abstract
Acute decompensated heart failure (ADHF) is a major cause of hospitalizations in older adults, leading to high mortality, morbidity, and healthcare costs. To address the persistent poor outcomes in ADHF, novel device-based approaches targeting specific pathophysiological mechanisms are urgently needed. The recently introduced DRI2P2S classification categorizes these innovative therapies based on their mechanisms. Devices include dilators (increasing venous capacitance), removers (directly removing sodium and water), inotropes (enhancing left ventricular contractility), interstitials (accelerating lymph removal), pushers (increasing renal arterial pressure), pullers (decreasing renal venous pressure), and selective drippers (selective intrarenal drug infusion). Some are tailored for chronic HF, while others focus on the acute setting. Most devices are in early development, necessitating further research to understand mechanisms, assess clinical effectiveness, and ensure safety before routine use in ADHF management. Exploring these innovative device-based strategies may lead to improved outcomes and revolutionize HF treatment in the future.
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Affiliation(s)
- Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy; Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | | | - Cristina De Colle
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | | | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Attilio Leone
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Chiara Valeriano
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | | | | | - Michele Mattia Viscusi
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Giulia Botti
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Carmine Morisco
- Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
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Bae DJ, Willey JZ, Ibeh C, Yuzefpolskaya M, Colombo PC. Stroke and Mechanical Circulatory Support in Adults. Curr Cardiol Rep 2023; 25:1665-1675. [PMID: 37921947 DOI: 10.1007/s11886-023-01985-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE OF THE REVIEW Short-term and durable mechanical circulatory support (MCS) devices represent life-saving interventions for patients with cardiogenic shock and end-stage heart failure. This review will cover the epidemiology, risk factors, and treatment of stroke in this patient population. RECENT FINDINGS Short-term devices such as intra-aortic balloon pump, Impella, TandemHeart, and Venoatrial Extracorporal Membrane Oxygenation, as well as durable continuous-flow left ventricular assist devices (LVADs), improve cardiac output and blood flow to the vital organs. However, MCS use is associated with high rates of complications, including ischemic and hemorrhagic strokes which carry a high risk for death and disability. Improvements in MCS technology have reduced but not eliminated the risk of stroke. Mitigation strategies focus on careful management of anti-thrombotic therapies. While data on therapeutic options for stroke are limited, several case series reported favorable outcomes with thrombectomy for ischemic stroke patients with large vessel occlusions, as well as with reversal of anticoagulation for those with hemorrhagic stroke. Stroke in patients treated with MCS is associated with high morbidity and mortality. Preventive strategies are targeted based on the specific form of MCS. Improvements in the design of the newest generation device have reduced the risk of ischemic stroke, though hemorrhagic stroke remains a serious complication.
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Affiliation(s)
- David J Bae
- Division of Medicine, Center for Advanced Cardiac Care, Columbia University, New York, NY, USA
| | - Joshua Z Willey
- Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Irving Medical Center, New York, NY, 10032, USA.
| | - Chinwe Ibeh
- Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Melana Yuzefpolskaya
- Division of Medicine, Center for Advanced Cardiac Care, Columbia University, New York, NY, USA
| | - Paolo C Colombo
- Division of Medicine, Center for Advanced Cardiac Care, Columbia University, New York, NY, USA
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Corujo Rodriguez A, Richter E, Ibekwe SO, Shah T, Faloye AO. Postcardiotomy Shock Syndrome: A Narrative Review of Perioperative Diagnosis and Management. J Cardiothorac Vasc Anesth 2023; 37:2621-2633. [PMID: 37806929 DOI: 10.1053/j.jvca.2023.09.011] [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: 06/14/2023] [Revised: 08/29/2023] [Accepted: 09/09/2023] [Indexed: 10/10/2023]
Abstract
Postcardiotomy shock (PCS) is generally described as the inability to separate from cardiopulmonary bypass due to ineffective cardiac output after cardiotomy, which is caused by a primary cardiac disorder, resulting in inadequate tissue perfusion. Postcardiotomy shock occurs in 0.5% to 1.5% of contemporary cardiac surgery cases, and is accompanied by an in-hospital mortality of approximately 67%. In the last 2 decades, the incidence of PCS has increased, likely due to the increased age and baseline morbidity of patients requiring cardiac surgery. In this narrative review, the authors discuss the epidemiology and pathophysiology of PCS, the rationale and evidence behind the initiation, continuation, escalation, and discontinuation of mechanical support devices in PCS, and the anesthetic implications.
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Affiliation(s)
| | - Ellen Richter
- Department of Anesthesiology, Emory University, Atlanta, GA
| | | | - Tina Shah
- Department of Anesthesiology, Emory University, Atlanta, GA
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Chen Z, Gao Y, Lin Y. Perspectives and Considerations of IABP in the Era of ECMO for Cardiogenic Shock. Adv Ther 2023; 40:4151-4165. [PMID: 37460921 DOI: 10.1007/s12325-023-02598-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/27/2023] [Indexed: 09/14/2023]
Abstract
The development of mechanical circulatory support (MCS) has been rapid, and its use worldwide in patients with cardiogenic shock is increasingly widespread. However, current statistical data and clinical research do not demonstrate its significant improvement in the patient prognosis. This review focuses on the widely used intra-aortic balloon pumps (IABP) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), analyzing and comparing their characteristics, efficacy, risk of complications, and the current exploration status of left ventricular mechanical unloading. Subsequently, we propose a rational approach to viewing the negative outcomes of current MCS, and look ahead to the future development trends of IABP.
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Affiliation(s)
- Zelin Chen
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Yuping Gao
- Department of Cardiovascular Medicine, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, No. 99, Longcheng Street, Taiyuan, 030032, China.
| | - Yuanyuan Lin
- Department of Cardiovascular Medicine, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, No. 99, Longcheng Street, Taiyuan, 030032, China.
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10
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Singhvi A, Punnen J. Acute mechanical circulatory support for cardiogenic shock in India. Indian J Thorac Cardiovasc Surg 2023; 39:47-62. [PMID: 37525701 PMCID: PMC10387029 DOI: 10.1007/s12055-023-01530-7] [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: 08/24/2022] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 08/02/2023] Open
Abstract
Cardiogenic shock continues to have high morbidity and mortality, despite advances in the field. Temporary mechanical circulatory support (TMCS) devices, if instituted in a timely fashion, can help stabilize critically ill patients with cardiogenic shock from various aetiologies and cardiac arrest, and provide time for organ recovery or till durable support or transplantation can be achieved. Currently, several options for TMCS devices exist. In this review, we discuss indications, contraindications, characteristics of the various available devices, and important issues pertaining to their management.
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Affiliation(s)
- Aditi Singhvi
- Narayana Institute of Cardiac Sciences, Narayana Health, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India
| | - Julius Punnen
- Narayana Institute of Cardiac Sciences, Narayana Health, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India
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11
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Patnaik S, Nathan S, Bui A, Kar B, Gregoric ID, Gilley CB. Impact of structured physical therapy protocol among heart transplant recipients while on intra-aortic balloon pump in the pretransplant period. Artif Organs 2023; 47:198-204. [PMID: 35943826 DOI: 10.1111/aor.14378] [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: 03/30/2021] [Revised: 04/06/2022] [Accepted: 08/02/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Use of prolonged femoral intra-aortic balloon pump support limits the mobility of patients awaiting heart transplant. We assessed the safety and outcomes of a structured, tilting physical therapy protocol in patients supported by intra-aortic balloon pumps while awaiting transplant. METHODS We retrospectively reviewed five years of transplant patients. Eighteen patients received femoral intra-aortic balloon support, a heart transplant, and met all eligibility criteria. We compared complications and outcomes between patients who received the structured, tilting physical therapy (Protocol Group) and those that received standard of care (Control Group). RESULTS Complications were not significantly different between groups. The majority of the Protocol Group were discharged to home (10/12), while half (3/6) of the Control Group were discharged to a rehabilitation facility. Post-transplant length of stay was significantly less in the Protocol Group (median 16 vs. 28 days, p = 0.03). CONCLUSION Despite the small number analyzed, the data indicates that the structured, tilting physical therapy protocol led to a significantly reduced length of stay post-transplantation. Importantly, use of the protocol did not result in access site complications, thrombosis, or arrhythmias in the majority of the patients.
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Affiliation(s)
- Soumya Patnaik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sriram Nathan
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Amanda Bui
- Department of Physical Therapy, Memorial Hermann Hospital-Texas Medical Center, Houston, Texas, USA
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Igor D Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Christa Bauer Gilley
- Department of Physical Therapy, Memorial Hermann Hospital-Texas Medical Center, Houston, Texas, USA
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12
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Baran DA, Jaiswal A, Hennig F, Potapov E. Temporary Mechanical Circulatory Support: Devices, Outcomes and Future Directions. J Heart Lung Transplant 2022; 41:678-691. [DOI: 10.1016/j.healun.2022.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/15/2022] [Accepted: 03/22/2022] [Indexed: 12/22/2022] Open
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13
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Nishida H, Ota T, Onsager D, Grinstein J, Jeevanandam V, Song T. Ten-year, single center experience of ambulatory axillary intra-aortic balloon pump support for heart failure. J Cardiol 2021; 79:611-617. [PMID: 34895789 DOI: 10.1016/j.jjcc.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The axillary intra-aortic balloon pump has an advantage over the femoral intra-aortic balloon pump in terms of mobility. While axillary intra-aortic balloon pump has been widely used recently as a mode of mechanical circulatory support, the number of reported cases is limited. The purpose of this study is to summarize our experience and to evaluate the safety and efficacy of axillary intra-aortic balloon pump support. METHODS Between July 2009 and July 2019, 241 patients underwent axillary intra-aortic balloon pump support for heart failure. The intended therapeutic goals were bridge to heart transplantation (n=146), left ventricular assist device (n=66), and recovery (n=29). Intra-aortic balloon pumps were inserted through a graft sutured onto the axillary artery in 142 patients (58.9%) and percutaneously in 99 patients (41.1%). It was placed from the right axillary artery in 147 patients (61.0%) and left in 94 patients (39.0%). Primary outcome measures of interest included achievement of intended therapeutic goal, hemodynamic data, ambulatory data, intra-aortic balloon pump-related death, and complications. RESULTS Ambulation was possible in 217 patients (90.0%) during support. Hemodynamic parameters improved significantly after axillary intra-aortic balloon pump support. In total, 13 patients (5.4%) died and 10 patients (4.1%) required escalation of mechanical support. There were no deaths directly attributable to intra-aortic balloon pumps. Intra-aortic balloon pump-related stroke occurred in 6 patients (2.5%). Overall, 86.7% were successfully bridged to intended therapy (transplantation 90.4%, left ventricular assist device 90.9%, and recovery 58.6%). CONCLUSIONS Axillary intra-aortic balloon pumps allow most patients to ambulate during support, improve hemodynamics, and lead to the intended goals successfully.
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Affiliation(s)
- Hidefumi Nishida
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
| | - Takeyoshi Ota
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - David Onsager
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Jonathan Grinstein
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | | | - Tae Song
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
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14
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Morici N, Marini C, Sacco A, Tavazzi G, Saia F, Palazzini M, Oliva F, De Ferrari GM, Colombo PC, Kapur NK, Garan AR, Pappalardo F. Intra-aortic balloon pump for acute-on-chronic heart failure complicated by cardiogenic shock. J Card Fail 2021; 28:1202-1216. [PMID: 34774745 DOI: 10.1016/j.cardfail.2021.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 12/22/2022]
Abstract
The Intra-aortic balloon pump (IABP) is widely implanted as temporary mechanical circulatory support for cardiogenic shock (CS). However, its use is declining following the results of the IABP-SHOCK II trial, which failed to show a clinical benefit of IABP in acute coronary syndrome (ACS) related CS. Acute-on-chronic heart failure has become an increasingly recognized, distinct etiology of CS (HF-CS). The pathophysiology of HF-CS differs from ACS-CS, as it typically represents the progression from a state of congestion (with relatively preserved cardiac output) to a low output state with hypoperfusion. The IABP is a "volume displacement pump" that promotes forward flow from a high-capacitance reservoir to low-capacitance vessels, improving peripheral perfusion and decreasing left ventricular afterload in the setting of high filling pressures. The IABP can improve ventricular-vascular coupling and, therefore, myocardial energetics. Additionally, many HF-CS patients are candidates for cardiac replacement therapies (left ventricular assist device or heart transplantation), and, therefore, may benefit from a "bridge" strategy that stabilizes the hemodynamics and end-organ function in preparation for more durable therapies. Notably, the new United Network for Organ Sharing donor heart allocation system has recently prioritized patients on IABP support. This review describes the role of IABP for the treatment of HF-CS. It also briefly discusses new strategies for vascular access as well as a fully implantable versions for a longer duration of support.
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Affiliation(s)
- Nuccia Morici
- Cardiac Intensive Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy..
| | - Claudia Marini
- S.C. Cardiologia, Polo San Carlo Borromeo, ASST Santi Paolo e Carlo, Milano; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alice Sacco
- Cardiac Intensive Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia Italy; Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Anestesia e Rianimazione I, Pavia, Italy; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Matteo Palazzini
- Cardiac Intensive Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; School of Medicine and Surgery, Università degli Studi Milano-Bicocca, Milan, Italy; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabrizio Oliva
- Cardiac Intensive Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gaetano Maria De Ferrari
- Dept of Cardiology OU Città della Salute e della Scienza di Torino, Dept of Medical Sciences, University of Torino, Torino, Italy; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University Medical Center-New York Presbyterian, NewYork, USA; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Navin K Kapur
- Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, USA; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Arthur Reshad Garan
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Federico Pappalardo
- School of Medicine and Surgery, Università degli Studi Milano-Bicocca, Milan, Italy; Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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15
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Baldetti L, Pagnesi M, Gramegna M, Belletti A, Beneduce A, Pazzanese V, Calvo F, Sacchi S, Van Mieghem NM, den Uil CA, Metra M, Cappelletti AM. Intra-Aortic Balloon Pumping in Acute Decompensated Heart Failure With Hypoperfusion: From Pathophysiology to Clinical Practice. Circ Heart Fail 2021; 14:e008527. [PMID: 34706550 DOI: 10.1161/circheartfailure.121.008527] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Trials on intra-aortic balloon pump (IABP) use in cardiogenic shock related to acute myocardial infarction have shown disappointing results. The role of IABP in cardiogenic shock treatment remains unclear, and new (potentially more potent) mechanical circulatory supports with arguably larger device profile are emerging. A reappraisal of the physiological premises of intra-aortic counterpulsation may underpin the rationale to maintain IABP as a valuable therapeutic option for patients with acute decompensated heart failure and tissue hypoperfusion. Several pathophysiological features differ between myocardial infarction- and acute decompensated heart failure-related hypoperfusion, encompassing cardiogenic shock severity, filling status, systemic vascular resistances rise, and adaptation to chronic (if preexisting) left ventricular dysfunction. IABP combines a more substantial effect on left ventricular afterload with a modest increase in cardiac output and would therefore be most suitable in clinical scenarios characterized by a disproportionate increase in afterload without profound hemodynamic compromise. The acute decompensated heart failure syndrome is characterized by exquisite afterload-sensitivity of cardiac output and may be an ideal setting for counterpulsation. Several hemodynamic variables have been shown to predict response to IABP within this scenario, potentially guiding appropriate patient selection. Finally, acute decompensated heart failure with hypoperfusion may frequently represent an end stage in the heart failure history: IABP may provide sufficient hemodynamic support and prompt end-organ function recovery in view of more definitive heart replacement therapies while preserving ambulation when used with a transaxillary approach.
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Affiliation(s)
- Luca Baldetti
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Matteo Pagnesi
- Department of Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M.P., M.M.)
| | - Mario Gramegna
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Alessandro Belletti
- Cardiac Intensive Care Unit, Department of Anesthesia and Intensive Care (A. Belletti)
| | | | - Vittorio Pazzanese
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Francesco Calvo
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Stefania Sacchi
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Nicolas M Van Mieghem
- Department of Cardiology and Intensive Care Medicine, Thoraxcenter, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (N.M.V.M., C.A.d.U.)
| | - Corstiaan A den Uil
- Department of Cardiology and Intensive Care Medicine, Thoraxcenter, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (N.M.V.M., C.A.d.U.).,Department of Intensive Care Medicine, Maasstad Hospital, Rotterdam, the Netherlands (C.A.d.U.)
| | - Marco Metra
- Department of Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M.P., M.M.)
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16
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Safety and Feasibility of an Early Mobilization Protocol for Patients with Femoral Intra-Aortic Balloon Pumps as Bridge to Heart Transplant. ASAIO J 2021; 68:714-720. [PMID: 34380951 DOI: 10.1097/mat.0000000000001557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Intra-aortic balloon pumps (IABPs) can be used to provide hemodynamic support in patients with end-stage heart failure as a bridge to transplantation (BTT). The IABP is commonly inserted via the common femoral artery, which can limit patients' mobility. The Ramsey protocol, developed by a critical care physical therapist, allows patients with femoral IABPs to ambulate with the assistance of a tilt table. The aim of this study was to determine the safety and feasibility of a modified Ramsey protocol for early mobilization of patients with femoral IABPs as BTT. This is a retrospective single-center review of patients with femoral IABPs as BTT using a tilt table protocol from May 2019 to May 2020. Primary outcomes were time to successful ambulation, number of successful ambulation events, and ambulation-associated adverse events, including IABP augmentation, waveform, positioning changes, and vascular complications at the insertion site. Twenty-four patients (mean age 55 ± 16 years) underwent femoral IABP insertion as BTT and were mobilized following our protocol. Nineteen patients (79.2%) successfully ambulated with a median of three sessions (interquartile range, 2-4) per patient. The median time from IABP insertion to ambulation was 3 days (interquartile range, 2-5). Twenty-one patients underwent heart transplantation, of which all 19 who ambulated were successfully bridged to transplantation. Early mobilization in select patients with femoral IABPs can be performed safely and successfully, avoiding the deleterious effects of bed rest that have been historically seen in this patient population.
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17
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Brown MA, Sheikh FH, Ahmed S, Najjar SS, Molina EJ. Intra-Aortic Balloon Pump as a Bridge to Durable Left Ventricular Assist Device. J Am Heart Assoc 2021; 10:e019376. [PMID: 34308683 PMCID: PMC8475697 DOI: 10.1161/jaha.120.019376] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Left ventricular assist devices (LVAD) are increasingly being used as destination therapy in patients with Stage D heart failure. It has been reported that a majority of patients who receive a durable LVAD (dLVAD) present in cardiogenic shock due to decompensated heart failure (ADHF‐CS). As it stands, there is no consensus on the optimal management strategy for patients presenting with ADHF. Bridging with intra‐aortic balloon pumps (IABPs) continues to be a therapeutic option in patients with hemodynamic instability due to cardiogenic shock. The majority of data regarding the use of IABP in cardiogenic shock come from studies in patients presenting with acute myocardial infarction with cardiogenic shock and demonstrates that there is no benefit of routine IABP use in this patient population. However, the role of IABPs as a bridge to dLVAD in ADHF‐CS has yet to be determined. The hemodynamic changes seen in acute myocardial infarction with cardiogenic shock are known to be different and more acutely impaired than those presenting with ADHF‐CS as evidenced by differences in pressure/volume loops. Thus, data should not be extrapolated across these 2 very different disease processes. The aim of this review is to describe results from contemporary studies examining the use of IABPs as a bridge to dLVAD in patients with ADHF‐CS. Retrospective evidence from large registries suggests that the use of IABP as a bridge to dLVAD is feasible and safe when compared with other platforms of temporary mechanical circulatory support. However, there is currently a paucity of high‐quality evidence examining this increasingly important clinical question.
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Affiliation(s)
| | - Farooq H Sheikh
- Georgetown University School of Medicine Washington DC.,MedStar Washington Hospital Center Washington DC.,MedStar Heart and Vascular Institute Washington DC
| | - Sara Ahmed
- MedStar Washington Hospital Center Washington DC
| | - Samer S Najjar
- Georgetown University School of Medicine Washington DC.,MedStar Washington Hospital Center Washington DC.,MedStar Heart and Vascular Institute Washington DC
| | - Ezequiel J Molina
- Georgetown University School of Medicine Washington DC.,MedStar Washington Hospital Center Washington DC.,MedStar Heart and Vascular Institute Washington DC
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18
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Percutaneous Axillary Intra-aortic Balloon Pump Insertion Technique as Bridge to Advanced Heart Failure Therapy. ASAIO J 2021; 67:e81-e85. [PMID: 33770002 DOI: 10.1097/mat.0000000000001259] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In patients with advanced heart failure (HF), temporary mechanical circulator support (TMCS) is used to improve hemodynamics, via left ventricular unloading, and end-organ function as a bridge to definitive therapy. While listed for cardiac transplantation, use of TMCS may be prolonged, preventing adequate mobility. Here, we describe the technique for placement of a percutaneous axillary intra-aortic balloon pump (IABP) using single-site arterial access to facilitate ambulation and subsequent safe removal without surgery or a closure device. Retrospective review of the experience with this approach at a single institution between September 2017 and February 2020 documented feasibility and safety. Baseline demographics, hemodynamic data, and clinical outcomes were collected. Thirty-eight patients had a total of 56 IABPs placed. There were no significant access site or cerebrovascular complications. One fifth of IABPs (21.4%) had balloon failure or migration, requiring placement of a new device, though no patients had significant complications from balloon failure. The majority (81.6%) of patients in the cohort on axillary IABP support were ambulatory and ultimately received the intended therapy (63.2% transplant, 13.2% durable left ventricular assist device, 5.3% other cardiac surgery). Percutaneous, axillary IABP is feasible and associated with an acceptable complication rate as a bridge to definitive therapy.
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19
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Kimman JR, Van Mieghem NM, Endeman H, Brugts JJ, Constantinescu AA, Manintveld OC, Dubois EA, den Uil CA. Mechanical Support in Early Cardiogenic Shock: What Is the Role of Intra-aortic Balloon Counterpulsation? Curr Heart Fail Rep 2021; 17:247-260. [PMID: 32870448 PMCID: PMC7496039 DOI: 10.1007/s11897-020-00480-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Purpose of Review We aim to summarize recent insights and provide an up-to-date overview on the role of intra-aortic balloon pump (IABP) counterpulsation in cardiogenic shock (CS). Recent Findings In the largest randomized controlled trial (RCT) of patients with CS after acute myocardial infarction (AMICS), IABP did not lower mortality. However, recent data suggest a role for IABP in patients who have persistent ischemia after revascularization. Moreover, in the growing population of CS not caused by acute coronary syndrome (ACS), multiple retrospective studies and one small RCT report on significant hemodynamic improvement following (early) initiation of IABP support, which allowed bridging of most patients to recovery or definitive therapies like heart transplant or a left ventricular assist device (LVAD). Summary Routine use of IABP in patients with AMICS is not recommended, but many patients with CS either from ischemic or non-ischemic cause may benefit from IABP at least for hemodynamic improvement in the short term. There is a need for a larger RCT regarding the role of IABP in selected patients with ACS, as well as in patients with non-ACS CS.
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Affiliation(s)
- Jesse R Kimman
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Henrik Endeman
- Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Eric A Dubois
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Corstiaan A den Uil
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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20
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Arora S, Atreya AR, Birati EY, Shore S. Temporary Mechanical Circulatory Support as a Bridge to Heart Transplant or Durable Left Ventricular Assist Device. Interv Cardiol Clin 2021; 10:235-249. [PMID: 33745672 DOI: 10.1016/j.iccl.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Advanced heart failure refractory to medical therapy can result in patients presenting with progressively worsening hypoperfusion and cardiogenic shock. Temporary mechanical circulatory support is often necessary as a bridge to heart transplant or durable ventricular assist devices. These devices increase cardiac output. Several options are available for left ventricular support. With the exception of venoarterial extracorporeal membrane oxygenation, all other devices decrease left ventricular end-diastolic pressure. The choice of device should be driven by patient needs and the treating teams comfort. Timely identification of cardiogenic shock and use of shock teams are potential strategies that can help improve survival.
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Affiliation(s)
- Sonali Arora
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences Hospitals, 1-8-31/1, Minister Road, Krishna Nagar Colony, Secunderabad, Telangana 500003, India
| | - Auras R Atreya
- Interventional Cardiology, AIG Institute of Cardiac Sciences and Research, 1, Mindspace Road, Gachibowli, Hyderabad, Telangana 500032, India
| | - Edo Y Birati
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Division of Cardiovascular Medicine, Poriya Medical Center, Israel 152801; Perelman Center for Advanced Medicine, 11th Floor, South Tower, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Supriya Shore
- Department of Internal Medicine, Division of Cardiovascular Disease, University of Michigan, Ann Arbor, MI 48103, USA; University of Michigan, North Campus Research Complex, 2800 Plymouth Road, 16-169C, Ann Arbor, MI 48109, USA.
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21
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Ramirez-Ramos CF, Aranzazu-Uribe M, Pamplona A, Gallego-Muñoz C, Uribe-Molano JD, Muñoz Sierra JG, Vanegas-Cardona DM, Tenorio-Mejia CA, Eusse-Gomez CA, Uribe-Londoño CE. [Intra-aortic balloon counterpulsation placed through the subclavian artery as a bridge to heart transplantation. Case report]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2021; 2:135-140. [PMID: 37727800 PMCID: PMC10506553 DOI: 10.47487/apcyccv.v2i2.134] [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: 04/18/2021] [Accepted: 05/19/2021] [Indexed: 09/21/2023]
Abstract
Advanced heart failure is a major health problem for which heart transplantation or left ventricular assist devices are the only effective treatments. Intra-aortic balloon pump inserted using femoral artery access as a bridge to heart transplantation is still frequently used, but has the disadvantage of limiting the patient's movements, hence exposing him or her to the hazards of immobility and threatening the success of the procedure or hindering recovery. Access through the subclavian artery has become an attractive alternative since it doesn't impair the patient's mobility, and there is increasing evidence supporting its use. We present the first case of subclavian counterpulsation balloon implantation in a cardiovascular care center in Colombia.
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Affiliation(s)
- Cristhian Felipe Ramirez-Ramos
- Departamento de Cardiología Clínica, Clínica CardioVID y Universidad Pontificia Bolivariana. Medellín, Colombia. Universidad Pontificia BolivarianaDepartamento de Cardiología ClínicaClínica CardioVID y Universidad Pontificia BolivarianaMedellínColombia
| | - Mateo Aranzazu-Uribe
- Departamento de Medicina Interna, Universidad Pontificia Bolivariana. Medellín, Colombia. Médico.Universidad Pontificia BolivarianaDepartamento de Medicina InternaUniversidad Pontificia BolivarianaMedellínColombia
| | - Alejandra Pamplona
- Servicio de Urgencias Cardiovasculares, Clínica CardioVID. Medellín, Colombia. Servicio de Urgencias CardiovascularesClínica CardioVIDMedellínColombia
| | - Catalina Gallego-Muñoz
- Departamento de Cardiología Clínica, Cuidado Intensivo Coronario y Falla Cardiaca, Clínica CardioVID y Universidad Pontificia Bolivariana. Medellín, Colombia. Universidad Pontificia BolivarianaDepartamento de Cardiología ClínicaCuidado Intensivo Coronario y Falla CardiacaClínica CardioVID y Universidad Pontificia BolivarianaMedellínColombia
| | - Juan David Uribe-Molano
- Departamento de medicina critica y cuidado intensivo cardiovascular, Clìnica cardiioVID. Departamento de medicina critica y cuidado intensivo cardiovascularClìnica cardiioVID
| | - Juan Gonzalo Muñoz Sierra
- Departamento de Radiología Intervencionista y Neuro-radiología, Clínica CardioVID. Medellín, Colombia. Departamento de Radiología Intervencionista y Neuro-radiologíaClínica CardioVIDMedellínColombia
| | - Diego Mauricio Vanegas-Cardona
- Departamento de Cardiología Intervencionista y Hemodinámica Cardiovascular. Clínica CardioVID. Medellín, Colombia. Departamento de Cardiología Intervencionista y Hemodinámica CardiovascularClínica CardioVIDMedellínColombia
| | - Carlos Alberto Tenorio-Mejia
- Departamento de Cardiología Intervencionista y Hemodinámica Cardiovascular. Clínica CardioVID. Medellín, Colombia. Departamento de Cardiología Intervencionista y Hemodinámica CardiovascularClínica CardioVIDMedellínColombia
| | - Carlos Alberto Eusse-Gomez
- Departamento de Cardiología Intervencionista y Hemodinámica Cardiovascular. Clínica CardioVID. Medellín, Colombia. Departamento de Cardiología Intervencionista y Hemodinámica CardiovascularClínica CardioVIDMedellínColombia
| | - Carlos Esteban Uribe-Londoño
- Departamento de Cardiología Intervencionista y Hemodinámica Cardiovascular. Clínica CardioVID. Medellín, Colombia. Departamento de Cardiología Intervencionista y Hemodinámica CardiovascularClínica CardioVIDMedellínColombia
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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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23
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Symalla T, Jeevanandam V. An ambulatory counterpulsation system-a potential option for extended mechanical support. Indian J Thorac Cardiovasc Surg 2020; 36:275-278. [PMID: 33061211 DOI: 10.1007/s12055-019-00887-y] [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: 08/30/2019] [Revised: 09/26/2019] [Accepted: 09/29/2019] [Indexed: 01/14/2023] Open
Abstract
As the incidence of heart failure increases, an organ shortage for cardiac transplant worsens. There has been development of both short and long-term mechanical circulatory devices for this population, each with unique advantages and different adverse event profiles. The long-term devices provide excellent mechanical circulatory support but are associated with significant morbidity. The intravascular ventricular assist system (iVAS) is a minimally invasive, ambulatory, counterpulsation heart assist system developed to provide long-term support for patients with advanced heart failure while avoiding the surgical trauma of a left ventricular assist device and minimizing the risks of infection and hemocompatibility-related adverse events. Initial experience with the iVAS shows promising evidence for its use as a long-term mechanical circulatory support device.
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Affiliation(s)
- Trever Symalla
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave., Rm. E-500, MC5040, Chicago, IL 60637 USA
| | - Valluvan Jeevanandam
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave., Rm. E-500, MC5040, Chicago, IL 60637 USA
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24
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Seliem A, Hall SA. The New Era of Cardiogenic Shock: Progress in Mechanical Circulatory Support. Curr Heart Fail Rep 2020; 17:325-332. [DOI: 10.1007/s11897-020-00490-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
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25
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Nishida H, Koda Y, Kalantari S, Nguyen A, Chung B, Grinstein J, Kim G, Sarswat N, Smith B, Song T, Onsager D, Jeevanandam V, Ota T. Outcomes of Ambulatory Axillary Intraaortic Balloon Pump as a Bridge to Heart Transplantation. Ann Thorac Surg 2020; 111:1264-1270. [PMID: 32882197 DOI: 10.1016/j.athoracsur.2020.06.077] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The axillary intraaortic balloon pump (IABP) is frequently used in selected patients for circulatory support as a bridge to heart transplantation. The purpose of this study was to investigate the safety and efficacy of axillary intraaortic balloon pump (IABP) support for heart transplant candidates. METHODS The study investigators collected data on 133 patients who underwent axillary IABP support as a bridge to transplantation from July 2009 to April 2019. Of these patients, 94 (70.7%) underwent IABP insertion with surgical axillary grafts, and 39 (29.3%) underwent percutaneous IABP insertion. The outcomes of interest included ambulatory data, IABP-related complications, and successful heart transplantation with this type of support. RESULTS The overall preoperative ejection fraction was 20.3% ± 8.0%. The median duration of axillary IABP support was 21days, with 131patients (98.5%) mobilizing with the device. Hemodynamic variables significantly improved after the axillary IABP support was placed. Overall, 122 patients (91.7%) were successfully bridged to heart transplantation. Six patients (4.5%) required escalation to further mechanical support. Two patients (1.5%) died while awaiting transplantation. Four patients (3.0%) experienced a stroke during axillary IABP support (3 before transplantation and1 after transplantation). Two of the 3 patients with a stroke diagnosis before transplantation recovered and eventually underwent heart transplantation. CONCLUSIONS With axillary IABP support, most patients were able to ambulate and undergo physical rehabilitation while waiting for heart transplantation. This study demonstrates that axillary IABP results in a high success rate of bridge to transplantation and a low number of complications. Thus, an ambulatory axillary IABP provided efficient and safe support for selected patients as a bridge to heart transplantation.
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Affiliation(s)
- Hidefumi Nishida
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Yojiro Koda
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Sara Kalantari
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Ann Nguyen
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Bow Chung
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Jonathan Grinstein
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Gene Kim
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Nitasha Sarswat
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Bryan Smith
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Tae Song
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - David Onsager
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | | | - Takeyoshi Ota
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
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26
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Kothari P, Ellis J, Pretorius VG, Khoche S. The Risk of Malposition: A Tale of Two Devices. J Cardiothorac Vasc Anesth 2020; 35:963-966. [PMID: 32758408 DOI: 10.1053/j.jvca.2020.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Perin Kothari
- University of California, San Diego, UCSD Medical Center, La Jolla, CA
| | - Jonathan Ellis
- University of California, San Diego, UCSD Medical Center, La Jolla, CA
| | | | - Swapnil Khoche
- University of California, San Diego, UCSD Medical Center, La Jolla, CA
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27
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Wong ASK, Sin SWC. Short-term mechanical circulatory support (intra-aortic balloon pump, Impella, extracorporeal membrane oxygenation, TandemHeart): a review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:829. [PMID: 32793674 PMCID: PMC7396256 DOI: 10.21037/atm-20-2171] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Cardiogenic shock remains a major cause of morbidity and mortality for patients with acute myocardial infarction and advanced heart failure. Intra-aortic balloon pump has been the most widely used short-term mechanical circulatory support device to rapidly stabilize hemodynamics. However, it provides modest support, current evidence does not show a decrease in mortality, and the latest guidelines no longer recommend its routine use. Several percutaneous mechanical circulatory support devices have been introduced into clinical practice (Impella, extracorporeal membrane oxygen, TandemHeart), providing a greater level of hemodynamic support. These resource-intensive devices demand a careful selection of patients that stand to benefit the most. Premature initiation of mechanical circulatory support exposes the patient to unnecessary risk, whereas delaying therapy leads to irreversible end-organ injury, rendering any intervention medically futile. Cannulation methods, pump designs, and circuit configurations differ between devices, as do the adverse effects and physiological impact on the myocardium, which needs to be factored into consideration before deployment on the patient in cardiogenic shock. This article will review the commonly used percutaneous mechanical circulatory support devices in the setting of cardiogenic shock, compare their advantages and disadvantages, evaluate key clinical trials, and discuss a practical approach to guide clinicians’ decision and management.
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Affiliation(s)
- Alfred S K Wong
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China
| | - Simon W C Sin
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China.,Department of Anaesthesiology, The University of Hong Kong, Hong Kong, China
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28
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Salna M, Abrams D, Brodie D. Physical rehabilitation in the awake patient receiving extracorporeal circulatory or gas exchange support. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:834. [PMID: 32793679 PMCID: PMC7396238 DOI: 10.21037/atm.2020.03.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intensive care unit (ICU)-acquired weakness is a common and serious sequela of critical illness. There is a growing body of evidence supporting the use of early mobilization in the ICU to mitigate this adverse effect. Recent data suggest that such a strategy may be feasible in patients with the most severe forms of cardiopulmonary failure—those requiring temporary mechanical circulatory support (TCS) or extracorporeal life support (ECLS). Both the modality of mechanical support and patient-specific characteristics must be taken into consideration when determining the appropriateness of an early mobilization strategy. The purpose of this review is to explore the current understanding of and evidence for mobilization and rehabilitation of patients receiving TCS or ECLS, including the identification of factors that may predict greater success for early mobilization and potential risks and contraindications to active physical therapy. While it is not yet known which of these patients are most likely to benefit from physical rehabilitation, a common theme is the importance of an interprofessional team approach to ensure patient safety and maximize the likelihood of successful mobilization.
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Affiliation(s)
- Michael Salna
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
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29
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Fujino T, Imamura T, Kinugawa K. Future Perspectives of Intra-Aortic Balloon Pumping for Cardiogenic Shock. Int Heart J 2020; 61:424-428. [DOI: 10.1536/ihj.20-004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Takeo Fujino
- Department of Medicine, Section of Cardiology, University of Chicago Medicine
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30
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Uriel N, Jeevanandam V, Imamura T, Onsager D, Song T, Ota T, Juricek C, Combs P, Lammy T, Patel-Raman S, Woolley JR, Sayer G, Milano C, Schroder J, Molina E, Grinstein J, Suarez E, Estep JD, Aggarwal S, Silvestry S, Raval N. Clinical Outcomes and Quality of Life With an Ambulatory Counterpulsation Pump in Advanced Heart Failure Patients. Circ Heart Fail 2020; 13:e006666. [DOI: 10.1161/circheartfailure.119.006666] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The NuPulseCV intravascular ventricular assist system (iVAS) provides extended duration ambulatory counterpulsation via a durable pump placed through the distal subclavian artery.
Methods:
We performed a prospective, single-arm, multicenter, US Food and Drug Administration-approved feasibility trial of iVAS therapy as a bridge to transplant or decision following the FIH (First-In-Human) trial.
Results:
Forty-seven patients were enrolled, and 45 patients (median 61 years old, 37 males, and 30 listed on United Network of Organ Sharing) received iVAS support for median 44 (25–87) days. There were no intraoperative complications. Success was defined as survival or transplant on iVAS therapy free from disabling stroke. Outcome success at 30 days (the primary end point of this study) and at 6 months was 89% and 80%, respectively. During 6 months of iVAS support, 2 patients died and 2 patients experienced disabling neurological dysfunction. Six-minute walk distance, 2-minute step test, and Kansas City Cardiomyopathy Questionnaire score improved during 4-week iVAS support.
Conclusions:
This feasibility trial demonstrated promising short-term outcomes of iVAS therapy with improved functional capacity and quality of life during the therapy.
Registration:
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02645539.
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Affiliation(s)
- Nir Uriel
- Division of Cardiology, Columbia University Medical Center, New York, NY (N.U., G.S.)
| | - Valluvan Jeevanandam
- Department of Surgery, University of Chicago Medical Center, IL (V.J., T.I., D.O., T.S., T.O., C.J., P.C., T.L.)
| | - Teruhiko Imamura
- Department of Surgery, University of Chicago Medical Center, IL (V.J., T.I., D.O., T.S., T.O., C.J., P.C., T.L.)
- Second Department of Medicine, University of Toyama, Japan (T.I.)
| | - David Onsager
- Department of Surgery, University of Chicago Medical Center, IL (V.J., T.I., D.O., T.S., T.O., C.J., P.C., T.L.)
| | - Tae Song
- Department of Surgery, University of Chicago Medical Center, IL (V.J., T.I., D.O., T.S., T.O., C.J., P.C., T.L.)
| | - Takeyoshi Ota
- Department of Surgery, University of Chicago Medical Center, IL (V.J., T.I., D.O., T.S., T.O., C.J., P.C., T.L.)
| | - Colleen Juricek
- Department of Surgery, University of Chicago Medical Center, IL (V.J., T.I., D.O., T.S., T.O., C.J., P.C., T.L.)
| | - Pamela Combs
- Department of Surgery, University of Chicago Medical Center, IL (V.J., T.I., D.O., T.S., T.O., C.J., P.C., T.L.)
| | - Thomas Lammy
- Department of Surgery, University of Chicago Medical Center, IL (V.J., T.I., D.O., T.S., T.O., C.J., P.C., T.L.)
| | | | | | - Gabriel Sayer
- Division of Cardiology, Columbia University Medical Center, New York, NY (N.U., G.S.)
| | - Carmelo Milano
- Department of Cardiac Surgery, Duke University, Durham, NC (C.M., J.S.)
| | - Jacob Schroder
- Department of Cardiac Surgery, Duke University, Durham, NC (C.M., J.S.)
| | - Ezequiel Molina
- Department of Surgery, MedStar Washington Hospital Center, DC. (E.M.)
| | - Jonathan Grinstein
- Department of Cardiology, MedStar Washington Hospital Center, DC. (J.G.)
| | - Erik Suarez
- Department of Cardiovascular Surgery, Houston Methodist Research Institute, Houston, TX (E.S.)
| | - Jerry D. Estep
- Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic Foundation, OH (J.D.E.)
| | - Sanjeev Aggarwal
- Mid America Heart & Lung Surgeons, Saint Luke’s Mid-America Heart Institute, Kansas City, MO (S.A.)
| | - Scott Silvestry
- Department of Heart Failure and Transplant, AdventHealth Cardiovascular Institute, Orlando, FL (S.S., N.R.)
| | - Nirav Raval
- Department of Heart Failure and Transplant, AdventHealth Cardiovascular Institute, Orlando, FL (S.S., N.R.)
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31
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Bohannon RW, Crouch RH. Two-Minute Step Test of Exercise Capacity: Systematic Review of Procedures, Performance, and Clinimetric Properties. J Geriatr Phys Ther 2020; 42:105-112. [PMID: 29210933 DOI: 10.1519/jpt.0000000000000164] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE The 2-minute step test (TMST) is one of many alternatives for measuring exercise capacity. First introduced in 1999 as part of the Senior Fitness Test, the TMST has the advantage of requiring limited space, only a few minutes' time, and no expensive equipment. These advantages notwithstanding, the test must be clinimetrically sound if it is to be recommended. We sought therefore to summarize the literature addressing TMST performance and measurement properties. METHODS Relevant literature was identified by searches of 3 electronic databases (PubMed, Scopus, and Cumulative Index of Nursing and Allied Health) and hand searches. Inclusion of an article required that it described use of the TMST of Rikli and Jones and that it focused on adults. Articles published in a language other than English were excluded. Studies were abstracted for information on participants, TMST description, and findings. RESULTS AND DISCUSSION Thirty articles were deemed appropriate based on inclusion and exclusion criteria. The participants in the studies included community-dwelling healthy older adults and adults with assorted pathologies. Studies described varied methods of conducting the TMST. Among tests in which steps for one side were counted over a full 2 minutes, the mean number of steps among populations ranged from 29.1 for patients with chronic stroke to 110.8 for older osteoporotic women. Numerous reviewed studies provide support for the validity of the TMST. Only one study addressed reliability and none focused on responsiveness. Normative data have been proffered. CONCLUSIONS The TMST has been widely used since first introduced, albeit not always as originally described. There is considerable evidence for the validity of the test, but its reliability and responsiveness are not yet firmly established.
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Affiliation(s)
- Richard W Bohannon
- Department of Physical Therapy, College of Pharmacy and Health Sciences, Campbell University, Lillington, North Carolina
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32
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Duran A, Nguyen DT, Graviss EA, Bhimaraj A, Trachtenberg B, Hussain I, Park M, Estep JD, Suarez EE, Guha A. Waitlist and post-transplant outcomes in patients listed with intra-aortic balloon pump for heart transplant: United Network for Organ Sharing registry. Int J Artif Organs 2020; 43:606-613. [PMID: 32081072 DOI: 10.1177/0391398820903312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intra-aortic balloon pump as bridge-to-transplant (BTT) has been used successfully in patients with refractory cardiogenic shock. However, the waitlist mortality in this population is high and predictors of waitlist mortality in this population are not known. We sought to identify predictors for waitlist mortality in patients listed with intra-aortic balloon pump and risk factors for 1-year mortality after heart transplant in this population. METHODS We identified patients listed for heart transplantation with intra-aortic balloon pump in the United Network for Organ Sharing data set from 1994 to 2015. Univariable and multivariable Cox proportional hazards models were used to identify predictors of waitlist mortality and 1-year post-transplant mortality. RESULTS From 1945 patients listed with intra-aortic balloon pump, 67.5% (N = 1313) were alive at 1 year and waitlist mortality was 32.5% (N = 632). We found that higher pulmonary vascular resistance, need for inotropes, and need for mechanical ventilation were associated with higher waitlist mortality. Mechanical ventilation and dialysis prior to transplantation were important predictors of 1-year post-transplant mortality. CONCLUSION Predictors of mortality such as high pulmonary vascular resistance, dialysis dependence, inotrope, and ventilator dependence in patients listed with intra-aortic balloon pump can help us identify those patients that are at high risk of dying prior to a heart transplantation.
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Affiliation(s)
- Antonio Duran
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Duc T Nguyen
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA.,Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Edward A Graviss
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA.,Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Arvind Bhimaraj
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA.,J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX, USA
| | - Barry Trachtenberg
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA.,J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX, USA
| | - Imad Hussain
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA.,J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX, USA
| | - Muyng Park
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA.,J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX, USA
| | - Jerry D Estep
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Eric E Suarez
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA.,J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX, USA
| | - Ashrith Guha
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA.,J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX, USA
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33
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Malick W, Fried JA, Masoumi A, Nair A, Zuver A, Huang A, Haythe J, Farr M, Rabbani L, Karmpaliotis D, Kirtane AJ, Topkara VK, Takeda K, Garan AR. Comparison of the Hemodynamic Response to Intra-Aortic Balloon Counterpulsation in Patients With Cardiogenic Shock Resulting from Acute Myocardial Infarction Versus Acute Decompensated Heart Failure. Am J Cardiol 2019; 124:1947-1953. [PMID: 31648782 DOI: 10.1016/j.amjcard.2019.09.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
The intra-aortic balloon pump (IABP) neither benefits nor harms patients with acute myocardial infarction (AMI) with cardiogenic shock (CS) but may stabilize those with chronic heart failure who decompensate into CS. We sought to compare its hemodynamic effects in these 2 populations. We performed a retrospective analysis of the hemodynamic effects of IABP for AMI or acute decompensated heart failure (ADHF) patients with hemodynamic evidence of CS. The primary outcome was cardiac output (CO) change following insertion. In total, 205 patients were treated for CS resulting from AMI (73; 35.6%) or ADHF (132; 64.4%). At baseline, both cohorts had significant hemodynamic compromise with mean arterial pressure 75.6 ± 12.3 mm Hg, CO 3.02 ± 0.84 L/min, and cardiac power index 0.26 ± 0.06 W/m2; these parameters were nearly identical between groups though ADHF-CS patients had a higher pre-IABP mean pulmonary artery (PA) pressure than AMI-CS patients. After IABP insertion, ADHF-CS patients had moderate CO augmentation whereas AMI-CS experienced almost no improvement (0.58 ± 0.79 L/min vs 0.12 ± 1.00 L/min; p = 0.0009). Intracardiac filling pressures were reduced by similar amounts in both cohorts. Systemic vascular resistance was reduced in patients with ADHF-CS but not in those with AMI-CS. In conclusion, following IABP insertion, ADHF-CS patients experience roughly a 5-fold greater CO augmentation compared with AMI-CS patients. Pre-IABP PA pressure differences and differential systemic vascular resistance reduction may explain these results and shed light on recent evidence supporting IABP use in ADHF-CS and curbing it in AMI-CS.
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34
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Macapagal FR, McClellan E, Macapagal RO, Green L, Bonuel N. Nursing Care and Treatment of Ambulatory Patients With Percutaneously Placed Axillary Intra-aortic Balloon Pump Before Heart Transplant. Crit Care Nurse 2019; 39:45-52. [PMID: 30936130 DOI: 10.4037/ccn2019729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Transplant cardiologists in our hospital have performed the percutaneously placed axillary-subclavian intra-aortic balloon pump procedure since 2007. This procedure allows patients to mobilize and walk while they wait for a heart transplant, rather than remaining on bed rest as they would with a traditional femoral intra-aortic balloon pump. This procedure has presented challenges to the nursing staff. A 2007 literature search revealed no precedent or published nursing articles on this subject. This article reviews heart failure, medical treatments, complications of bed rest associated with the femoral intra-aortic balloon pump, the nursing challenges and unique problems of caring for patients with percutaneously placed axillary-subclavian intra-aortic balloon pumps, and our solutions for those challenges.
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Affiliation(s)
- Frederick R Macapagal
- Frederick R. Macapagal is a registered nurse III in the cardiac intensive care unit at DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas. .,Emma McClellan is Director, cardiac intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital. .,Rosario O. Macapagal is Educator, cardiovascular intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital. .,Lisa Green is a clinical research nurse at Houston Methodist Research Institute, DeBakey Heart and Vascular Center, Houston Methodist Hospital. .,Nena Bonuel is System Director, Nursing Practice, at Harris Health System, Houston, Texas.
| | - Emma McClellan
- Frederick R. Macapagal is a registered nurse III in the cardiac intensive care unit at DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.,Emma McClellan is Director, cardiac intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Rosario O. Macapagal is Educator, cardiovascular intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Lisa Green is a clinical research nurse at Houston Methodist Research Institute, DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Nena Bonuel is System Director, Nursing Practice, at Harris Health System, Houston, Texas
| | - Rosario O Macapagal
- Frederick R. Macapagal is a registered nurse III in the cardiac intensive care unit at DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.,Emma McClellan is Director, cardiac intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Rosario O. Macapagal is Educator, cardiovascular intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Lisa Green is a clinical research nurse at Houston Methodist Research Institute, DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Nena Bonuel is System Director, Nursing Practice, at Harris Health System, Houston, Texas
| | - Lisa Green
- Frederick R. Macapagal is a registered nurse III in the cardiac intensive care unit at DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.,Emma McClellan is Director, cardiac intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Rosario O. Macapagal is Educator, cardiovascular intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Lisa Green is a clinical research nurse at Houston Methodist Research Institute, DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Nena Bonuel is System Director, Nursing Practice, at Harris Health System, Houston, Texas
| | - Nena Bonuel
- Frederick R. Macapagal is a registered nurse III in the cardiac intensive care unit at DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.,Emma McClellan is Director, cardiac intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Rosario O. Macapagal is Educator, cardiovascular intensive care unit, at DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Lisa Green is a clinical research nurse at Houston Methodist Research Institute, DeBakey Heart and Vascular Center, Houston Methodist Hospital.,Nena Bonuel is System Director, Nursing Practice, at Harris Health System, Houston, Texas
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Dziekiewicz M, Banaszewski M, Kuć M, Stępińska J. Intra-Aortic Balloon Pump Catheter Insertion Using a Novel Left External Iliac Artery Approach in A Case of Chronic Heart Failure Due to Dilated Cardiomyopathy. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1826-1829. [PMID: 31811112 PMCID: PMC6913267 DOI: 10.12659/ajcr.920554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patient: Female, 67-year-old Final Diagnosis: Heart failure Symptoms: Chest pain • dyspnoea • poor exercise tolerance Medication: — Clinical Procedure: Intraoartic baloon pump insertion – new technique Specialty: Cardiac surgery
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Affiliation(s)
- Mirosław Dziekiewicz
- Department of Vascular and Endovascular Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Marek Banaszewski
- Department of Intensive Cardiac Therapy, Institute of Cardiology, Warsaw, Poland
| | - Mateusz Kuć
- Department of Cardiac Surgery and Transplantology, Institute of Cardiology, Warsaw, Poland
| | - Janina Stępińska
- Department of Intensive Cardiac Therapy, Institute of Cardiology, Warsaw, Poland
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Obaidi AH, Kunavarapu C, Kwan M. Axillary intraaortic balloon pump rupture and cerebral embolism because of helium leak. J Heart Lung Transplant 2019; 38:1122-1123. [PMID: 31548034 DOI: 10.1016/j.healun.2019.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/19/2019] [Accepted: 08/05/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Adam H Obaidi
- Department of Cardiovascular Disease, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | | | - Michael Kwan
- Advanced Heart Failure Program, Methodist Hospital, San Antonio, Texas
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Salutary Effects of the PULVAD, a Novel Implantable Counterpulsation Assist Device, on Cardiac Mechanoenergetics. ASAIO J 2019; 65:473-480. [DOI: 10.1097/mat.0000000000000838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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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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Ghia S, Dhawan R, Chaney MA, Jeevanandam V, Stone M, Pawale A, Sladen RN. Can I Go Home With That Balloon Pump? J Cardiothorac Vasc Anesth 2018. [DOI: 10.1053/j.jvca.2018.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mandawat A, Rao SV. Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.116.004337. [PMID: 28500136 DOI: 10.1161/circinterventions.116.004337] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Despite a high rate of early revascularization and use of intra-aortic balloon pump counterpulsation therapy, the prognosis of patients with cardiogenic shock has remained poor. In the hopes of improving outcomes, clinicians are increasingly turning to percutaneous left and right mechanical circulatory support devices. Until recently, the evidence base for these devices had consisted only of observational data, meta-analyses, and small feasibility trials. In this article, we describe the contemporary outcomes of patients with cardiogenic shock, the hemodynamics of cardiogenic shock, and hemodynamic effects of percutaneous mechanical circulatory support devices. We then use this discussion to provide clinicians with a useful framework for understanding when selecting between or while managing patients with a percutaneous mechanical circulatory support devices. We critically review the recently published data for and against the use of commercially available devices-the intra-aortic balloon pump counterpulsation, the Impella system, the TandemHeart, and venous-arterial extracorporeal membrane oxygenation-and highlight gaps in our understanding. Given such gaps, a consensus multidisciplinary approach that combines expertise from interventional cardiologists, heart failure specialists, cardiac surgeons, and cardiac anesthesiologists may help pair the right patient with the right device at the right time.
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Affiliation(s)
| | - Sunil V Rao
- From the Duke Clinical Research Institute, Durham, NC
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Abstract
Cardiac transplantation is the gold standard treatment for patients with advanced congestive heart failure that is refractory to maximal medical therapy. However, donor heart availability remains the major limiting factor, resulting in a large number of patients waiting long periods of time before transplantation. As a result, mechanical circulatory support devices have been increasingly used as a 'bridge' in order to sustain organ function and stabilise haemodynamics while patients remain on the transplant waiting list or undergo left ventricular assist device surgery. Intra aortic balloon pumps (IABP) are commonly used for temporary circulatory support in patients with advanced heart failure. IABP is traditionally placed percutaneously through the transfemoral artery approach. The major limitation with this approach is ambulatory restriction that can promote deconditioning, particularly in situations of prolonged circulatory support. A subclavian/axillary artery approach IABP insertion allows patients to be ambulatory during the pre-transplant period. In this review, we aim to summarise the physiology of IABP, the evidence for its use in advanced CHF and the efficacy and safety of subclavian artery IABP insertion.
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Affiliation(s)
- Syed Yaseen Naqvi
- Department of Cardiology, Advanced Heart Transplant Program, University of Rochester Medical Center Rochester, USA
| | | | - Ayhan Yoruk
- Department of Cardiology, Advanced Heart Transplant Program, University of Rochester Medical Center Rochester, USA
| | - Leway Chen
- Department of Cardiology, Advanced Heart Transplant Program, University of Rochester Medical Center Rochester, USA
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Jeevanandam V, Song T, Onsager D, Ota T, LaBuhn CJ, Lammy T, Sayer G, Kim G, Patel-Raman S, Uriel N. The first-in-human experience with a minimally invasive, ambulatory, counterpulsation heart assist system for advanced congestive heart failure. J Heart Lung Transplant 2018; 37:1-6. [DOI: 10.1016/j.healun.2017.10.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 11/29/2022] Open
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Nwaejike N, Son AY, Patel CB, Schroder JN, Milano CA, Daneshmand MA. The Axillary Intra-Aortic Balloon Pump as a Bridge to Recovery Allows Early Ambulation in Long-Term Use. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nnamdi Nwaejike
- Department of Cardiothoracic Surgery, University Hospitals of South Manchester, Wythenshawe, UK
| | - Andre Y. Son
- New York University School of Medicine, New York, NY USA
| | - Chetan B. Patel
- Division of Cardiology, Duke University Medical Center, Durham, NC USA
| | - Jacob N. Schroder
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC USA
| | - Carmelo A. Milano
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC USA
| | - Mani A. Daneshmand
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC USA
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The Axillary Intra-Aortic Balloon Pump as a Bridge to Recovery Allows Early Ambulation in Long-Term Use. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:472-478. [DOI: 10.1097/imi.0000000000000432] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We evaluated the feasibility, tolerability, and efficacy of a strategy for transaxillary artery intra-aortic balloon pump placement for extended mechanical circulatory support of patients with post-cardiotomy shock as a bridge to recovery. Patients requiring prolonged intra-aortic balloon pump support for postcardiotomy heart failure were identified. Intra-aortic balloon pump was tunneled through a 6-mm Dacron graft anastomosed to the right axillary artery. The intra-aortic balloon pump catheter is advanced under fluoroscopic guidance into the descending thoracic aorta. Three patients were transferred from outside facilities, requiring prolonged intra-aortic balloon pump support for postcardiotomy heart failure. Patients included a 54-year-old woman with occluded grafts and left ventricular thrombus after coronary artery bypass grafting, ejection fraction (EF) of 23.4% on dobutamine infusion, intra-aortic balloon pump support for 39 days, max daily ambulated distance of 1250 feet, and discharged home on day 51 on milrinone infusion; a 63-year-old man with kinked left internal mammary artery to left anterior descending artery graft (surgically repaired), multiple failed extubations requiring tracheostomy, EF of 15% on epinephrine and milrinone, intra-aortic balloon pump support for 43 days, max daily ambulated distance of 400 feet, and discharged home on day 54; and a 66-year-old man after redo coronary artery bypass grafting + carotid endarterectomy, with failure to wean off cardiopulmonary bypass requiring veno-arterial extracorporeal membrane oxygenator, EF of 20% on epinephrine and norepinephrine, intra-aortic balloon pump support for 41 days, max daily ambulated distance of 2800 feet, and discharged home on day 91. There were no infection, thromboembolic, cerebrovascular, bleeding, or intra-aortic balloon pump malpositioning/migration complications. We found that transaxillary artery intra-aortic balloon pump is well tolerated by patients and allows early ambulation and aggressive physical therapy in patients needing extended support. Duration of intra-aortic balloon pump support was up to 43 days with no complications.
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den Uil CA, Akin S, Jewbali LS, dos Reis Miranda D, Brugts JJ, Constantinescu AA, Kappetein AP, Caliskan K. Short-term mechanical circulatory support as a bridge to durable left ventricular assist device implantation in refractory cardiogenic shock: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2017; 52:14-25. [DOI: 10.1093/ejcts/ezx088] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Nwaejike N, Son AY, Milano CA, Daneshmand MA. Is there a role for upper-extremity intra-aortic balloon counterpulsation as a bridge-to-recovery or a bridge-to-transplant in the treatment of end-stage heart failure? Interact Cardiovasc Thorac Surg 2017; 25:654-658. [DOI: 10.1093/icvts/ivx165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/22/2017] [Indexed: 11/14/2022] Open
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New Innovations in Circulatory Support With Ventricular Assist Device and Extracorporeal Membrane Oxygenation Therapy. Anesth Analg 2017; 124:1071-1086. [DOI: 10.1213/ane.0000000000001629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Murks C, Juricek C. Balloon Pumps Inserted via the Subclavian Artery: Bridging the Way to Heart Transplant. AACN Adv Crit Care 2016; 27:301-315. [PMID: 27959314 DOI: 10.4037/aacnacc2016355] [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] [Indexed: 11/01/2022]
Abstract
Intra-aortic balloon pumps have traditionally been inserted via the femoral artery, limiting patients' activity and exposing patients to complications of immobility. For patients awaiting cardiac transplant, these complications may threaten a successful outcome, or at the least, complicate recuperation after transplant. A novel approach to insertion of balloon pumps via the subclavian artery is presented here, including routine nursing care, complications and related nursing actions, and experience with and advantages of this method. A team approach to care of these patients, including rehabilitation and exercise protocols, is recommended.
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Affiliation(s)
- Catherine Murks
- Catherine Murks is Nurse Practitioner, Department of Medicine, Section of Cardiology, University of Chicago Medicine, 5841 S. Maryland, MC 2016, Chicago, IL 60637 . Colleen Juricek is Ventricular Assist Device Coordinator, Department of Surgery, Section of Cardiac Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Colleen Juricek
- Catherine Murks is Nurse Practitioner, Department of Medicine, Section of Cardiology, University of Chicago Medicine, 5841 S. Maryland, MC 2016, Chicago, IL 60637 . Colleen Juricek is Ventricular Assist Device Coordinator, Department of Surgery, Section of Cardiac Surgery, University of Chicago Medicine, Chicago, Illinois
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