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Ardito V, Sarucanian L, Rognoni C, Pieri M, Scandroglio AM, Tarricone R. Impella Versus VA-ECMO for Patients with Cardiogenic Shock: Comprehensive Systematic Literature Review and Meta-Analyses. J Cardiovasc Dev Dis 2023; 10:jcdd10040158. [PMID: 37103037 PMCID: PMC10142129 DOI: 10.3390/jcdd10040158] [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: 02/27/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 04/28/2023] Open
Abstract
Impella and VA-ECMO are two possible therapeutic courses for the treatment of patients with cardiogenic shock (CS). The study aims to perform a systematic literature review and meta-analyses of a comprehensive set of clinical and socio-economic outcomes observed when using Impella or VA-ECMO with patients under CS. A systematic literature review was performed in Medline, and Web of Science databases on 21 February 2022. Nonoverlapping studies with adult patients supported for CS with Impella or VA-ECMO were searched. Study designs including RCTs, observational studies, and economic evaluations were considered. Data on patient characteristics, type of support, and outcomes were extracted. Additionally, meta-analyses were performed on the most relevant and recurring outcomes, and results shown using forest plots. A total of 102 studies were included, 57% on Impella, 43% on VA-ECMO. The most common outcomes investigated were mortality/survival, duration of support, and bleeding. Ischemic stroke was lower in patients treated with Impella compared to the VA-ECMO population, with statistically significant difference. Socio-economic outcomes including quality of life or resource use were not reported in any study. The study highlighted areas where further data collection is needed to clarify the value of complex, new technologies in the treatment of CS that will enable comparative assessments focusing both on the health impact on patient outcomes and on the financial burden for government budgets. Future studies need to fill the gap to comply with recent regulatory updates at the European and national levels.
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Affiliation(s)
- Vittoria Ardito
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, Italy
| | - Lilit Sarucanian
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, Italy
| | - Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, Italy
| | - Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, Italy
- Department of Social and Political Science, Bocconi University, 20136 Milan, Italy
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Balthazar T, Bennett J, Adriaenssens T. Hemolysis during short-term mechanical circulatory support: from pathophysiology to diagnosis and treatment. Expert Rev Med Devices 2022; 19:477-488. [PMID: 35912874 DOI: 10.1080/17434440.2022.2108319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Despite advances in heart failure therapies and percutaneous coronary interventions, survival for cardiogenic shock remains poor. Percutaneous ventricular assist devices (pVAD) are increasingly used, but current evidence remains conflicting. The Impella is an example of such a device, based on a catheter mounted micro-axial continuous flow pump, that has been rapidly adopted in routine practice. An important aspect in the post implantation care is the prevention of complications. Hemolysis is one of the more frequent complications seen with this device. AREAS COVERED In this review we discuss the pathophysiology, diagnosis and treatment of hemolysis in patients supported with a pVAD. A practical algorithm for rapid identification of hemolysis and the underlying cause is presented, allowing for early treatment and prevention of further complications. EXPERT OPINION Hemolysis remains a threat to patients supported with any mechanical circulatory support device. Prevention as well as treatment demands for sufficient knowledge about the device, the optimal position and hemodynamics. Future studies should try to clarify some of the elements that are still unclear such as optimal anticoagulation, the place of pentoxyfilline or extracorporeal removal of free hemoglobin. This could help to optimize outcomes in clinical practice as well as future studies.
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Affiliation(s)
- Tim Balthazar
- University Hospitals Brussel, Department of Cardiology, Jette, Belgium
| | - Johan Bennett
- University Hospitals Leuven, Department of Cardiovascular Medicine, Leuven, Belgium.,Katholieke Universiteit Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - Tom Adriaenssens
- University Hospitals Leuven, Department of Cardiovascular Medicine, Leuven, Belgium.,Katholieke Universiteit Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
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3
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Chen JL, Tsai YT, Lin CY, Ke HY, Lin YC, Yang HY, Liu CT, Sung SY, Chang JT, Wang YH, Lin TC, Tsai CS, Hsu PS. Extracorporeal Life Support and Temporary CentriMag Ventricular Assist Device to Salvage Cardiogenic-Shock Patients Suffering from Prolonged Cardiopulmonary Resuscitation. J Clin Med 2022; 11:jcm11133773. [PMID: 35807056 PMCID: PMC9267666 DOI: 10.3390/jcm11133773] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/08/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The extracorporeal life support (ECLS) and temporary bilateral ventricular assist device (t-BiVAD) are commonly applied in patients with cardiogenic shock. Prolonged cardiopulmonary resuscitation (CPR) has poor prognosis. Herein, we report our findings on a combined ECLS and t-BiVAD approach to salvage cardiogenic-shock patients with CPR for more than one hour. Methods: Fifty-nine patients with prolonged CPR and rescued by ECLS and subsequent t-BiVAD were retrospectively collected between January 2015 and December 2019. Primary diagnoses included ischemic, dilated cardiomyopathy, acute myocardial infarction, post-cardiotomy syndrome, and fulminant myocarditis. The mean LVEF was 16.9% ± 6.56% before t-BiVAD. The median ECLS-to-VAD interval is 26 h. Results: A total of 26 patients (44%) survived to weaning, including 13 (22%) bridged to recovery, and 13 (22%) bridged to transplantation. Survivors to discharge demonstrated better systemic perfusion and hemodynamics than non-survivors. The CentriMag-related complications included bleeding (n = 22, 37.2%), thromboembolism (n = 5, 8.4%), and infection (n = 4, 6.7%). The risk factors of mortality included Glasgow Coma Scale (Motor + Eye) ≤ 5, and lactate ≥ 8 mmol/L at POD-1, persistent ventricular rhythm or asystole, and total bilirubin ≥ 6 mg/dL at POD-3. Mortality factors included septic shock (n = 11, 18.6%), central failure (n = 10, 16.9%), and multiple organ failure (n = 12, 20.3%). Conclusions: Combined ECLS and t-BiVAD could be a salvage treatment for patients with severe cardiogenic shock, especially for those already having prolonged CPR. This combination can correct organ malperfusion and allow sufficient time to bridge patients to recovery and heart transplantation, especially in Asia, where donation rates are low, as well as intracorporeal VAD or total artificial heart being seldom available.
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Affiliation(s)
- Jia-Lin Chen
- Department of Anesthesia, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (J.-L.C.); (T.-C.L.)
| | - Yi-Ting Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (Y.-T.T.); (C.-Y.L.); (H.-Y.K.); (Y.-C.L.); (H.-Y.Y.); (C.-T.L.); (S.-Y.S.); (J.-T.C.); (Y.-H.W.)
| | - Chih-Yuan Lin
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (Y.-T.T.); (C.-Y.L.); (H.-Y.K.); (Y.-C.L.); (H.-Y.Y.); (C.-T.L.); (S.-Y.S.); (J.-T.C.); (Y.-H.W.)
| | - Hong-Yan Ke
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (Y.-T.T.); (C.-Y.L.); (H.-Y.K.); (Y.-C.L.); (H.-Y.Y.); (C.-T.L.); (S.-Y.S.); (J.-T.C.); (Y.-H.W.)
| | - Yi-Chang Lin
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (Y.-T.T.); (C.-Y.L.); (H.-Y.K.); (Y.-C.L.); (H.-Y.Y.); (C.-T.L.); (S.-Y.S.); (J.-T.C.); (Y.-H.W.)
| | - Hsiang-Yu Yang
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (Y.-T.T.); (C.-Y.L.); (H.-Y.K.); (Y.-C.L.); (H.-Y.Y.); (C.-T.L.); (S.-Y.S.); (J.-T.C.); (Y.-H.W.)
| | - Chien-Ting Liu
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (Y.-T.T.); (C.-Y.L.); (H.-Y.K.); (Y.-C.L.); (H.-Y.Y.); (C.-T.L.); (S.-Y.S.); (J.-T.C.); (Y.-H.W.)
| | - Shih-Ying Sung
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (Y.-T.T.); (C.-Y.L.); (H.-Y.K.); (Y.-C.L.); (H.-Y.Y.); (C.-T.L.); (S.-Y.S.); (J.-T.C.); (Y.-H.W.)
| | - Jui-Tsung Chang
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (Y.-T.T.); (C.-Y.L.); (H.-Y.K.); (Y.-C.L.); (H.-Y.Y.); (C.-T.L.); (S.-Y.S.); (J.-T.C.); (Y.-H.W.)
| | - Ying-Hsiang Wang
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (Y.-T.T.); (C.-Y.L.); (H.-Y.K.); (Y.-C.L.); (H.-Y.Y.); (C.-T.L.); (S.-Y.S.); (J.-T.C.); (Y.-H.W.)
| | - Tso-Chou Lin
- Department of Anesthesia, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (J.-L.C.); (T.-C.L.)
| | - Chien-Sung Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (Y.-T.T.); (C.-Y.L.); (H.-Y.K.); (Y.-C.L.); (H.-Y.Y.); (C.-T.L.); (S.-Y.S.); (J.-T.C.); (Y.-H.W.)
- Correspondence: (C.-S.T.); (P.-S.H.); Tel.: +886-2-87927212 (P.-S.H.); Fax: +886-2-87927376 (P.-S.H.)
| | - Po-Shun Hsu
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (Y.-T.T.); (C.-Y.L.); (H.-Y.K.); (Y.-C.L.); (H.-Y.Y.); (C.-T.L.); (S.-Y.S.); (J.-T.C.); (Y.-H.W.)
- Correspondence: (C.-S.T.); (P.-S.H.); Tel.: +886-2-87927212 (P.-S.H.); Fax: +886-2-87927376 (P.-S.H.)
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Transcatheter closure of patent foramen ovale accompanying right-to-left shunt during Impella support. J Artif Organs 2022; 25:262-265. [DOI: 10.1007/s10047-021-01305-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/14/2021] [Indexed: 11/28/2022]
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Tindale A, Vela MM, Panoulas V. Using base excess, albumin, lactate and renal function to predict 30-day mortality in patients requiring impella monotherapy for left-sided mechanical circulatory support: The BALLAR score. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 41:129-135. [PMID: 34920962 DOI: 10.1016/j.carrev.2021.12.008] [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: 09/09/2021] [Revised: 10/30/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To create a simple scoring system that can estimate 30-day mortality in patients requiring left-sided Impella implantation as standalone mechanical circulatory support (MCS). METHODS We retrospectively analysed 79 consecutive patients who required left-sided Impella MCS monotherapy. Regression analysis was used to elucidate significant associations between biochemical markers before Impella implantation and all-cause mortality at 30 days. Using these factors, a simple additive scoring system was created using a previously validated approach. RESULTS The BALLAR scoring system was created. Patients are assigned points based upon biochemical markers. These are summed and the final points tally provides an estimate of 30-day mortality. The points are assigned as follows: Lactate (mmol/l): ≤1.9: 0 points, 2-4.9: 1 Point, ≥5: 4 Points Creatinine Clearance (ml/min): ≤29.9: 6 points, 30-59.9: 4 points, 60-89.9: 1 point, ≥90: 0 points Serum Albumin (mmol/l): <25: 6 points, 25-34.9: 3 points, ≥35: 0 points Base Excess (mmol/L): < -2: 2 points, ≥-2: 0 points The total score can be used to estimate the probability of death at 30 days. A score less than 6 predicts a 30-day mortality of under 5%, whereas a score over 11 predicts a greater than 95% chance of death within 30 days. CONCLUSION Using this simple heuristic predicted 89% of 30-day deaths in our cohort. All the misclassifications were in the intermediate probability range (scores 5-11). This simple scoring system gives an effective estimate of the probability of death at 30 days in our cohort of patients.
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Affiliation(s)
- Alexander Tindale
- Department of Cardiology, Harefield Hospital, Guys & St Thomas' Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, UK
| | - Maria Monteagudo Vela
- Department of Cardiothoracic Surgery, Hospital Universitario La Princesa, Madrid, Spain
| | - Vasileios Panoulas
- Department of Cardiology, Harefield Hospital, Guys & St Thomas' Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, UK.
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Upadhyay R, Alrayes H, Arno S, Kaushik M, Basir MB. Current Landscape of Temporary Percutaneous Mechanical Circulatory Support Technology. US CARDIOLOGY REVIEW 2021; 15:e21. [PMID: 39720506 PMCID: PMC11664789 DOI: 10.15420/usc.2021.15] [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: 04/05/2021] [Accepted: 07/06/2021] [Indexed: 11/04/2022] Open
Abstract
Mechanical circulatory support devices provide hemodynamic support to patients who present with cardiogenic shock. These devices work using different mechanisms to provide univentricular or biventricular support. There is a growing body of evidence supporting use of these devices as a goal for cardiac recovery or as a bridge to definitive therapy, but definitive, well-powered studies are still needed. Mechanical circulatory support devices are increasingly used using shock team and protocols, which can help clinicians in decision making, balancing operator and institutional experience and expertise. The aim of this article is to review commercially available mechanical circulatory support devices, their profiles and mechanisms of action, and the evidence available regarding their use.
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Affiliation(s)
- Rani Upadhyay
- Section of Interventional Cardiology, Stanford Health CareOakland, CA
| | | | - Scott Arno
- Division of Cardiology, Henry Ford HospitalDetroit, MI
| | | | - Mir B Basir
- Division of Cardiology, Henry Ford HospitalDetroit, MI
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7
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Panoulas V, Monteagudo-Vela M. Predictors of Short-term Survival in Cardiogenic Shock Patients Requiring Left Ventricular Support Using the Impella CP or 5.0. CJC Open 2021; 3:1002-1009. [PMID: 34505039 PMCID: PMC8413249 DOI: 10.1016/j.cjco.2021.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background Percutaneous ventricular assist devices (pVADs) have been used to support patients who are in cardiogenic shock (CS). There is limited data on 30-day mortality predictors in patients supported by an Impella pVAD. Methods All CS patients requiring left-sided Impella implantation in Harefield Hospital (Greater London, United Kingdom) between 2017 and 2020 were included in the current study. Logistic regression analysis was used to identify predictors of 30-day mortality. Results A total of 92 patients were included. The mean age was 53.8 ± 14.9 years, and 78.3% were male. CS etiology was predominantly acute coronary syndromes (44.6%), followed by decompensated dilated cardiomyopathy (28.3%). Survival at 30 days was 63% (58 of 92). Deceased patients had a lower left ventricular ejection fraction (LVEF) (15.1 ± 9.6 vs 21.8 ± 14.2, P < 0.001), higher serum lactate levels (2.8[1.6 to 5.4] vs 1.45 [1.08 to 3.53], P = 0.012), a higher percentage of prolonged invasive ventilation (> 24 hours) (64.7% vs 13.8%, P < 0.001), and worse renal and liver function. Serum lactate, baseline LVEF, and prolonged ventilation (> 24 hours) were independent predictors of 30-day survival with an area under the curve of 0.85 (95% confidence interval 0.769 to 0.930), P < 0.001. Conclusions In the current retrospective registry of patients requiring Impella pVAD implantation, independent 30-day mortality predictors included serum lactate, baseline LVEF, and prolonged invasive ventilation (> 24 hours). These parameters could highlight patients who would benefit from earlier mechanical circulatory support escalation or neurologic assessment to inform withdrawal decisions.
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Affiliation(s)
- Vasileios Panoulas
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College, London, United Kingdom
- Corresponding author: Dr Vasileios F. Panoulas, Harefield Hospital, Harefield, Middlesex, UB9 6JH, United Kingdom. Tel.: 44(0)1895 823737 x5200; fax: +44(0)1895 828892.
| | - María Monteagudo-Vela
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Zaiser AS, Fahrni G, Hollinger A, Knobel DT, Bovey Y, Zellweger NM, Buser A, Santer D, Pargger H, Gebhard CE, Siegemund M. Adverse Events of Percutaneous Microaxial Left Ventricular Assist Devices-A Retrospective, Single-Centre Cohort Study. J Clin Med 2021; 10:jcm10163710. [PMID: 34442010 PMCID: PMC8396891 DOI: 10.3390/jcm10163710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/08/2021] [Accepted: 08/17/2021] [Indexed: 12/16/2022] Open
Abstract
Worldwide, the left ventricular assist device Impella® (Abiomed, Danvers, MA, USA) is increasingly implanted in patients with acute cardiogenic shock or undergoing high-risk cardiac interventions. Despite its long history of use, few studies have assessed its safety and possible complications associated with its use. All patients treated with a left-sided Impella® device at the University Hospital of Basel from 1 January 2011 to 31 December 2019 were enrolled. The primary endpoint was the composite rate of mortality and adverse events (bleeding, acute kidney injury, and limb ischemia). Out of 281 included patients, at least one adverse event was present in 262 patients (93%). Rates of in-hospital, 90-day, and one-year mortality were 48%, 47%, and 50%, respectively. BARC type 3 bleeding (62%) and hemolysis (41.6%) were the most common complications. AKI was observed in 50% of all patients. Renal replacement therapy was required in 97 (35%) of all patients. Limb ischemia occurred in 13% of cases. Bleeding and hemolysis are common Impella®-associated complications. Additionally, we found a high rate of AKI. A careful selection of patients receiving microaxial LV support and defining the indication for its use are essential measures to be taken for the benefits to outweigh potential complications.
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Affiliation(s)
- Anna S. Zaiser
- Intensive Care Unit, University Hospital Basel, 4031 Basel, Switzerland; (A.S.Z.); (A.H.); (D.T.K.); (Y.B.); (N.M.Z.); (H.P.); (M.S.)
| | - Gregor Fahrni
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland;
| | - Alexa Hollinger
- Intensive Care Unit, University Hospital Basel, 4031 Basel, Switzerland; (A.S.Z.); (A.H.); (D.T.K.); (Y.B.); (N.M.Z.); (H.P.); (M.S.)
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
| | - Demian T. Knobel
- Intensive Care Unit, University Hospital Basel, 4031 Basel, Switzerland; (A.S.Z.); (A.H.); (D.T.K.); (Y.B.); (N.M.Z.); (H.P.); (M.S.)
| | - Yann Bovey
- Intensive Care Unit, University Hospital Basel, 4031 Basel, Switzerland; (A.S.Z.); (A.H.); (D.T.K.); (Y.B.); (N.M.Z.); (H.P.); (M.S.)
| | - Núria M. Zellweger
- Intensive Care Unit, University Hospital Basel, 4031 Basel, Switzerland; (A.S.Z.); (A.H.); (D.T.K.); (Y.B.); (N.M.Z.); (H.P.); (M.S.)
| | - Andreas Buser
- Regional Blood Transfusion Center SRK Basel and Department of Hematology, Transfusion Medicine, University Hospital Basel, 4031 Basel, Switzerland;
| | - David Santer
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland;
| | - Hans Pargger
- Intensive Care Unit, University Hospital Basel, 4031 Basel, Switzerland; (A.S.Z.); (A.H.); (D.T.K.); (Y.B.); (N.M.Z.); (H.P.); (M.S.)
| | - Caroline E. Gebhard
- Intensive Care Unit, University Hospital Basel, 4031 Basel, Switzerland; (A.S.Z.); (A.H.); (D.T.K.); (Y.B.); (N.M.Z.); (H.P.); (M.S.)
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
- Correspondence: ; Tel.: +41-61-328-53-85
| | - Martin Siegemund
- Intensive Care Unit, University Hospital Basel, 4031 Basel, Switzerland; (A.S.Z.); (A.H.); (D.T.K.); (Y.B.); (N.M.Z.); (H.P.); (M.S.)
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
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Chivasso P, Miele M, Romano R, Frunzo F, Presutto O, Colombino M, Cafarelli F, Baldi C, Fiore E, Masiello P, Mastrogiovanni G, Iesu S. Impella CP and ProtekDuo as a bridge to recovery following surgical revascularization complicated by electrical storm. Gen Thorac Cardiovasc Surg 2021; 69:877-881. [PMID: 33400196 DOI: 10.1007/s11748-020-01571-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
Short-term mechanical circulatory support (MCS) devices are designed to provide hemodynamic support for a wide range of clinical conditions such as high-risk cardiac surgery or interventional procedures, post-cardiotomy cardiogenic shock, acute decompensated heart failure. Electrical storm (defined as three or more sustained episodes of ventricular fibrillation-VF- in a 24-h period) is a rare but critical complication following revascularization in patients with ischemic heart disease and it is associated with a very high mortality (80-90%) both during the incident alone and during further observation. Here we report the case of a 38-year-old patient affected by coronary artery disease with moderate to severe left ventricular systolic dysfunction (EF 30-35%) who underwent emergency coronary artery bypass grafting (CABG) complicated by electrical storm and severe haemodynamic instability, successfully managed with a novel approach of biventricular mechanical circulatory support with extracorporeal life support (ECLS) in first instance, subsequently switched to Impella CP and ProtekDuo.
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Affiliation(s)
- Pierpaolo Chivasso
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy.
| | - Mario Miele
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Rosalba Romano
- Department of Cardiac Anaethesia, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Francesco Frunzo
- Department of Cardiac Anaethesia, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Oreste Presutto
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Mario Colombino
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Francesco Cafarelli
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Cesare Baldi
- Department of Interventional Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Emanuele Fiore
- Department of Cardiac Anaethesia, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Paolo Masiello
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Generoso Mastrogiovanni
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Severino Iesu
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
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Grigorov M, Mathbout M, Fahsah I, Ghafghazi S. The Sinking Heart: A case of left anterior descending artery intervention complicated by perforation and cardiac tamponade. Glob Cardiol Sci Pract 2020; 2020:e202035. [PMID: 33598495 PMCID: PMC7868096 DOI: 10.21542/gcsp.2020.35] [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: 11/16/2022] Open
Abstract
Coronary interventions are one of the most commonly performed procedures in interventional medicine. They have provided a life-prolonging and -saving solution, but are not without their own complications. These, although rare, do occur and are important to recognize in order to promptly and efficiently provide a solution to prevent catastrophic consequences to the patient. We present a 70-year-old male with a past medical history significant for hypertension, hyperlipidemia, and myasthenia gravis; who presented to the hospital with substernal, pressure-like chest pain with associated nausea and diaphoresis. He was found to have ST segment elevations in anterolateral leads, prompting catherization lab activation revealing left anterior descending (LAD) artery stenosis. Percutaneous intervention via balloon dilation and stent placement was performed with periprocedural mid-intervention hemodynamic collapse occurring. Subsequent left ventricular (LV) angiography was performed revealing preserved LV function without perforation - however a rim of contrast was noted surrounding the LV. Thus, hemodynamic collapse was recognized as result of cardiac tamponade with pericardial drain emergently inserted resulting in hemodynamic recovery. Our case aims to present a case of vascular perforation with the uniqueness in our diagnostic approach via fluoroscopic imaging.
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Affiliation(s)
- Mladen Grigorov
- Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky, 40202
| | - Mohammad Mathbout
- Division of Cardiovascular Medicine, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, 40202
| | - Ibrahim Fahsah
- Division of Cardiovascular Medicine, Department of Medicine, Norton Heart & Vascular Institute, Louisville, Kentucky, 40202
| | - Shahab Ghafghazi
- Division of Cardiovascular Medicine, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, 40202
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Schwartz B, Jain P, Salama M, Kapur NK. The Rise of Endovascular Mechanical Circulatory Support Use for Cardiogenic Shock and High Risk Coronary Intervention: Considerations and Challenges. Expert Rev Cardiovasc Ther 2020; 19:151-164. [PMID: 33356662 DOI: 10.1080/14779072.2021.1863147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Cardiogenic shock due to acute myocardial infarction and decompensated advanced heart failure remains a source of significant morbidity and mortality. Endovascular mechanical circulatory support devices including intra-aortic balloon pump (IABP), percutaneous left ventricular assist devices (Impella and Tandemheart pumps), and veno-arterial extracorporeal oxygenation (VA-ECMO) are utilized for a broadening range of indications.Areas covered: This narrative review explores the specific devices, their distinctive hemodynamic profiles, and practical considerations. Furthermore, reviewed are the trials evaluating device outcomes which have generated significant controversy within the field of heart failure and shock. New applications and future directions are discussed.Expert opinion: Use of endovascular mechanical circulatory support has increased over the last decade, though evidence supporting their use is lacking. Development of large-scale prospective registries and clinical classification systems will facilitate patient enrollment and inform trial design. Furthermore, expansion of indications for these devices is revolutionizing how the field of heart failure and cardiogenic shock thinks about hemodynamic support. The ability to tailor therapy to a patient's specific hemodynamic profile appears to be the future of cardiogenic shock management.
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Affiliation(s)
- Benjamin Schwartz
- Department of Internal Medicine, Tufts Medical Center, Boston, MA, USATurkey
| | - Pankaj Jain
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, USATurkey
| | - Michael Salama
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, USATurkey
| | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, USATurkey
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Fernando SM, Qureshi D, Tanuseputro P, Talarico R, Hibbert B, Mathew R, Rochwerg B, Belley-Côté EP, Fan E, Combes A, Brodie D, Schmidt M, Simard T, Di Santo P, Kyeremanteng K. Long-term mortality and costs following use of Impella® for mechanical circulatory support: a population-based cohort study. Can J Anaesth 2020; 67:1728-1737. [PMID: 32671805 DOI: 10.1007/s12630-020-01755-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The Impella® device is a form of mechanical circulatory support (MCS) used in critically ill adults with cardiogenic shock. We sought to evaluate short- and long-term outcomes following the use of Impella, including mortality, healthcare utilization, and costs. METHODS Population-based, retrospective cohort study of adult patients (≥ 16 yr) receiving Impella in Ontario, Canada (1 April 2012-31March 2019). We captured outcomes through linkage to health administrative databases. The primary outcome was mortality during hospitalization. Secondary outcomes included mortality at 30 days, 90 days, and one year following Impella insertion. We analyzed health system costs in Canadian dollars in the year following the date of the index admission, including the costs of inpatient admission. RESULTS We included 162 patients. Mean (standard deviation) age was 59.2 (14.5) yr, and 73.5% of patients were male. Median [interquartile range (IQR)] time to Impella insertion from date of hospital admission was 2 [1-9] days. In-hospital mortality was 56.8%, and a significant proportion of patients were bridged to a ventricular assist device (67.9%). Mortality at one year was 61.7%. Among hospital survivors, only 38.6% were discharged home independently. Median [IQR] total cost in the year following admission among all patients was $88,397 [32,718-225,628], of which $66,529 [22,789-183,165] was attributed to inpatient care. CONCLUSIONS In-hospital mortality among patients with cardiogenic shock receiving Impella is high, but with minimal increase at one year. While Impella patients accrued substantial costs, these largely reflected inpatient costs, and not costs incurred following hospital discharge.
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Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Danial Qureshi
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Peter Tanuseputro
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Robert Talarico
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Rebecca Mathew
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Emilie P Belley-Côté
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Alain Combes
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Pitié Salpêtrière, Paris, France
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
| | - Matthieu Schmidt
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Pitié Salpêtrière, Paris, France
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - Trevor Simard
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Pietro Di Santo
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
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Abstract
Abstract
Left ventricular assist device (LVAD) has emerged as a safe, durable, and revolutionary therapy for end-stage heart failure patients. Despite the appearance of newer-generation devices that have improved patient outcomes, the burden of adverse events remains significant. Although the survival rate for patients with LVAD is appreciated to be 81% at 1 year and 70% at 2 years, the incidence of adverse events is also high. Over time, both early and late postimplant complications have diminished in terms of prevalence and impact; however, complications, such as infections, bleeding, right heart failure, pump thrombosis, aortic insufficiency, or stroke, continue to represent a challenge for the practitioner. Therefore, the aim of this review is to highlight the most recent data regarding the current use of LVAD in the treatment of end-stage heart failure, with a specific focus on LVAD-related complications, in order to improve device-related outcomes. It will also revise how to mitigate the risk and how to approach specific adverse events. Withal, understanding the predisposing risk factors associated with postimplant complications, early recognition and appropriate treatment help to significantly improve the prognosis for patients with end-stage heart failure.
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Monteagudo-Vela M, Panoulas V, García-Saez D, de Robertis F, Stock U, Simon AR. Outcomes of heart transplantation in patients bridged with Impella 5.0: Comparison with native chest transplanted patients without preoperative mechanical circulatory support. Artif Organs 2020; 45:254-262. [PMID: 32936936 DOI: 10.1111/aor.13816] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 12/19/2022]
Abstract
The Impella (Abiomed, Danvers, MA, USA) has become an important adjunct treatment modality in bridging patients with end-stage heart failure to recovery or orthotopic heart transplantation (HTx). We compared the outcome of patients directly bridged to HTx with the Impella 5.0 versus patients without mechanical circulatory support (MCS). Patients with no previous sternotomy or MCS, who were transplanted between September 2014 and March 2019 were included in this retrospective analysis. Impella 5.0 was implanted using surgical access and transesophageal echocardiography guidance. Forty-two out of 155 transplanted patients fulfilled the insertion criteria. Eight (19%) were bridged with Impella 5.0 to HTx. Recipient and donor baseline characteristics were comparable in both groups. There were no significant differences in survival between the groups at 30-day (94% no MCS vs. 87.5% Impella group, P = .47) or 6 months (94% vs. 87.5%, P = .51). Patients on Impella 5.0 showed a significant recovery of hemodynamic parameters and end-organ function. Average duration of support to HTx was 16 ± 17 days. Impella 5.0, when used in suitable patients in a timely fashion can be a good strategy for bridging patients to HTx. The axillary approach allows for early extubation and mobilization. Outcomes of patients bridged to HTx with Impella 5.0 in acute cardiogenic shock are comparable to those of patients with no MCS.
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Affiliation(s)
- María Monteagudo-Vela
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Vasileios Panoulas
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Diana García-Saez
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Fabio de Robertis
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ulrich Stock
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Andre Rudiger Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Hakeem A, Uretsky BF. Mechanical Circulatory Support with the Impella Family: Festina Lente. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:638-639. [PMID: 32600795 DOI: 10.1016/j.carrev.2020.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Abdul Hakeem
- Robert Wood Johnson University Hospital, Rutgers University, New Brunswick, NJ
| | - Barry F Uretsky
- Central Arkansas Veterans Health System, University of Arkansas for Medical Sciences, Little Rock, AR.
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16
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Impella in Cardiogenic Shock: Who and When? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:697. [DOI: 10.1016/j.carrev.2020.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 11/20/2022]
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Optimal Patient Selection using Objective Parameters for Impella Left Ventricular Assist Device Therapy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:696. [DOI: 10.1016/j.carrev.2020.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/21/2022]
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