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Salazar L, Lorusso R. Protected cardiac surgery: strategic mechanical circulatory support to improve postcardiotomy mortality. Curr Opin Crit Care 2024; 30:385-391. [PMID: 38958182 DOI: 10.1097/mcc.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW To examine the evolving landscape of cardiac surgery, focusing on the increasing complexity of patients and the role of mechanical circulatory support (MCS) in managing perioperative low cardiac output syndrome (P-LCOS). RECENT FINDINGS P-LCOS is a significant predictor of mortality in cardiac surgery patients. Preoperative risk factors, such as cardiogenic shock and elevated lactate levels, can help identify those at higher risk. Proactive use of MCS, rather than reactive implementation after P-LCOS develops, may lead to improved outcomes by preventing severe organ hypoperfusion. The emerging concept of "protected cardiac surgery" emphasizes early identification of these high-risk patients and planned MCS utilization. Additionally, specific MCS strategies are being developed and refined for various cardiac conditions, including AMI-CS, valvular surgeries, and pulmonary thromboendarterectomy. SUMMARY This paper explores the shifting demographics and complexities in cardiac surgery patients. It emphasizes the importance of proactive, multidisciplinary approaches to identify high-risk patients and implement early MCS to prevent P-LCOS and improve outcomes. The concept of protected cardiac surgery, involving planned MCS use and shared decision-making, is highlighted. The paper also discusses MCS strategies tailored to specific cardiac procedures and the ethical considerations surrounding MCS implementation.
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Affiliation(s)
- Leonardo Salazar
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Cardio-Thoracic Surgery Intensive Care Unit, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CAIM), Maastricht, The Netherlands
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2
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Keane RR, Menon V, Cremer PC. Acute Heart Valve Emergencies. Cardiol Clin 2024; 42:237-252. [PMID: 38631792 DOI: 10.1016/j.ccl.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Within the cardiac intensive care unit, prompt recognition of severe acute valvular lesions is essential because hemodynamic collapse can occur rapidly, especially when cardiac chambers have not had time for compensatory remodeling. Within this context, optimal medical management, considerations for temporary mechanical circulatory support and decisive treatments strategies are addressed. Fundamental concepts include an appreciation for how sudden changes in flow and pressure gradients between cardiac chambers can impact hemodynamic and echocardiographic findings differently compared to similarly severe chronic lesions, as well as understanding the main causes for decompensated heart failure and cardiogenic shock for each valvular abnormality.
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Affiliation(s)
- Ryan R Keane
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Heart Vascular and Thoracic Institute, 9500 Euclid Ave: Desk J1-5, Cleveland, OH 44195, USA
| | - Venu Menon
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Heart Vascular and Thoracic Institute, 9500 Euclid Ave: Desk J1-5, Cleveland, OH 44195, USA
| | - Paul C Cremer
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Heart Vascular and Thoracic Institute, 9500 Euclid Ave: Desk J1-5, Cleveland, OH 44195, USA.
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3
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Anantharaman R, Sundar C, Jena KK, Arun K. Is primary transcatheter aortic valve implantation the new normal? J Geriatr Cardiol 2024; 21:458-461. [PMID: 38800548 PMCID: PMC11112153 DOI: 10.26599/1671-5411.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Affiliation(s)
| | - C. Sundar
- Department of Cardiology, Kauvery Hospital, Chennai, India
| | | | - K. Arun
- Department of Cardiology, Kauvery Hospital, Chennai, India
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4
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Fraccaro C, Karam N, Möllmann H, Bleiziffer S, Bonaros N, Teles RC, Carrilho Ferreira P, Chieffo A, Czerny M, Donal E, Dudek D, Dumonteil N, Esposito G, Fournier S, Hassager C, Kim WK, Krychtiuk KA, Mehilli J, Pręgowski J, Stefanini GG, Ternacle J, Thiele H, Thielmann M, Vincent F, von Bardeleben RS, Tarantini G. Transcatheter interventions for left-sided valvular heart disease complicated by cardiogenic shock: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the Association for Acute Cardiovascular Care (ACVC) and the ESC Working Group on Cardiovascular Surgery. EUROINTERVENTION 2023; 19:634-651. [PMID: 37624587 PMCID: PMC10587846 DOI: 10.4244/eij-d-23-00473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
Valvular heart disease (VHD) is one of the most frequent causes of heart failure (HF) and is associated with poor prognosis, particularly among patients with conservative management. The development and improvement of catheter-based VHD interventions have broadened the indications for transcatheter valve interventions from inoperable/high-risk patients to younger/lower-risk patients. Cardiogenic shock (CS) associated with severe VHD is a clinical condition with a very high risk of mortality for which surgical treatment is often deemed a prohibitive risk. Transcatheter valve interventions might be a promising alternative in this setting given that they are less invasive. However, supportive scientific evidence is scarce and often limited to small case series. Current guidelines on VHD do not contain specific recommendations on how to manage patients with both VHD and CS. The purpose of this clinical consensus statement, developed by a group of international experts invited by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Scientific Documents and Initiatives Committee, is to perform a review of the available scientific evidence on the management of CS associated with left-sided VHD and to provide a rationale and practical approach for the application of transcatheter valve interventions in this specific clinical setting.
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Affiliation(s)
- Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Nicole Karam
- Heart Valves Unit, Georges Pompidou European Hospital, Université Paris Cité, INSERM, Paris, France
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | | | - Nikolaos Bonaros
- Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Rui Campante Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental (HSC), Carnaxide, Portugal and Comprehensive Health Research Center (CHRC), Nova Medical School, Lisbon, Portugal
| | - Pedro Carrilho Ferreira
- Cardiology Department, Santa Maria University Hospital, CHULN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Centre, Freiburg University, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erwan Donal
- Service de Cardiologie, CCP CHU de Rennes, University of Rennes, INSERM, LTSI-UMR 1099, Rennes, France
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Giovanni Esposito
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Stephane Fournier
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland and University of Lausanne, Lausanne, Switzerland
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Won-Keun Kim
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Konstantin A Krychtiuk
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Julinda Mehilli
- Department of Cardiology, German Centre for Cardiovascular Research (DZHK), Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik I, Landshut-Achdorf Hospital, Landshut, Germany
| | - Jerzy Pręgowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Giulio G Stefanini
- Department of Biomedical Sciences Humanitas University, Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS Rozzano, Milan, Italy
| | - Julien Ternacle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC, Canada and Université Laval, Quebec, QC, Canada
- Haut-Leveque Cardiology Hospital, Bordeaux University, Pessac, France
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, Leipzig, Germany and University of Leipzig, Leipzig, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Flavien Vincent
- Service de Cardiologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | | | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Eftychiou S, Kalakoutas A, Proudfoot A. The role of temporary mechanical circulatory support in de novo heart failure syndromes with cardiogenic shock: A contemporary review. JOURNAL OF INTENSIVE MEDICINE 2023; 3:89-103. [PMID: 37188124 PMCID: PMC10175707 DOI: 10.1016/j.jointm.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 05/17/2023]
Abstract
Cardiogenic shock (CS) is a complex clinical syndrome with a high mortality rate. It can occur to due to multiple etiologies of cardiovascular disease and is phenotypically heterogeneous. Acute myocardial infarction-related CS (AMI-CS) has historically been the most prevalent cause, and thus, research and guidance have focused primarily on this. Recent data suggest that the burden of non-ischemic CS is increasing in the population of patents requiring intensive care admission. There is, however, a paucity of data and guidelines to inform the management of these patients who fall into two broad groups: those with existing heart failure and CS and those with no known history of heart failure who present with "de novo" CS. The use of temporary mechanical circulatory support (MCS) has expanded across all etiologies, despite its high cost, resource intensity, complication rates, and lack of high-quality outcome data. Herein, we discuss the currently available evidence on the role of MCS in the management of patients with de novo CS to include fulminant myocarditis, right ventricular (RV) failure, Takotsubo syndrome, post-partum cardiomyopathy, and CS due to valve lesions and other cardiomyopathies.
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Affiliation(s)
| | - Antonis Kalakoutas
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0AG, UK
- Barts and the London School of Medicine and Dentistry, London E1 2AD, UK
| | - Alastair Proudfoot
- Department of Perioperative Medicine, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK
- Queen Mary University of London, London EC1M 6BQ, UK
- Department of Anaesthesiology and Intensive Care, German Heart Centre Berlin, Berlin 13353, Germany
- Corresponding author: Alastair Proudfoot, Department of Perioperative Medicine, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK
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Avvedimento M, Angellotti D, Ilardi F, Leone A, Scalamogna M, Catiello DS, Manzo R, Mariani A, Molaro MI, Simonetti F, Spaccarotella CAM, Piccolo R, Esposito G, Franzone A. Acute advanced aortic stenosis. Heart Fail Rev 2023:10.1007/s10741-023-10312-7. [PMID: 37083966 PMCID: PMC10403405 DOI: 10.1007/s10741-023-10312-7] [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] [Accepted: 04/09/2023] [Indexed: 04/22/2023]
Abstract
Acute decompensation often represents the onset of symptoms associated with severe degenerative aortic stenosis (AS) and usually complicates the clinical course of the disease with a dismal impact on survival and quality of life. Several factors may derange the faint balance between left ventricular preload and afterload and precipitate the occurrence of symptoms and signs of acute heart failure (HF). A standardized approach for the management of this condition is currently lacking. Medical therapy finds very limited application in this setting, as drugs usually indicated for the control of acute HF might worsen hemodynamics in the presence of AS. Urgent aortic valve replacement is usually performed by transcatheter than surgical approach whereas, over the last decades, percutaneous balloon valvuloplasty gained renewed space as bridge to definitive therapy. This review focuses on the pathophysiological aspects of acute advanced AS and summarizes current evidence on its management.
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Affiliation(s)
- Marisa Avvedimento
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Domenico Angellotti
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Maria Scalamogna
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Domenico Simone Catiello
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Andrea Mariani
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Maddalena Immobile Molaro
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Fiorenzo Simonetti
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | | | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy.
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Ortoleva J. Intra-aortic balloon pump as a vent in VA-ECMO; lower risk, but beware. J Cardiothorac Vasc Anesth 2022; 36:4553. [PMID: 36057508 DOI: 10.1053/j.jvca.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 07/31/2022] [Accepted: 08/03/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Jamel Ortoleva
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, United States.
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8
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Davoodabadi Z, Hosseini Z, Norouzi S, Davoodabadi H, Sheikh-Sharbafan R, Ghodsi S. Cardiogenic shock following acute MI in a young patient with familial hypercholesterolemia, and severe aortic stenosis: A case report. Heliyon 2022; 8:e11909. [PMID: 36506387 PMCID: PMC9732302 DOI: 10.1016/j.heliyon.2022.e11909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/15/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background Familial hypercholesterolemia is a relatively rare disorder with various clinical manifestations including premature coronary artery disease. Case presentation A 15-year-old boy presented with acute exacerbation of dyspnea and exertional chest pain with a progressive feature since one month earlier. He had a clustered family history of premature cardiovascular death, hyperlipidemia, and cutaneous lesions in two of his siblings. He presented with acute severe heart failure accompanied with high levels of cardiac troponin and LDL cholesterol. Echocardiography revealed severe LV dysfunction, in concert with valvular and supravalvular Aortic stenosis. He underwent Coronary angiography, which showed involvement of Left main coronary artery and two-vessel disease. The patient was diagnosed with cardiogenic shock secondary to acute non-ST segment elevation myocardial infarction, and phenotype of familial hypercholesterolemia. Conclusions Premature malignant atherogenesis in both aortic root and coronary arteries with early presentation of acute myocardial infarction and severe heart failure is an uncommon constellation in early course of the FH, which leads to confined treatment options.
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Affiliation(s)
- Zeinab Davoodabadi
- Department of Cardiology, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Zahra Hosseini
- Department of Cardiology, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Somayyeh Norouzi
- Department of Cardiology, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Hassan Davoodabadi
- Department of General Surgery, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Reza Sheikh-Sharbafan
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Ghodsi
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author.
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