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Abdul-Rahman T, Lizano-Jubert I, Garg N, Tejerina-Marion E, Awais Bukhari SM, Luisa Ek A, Wireko AA, Mares AC, Sikora V, Gupta R. The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery. Healthcare (Basel) 2023; 11:healthcare11081094. [PMID: 37107928 PMCID: PMC10137626 DOI: 10.3390/healthcare11081094] [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: 02/01/2023] [Revised: 02/28/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
In the United States, about one million people are seen to visit the operating theater for cardiac surgery annually. However, nearly half of these visits result in complications such as renal, neurological, and cardiac injury of varying degrees. Historically, many mechanisms and approaches have been explored in attempts to reduce injuries associated with cardiac surgery and percutaneous procedures. Devices such as cardioplegia, mechanical circulatory support, and other methods have shown promising results in managing and preventing life-threatening cardiac-surgery-related outcomes such as heart failure and cardiogenic shock. Comparably, cardioprotective devices such as TandemHeart, Impella family devices, and venoarterial extracorporeal membrane oxygenation (VA-ECMO) have also been proven to show significant cardioprotection through mechanical support. However, their use as interventional agents in the prevention of hemodynamic changes due to cardiac surgery or percutaneous interventions has been correlated with adverse effects. This can lead to a rebound increased risk of mortality in high-risk patients who undergo cardiac surgery. Further research is necessary to delineate and stratify patients into appropriate cardioprotective device groups. Furthermore, the use of one device over another in terms of efficacy remains controversial and further research is necessary to assess device potential in different settings. Clinical research is also needed regarding novel strategies and targets, such as transcutaneous vagus stimulation and supersaturated oxygen therapy, aimed at reducing mortality among high-risk cardiac surgery patients. This review explores the recent advances regarding the use of cardioprotective devices in patients undergoing percutaneous procedures and cardiac surgery.
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Affiliation(s)
- Toufik Abdul-Rahman
- Medical Institute, Sumy State University, 40007 Sumy, Ukraine
- Department of Cardiology, Otto Von Guericke University of Magdeburg, 39120 Magdeburg, Germany
| | - Ileana Lizano-Jubert
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac Campus Norte, Huixquilucan 52786, Mexico
| | - Neil Garg
- Rowan-Virtua School of Osteopathic Medicine, One Medical Center Drive Stratford, Stratford, NJ 08084, USA
| | - Emilio Tejerina-Marion
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac Campus Norte, Huixquilucan 52786, Mexico
| | | | - Ana Luisa Ek
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac Campus Norte, Huixquilucan 52786, Mexico
| | - Andrew Awuah Wireko
- Medical Institute, Sumy State University, 40007 Sumy, Ukraine
- Department of Cardiology, Otto Von Guericke University of Magdeburg, 39120 Magdeburg, Germany
| | - Adriana C Mares
- Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Vladyslav Sikora
- Medical Institute, Sumy State University, 40007 Sumy, Ukraine
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli, 20, 71122 Foggia, Italy
| | - Rahul Gupta
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA 18103, USA
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Rajak K, Halder A, Paghdar S, Desai SP, Ruiz J, Goswami R. Extracorporeal Membrane Oxygenation-Impella (ECPELLA) in a Patient With Recalcitrant Ventricular Tachycardia Undergoing Ablation. Cureus 2023; 15:e38114. [PMID: 37113459 PMCID: PMC10128096 DOI: 10.7759/cureus.38114] [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] [Accepted: 04/23/2023] [Indexed: 04/29/2023] Open
Abstract
In advanced heart failure, refractory hemodynamically unstable ventricular tachycardia (VT) can be life-threatening. The utilization of short-term temporary mechanical circulatory support (MCS) has been described. Still, it is limited to the intra-aortic balloon pump (IABP) or Impella 2.5/CP (Abiomed Inc., Danvers, MA, USA) which may only provide up to 1-2.5 L/min of added support. Escalation of MCS therapies should be considered. Referrals to advanced tertiary heart transplant centers should be done early to afford patients the best chance at an optimal outcome, with the option for heart transplant evaluation if needed. We present a case of recalcitrant hemodynamically unstable VT complicated by cardiac arrest, eventually undergoing successful VT ablation while supported on veno-arterial extracorporeal membrane oxygenation (VA ECMO) and Impella 5.5 as a vent strategy in the extracorporeal membrane oxygenation-Impella (ECPELLA) configuration.
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Affiliation(s)
- Kripa Rajak
- Internal Medicine, University of Pittsburgh Medical Center (UPMC) Harrisburg, Harrisburg, USA
| | - Anupam Halder
- Internal Medicine, University of Pittsburgh Medical Center (UPMC) Harrisburg, Harrisburg, USA
| | | | | | - Jose Ruiz
- Transplant, Mayo Clinic, Jacksonville, USA
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Tutunjian AM, Ortoleva JP, Zhan Y, Chen FY, Couper GS, Kawabori M. Using aortic arch short axis views during transesophageal echocardiographic examination facilitates right ventricular assist device imaging. J Card Surg 2022; 37:1052-1055. [PMID: 34989464 DOI: 10.1111/jocs.16204] [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: 08/23/2021] [Revised: 11/18/2021] [Accepted: 12/15/2021] [Indexed: 12/01/2022]
Abstract
Given the increased need for mechanical circulatory support and subsequent development of right ventricular assist devices (RVAD), appropriate imaging needs to be described to facilitate care in patients with cardiogenic shock and heart failure. We present three cases in which the upper esophageal aortic arch short axis (UE AA SAX) view on transesophageal echocardiography (TEE) was utilized to effectively image RVADs: to confirm normal positioning, to detect and guide repositioning, and to visualize malfunction. These cases support the importance of the UE AA SAX TEE view in RVAD outflow imaging and, when obtainable, should be included in routine RVAD assessment.
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Affiliation(s)
- Alyssa M Tutunjian
- Tufts University School of Medicine, Boston, Massachusetts, USA.,CardioVascular Center, Cardiac Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jamel P Ortoleva
- Department of Anesthesia, Tufts Medical Center, Boston, Massachusetts, USA
| | - Yong Zhan
- CardioVascular Center, Cardiac Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Frederick Y Chen
- CardioVascular Center, Cardiac Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Gregory S Couper
- CardioVascular Center, Cardiac Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Masashi Kawabori
- CardioVascular Center, Cardiac Surgery, Tufts Medical Center, Boston, Massachusetts, USA
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Iannaccone M, Venuti G, di Simone E, De Filippo O, Bertaina M, Colangelo S, Boccuzzi G, de Piero ME, Attisani M, Barbero U, Zanini P, Livigni S, Noussan P, D'Ascenzo F, de Ferrari GM, Porto I, Truesdell AG. Comparison of ECMO vs ECpella in patients with non post-pericardiotomy cardiogenic shock: An updated meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:134-141. [PMID: 34654655 DOI: 10.1016/j.carrev.2021.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/12/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The impact of Impella and ECMO (ECPELLA) in cardiogenic shock (CS) remains to be defined. The aim of this meta-analysis is to evaluate the benefit of ECPELLA compared to VA-ECMO in patients with non post-pericardiotomy CS. METHODS All studies reporting short term outcomes of ECpella or VA ECMO in non post-pericardiotomy CS were included. The primary endpoint was 30-day mortality. Vascular and bleeding complications and LVAD implantation/heart transplant within 30-days were assessed as secondary outcomes. RESULTS Of 407 studies identified, 13 observational studies (13,682 patients, 13,270 with ECMO and 412 with ECpella) were included in this analysis. 30-day mortality was 55.8% (51.6-59.9) in the VA-ECMO group and 58.3% (53.5-63.0) in the ECpella group. At meta-regression analysis the implantation of IABP did not affect mortality in the ECMO group. The rate of major bleeding in patients on VA-ECMO and ECpella support were 21.3% (16.9-26.5) and 33.1% (25.9-41.2) respectively, while the rates of the composite outcome of LVAD implantation and heart transplantation within 30-days in patients on VA-ECMO and ECpella support were 14.4% (9.0-22.2) and 10.8%. When directly compared in 3 studies, ECpella showed a positive effect on 30-day mortality compared to ECMO (OR: 1.81: 1.039-3.159). CONCLUSION Our data suggest that ECpella may reduce 30-day mortality and increase left ventricle recovery, despite increased of bleeding rates.
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Affiliation(s)
- Mario Iannaccone
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy.
| | | | - Emanuela di Simone
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Città della Scienza e della Salute, University of Turin, Turin, Italy
| | - Maurizio Bertaina
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Salvatore Colangelo
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Giacomo Boccuzzi
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Maria Elena de Piero
- Department of Anesthesiology and Intensive Care, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Matteo Attisani
- Division of Cardiology, Città della Scienza e della Salute, University of Turin, Turin, Italy
| | | | - Paola Zanini
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Sergio Livigni
- Department of Anesthesiology and Intensive Care, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Patrizia Noussan
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Città della Scienza e della Salute, University of Turin, Turin, Italy
| | | | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
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Abstract
BACKGROUND Patients with isolated left ventricular failure may have positive outcomes after being implanted with a left ventricular assist device. Unfortunately, almost half of patients with heart failure and reduced ejection fraction also have evidence of right ventricular dysfunction. For a subset of this population with severe biventricular failure, or those who develop right ventricular dysfunction after left ventricular assist device implantation, patients may necessitate biventricular assist devices or the total artificial heart. OBJECTIVES This overview of mechanical circulatory support devices will enhance nurses' ability to differentiate criteria for implantation, current practice, and outcomes with a focus on durable ventricular assist devices and the total artificial heart. METHODS A review of the literature involved searching CINAHL and PubMed databases using keywords biventricular assist devices, total artificial heart, and durable mechanical circulatory support. Results were narrowed to articles based on adults, 18 years or older. Seventy-eight relevant articles were identified, and 8 articles compared the durable biventricular assist devices. RESULTS Similar patient outcomes were found when comparing the use of left ventricular assist devices as biventricular support versus the total artificial heart. DISCUSSION The decision to implant the appropriate durable mechanical circulatory support for a patient in biventricular failure is complex and dependent on patient factors.
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Sandoval E, Fernández-Cisneros A, Pereda D. Minimally invasive single-incision temporary biventricular assist device. Asian Cardiovasc Thorac Ann 2020; 28:604-606. [PMID: 33141596 DOI: 10.1177/0218492320951014] [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] [Indexed: 11/17/2022]
Abstract
New short-term devices have been developed to allow percutaneous insertion. However, in some cases, open insertion becomes necessary. Less invasive insertion of short-term devices has been described previously, using two incisions. We present the case of a patient who underwent minimally invasive insertion of a biventricular device, using a single incision.
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Affiliation(s)
- Elena Sandoval
- Cardiovascular Surgery Department, ICCV, Hospital Clínic, Barcelona, Spain
| | | | - Daniel Pereda
- Cardiovascular Surgery Department, ICCV, Hospital Clínic, Barcelona, Spain.,CIBER de Enfermedades Cardiovasculares, Madrid, Spain
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