1
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Lamberti KK, Goffer EM, Edelman ER, Keller SP. Differential Effects of Pharmacologic and Mechanical Support on Right-Left Ventricular Coupling. J Cardiovasc Transl Res 2024:10.1007/s12265-024-10522-w. [PMID: 38767797 DOI: 10.1007/s12265-024-10522-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Percutaneous ventricular assist devices are increasingly relied on to maintain perfusion for cardiogenic shock patients. Optimal medical management strategies however remain uncertain from limited understanding of interventricular effects. This study analyzed the effects of pharmacologic and left-sided mechanical support on right ventricular function. METHODS A porcine model was developed to assess biventricular function during bolus pharmacologic administration before and after left-sided percutaneous ventricular assist and in cardiogenic shock. RESULTS The presence of mechanical support increased right ventricular load and stress with respect to the left ventricle. This shifted and exaggerated the relative effects of commonly used vasoactive agents. Furthermore, induction of cardiogenic shock led to differential pulmonary vascular and right ventricular responses. CONCLUSIONS Left ventricular ischemia and mechanical support altered interventricular coupling. Resulting impacts of pharmacologic agents indicate differential right heart responses and sensitivity to treatments and the need for further study to optimize biventricular function in shock patients.
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Affiliation(s)
- Kimberly K Lamberti
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Efrat M Goffer
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Medicine (Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Steven P Keller
- Department of Medicine (Pulmonary and Critical Care Medicine), Johns Hopkins University, 1830 E. Monument Street 1830 Building; 5th Floor, Baltimore, MD, 21215, USA.
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21215, USA.
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2
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Valdes CA, Stinson G, Sharaf OM, Jimenez Contreras F, Bilgili A, Ahmed MM, Vilaro J, Parker AM, Al-Ani MAZ, Demos D, Aranda J, Bleiweis M, Beaver TM, Jeng EI. Reconsidering FDA Guidelines: A Single-Center Experience of Prolonged Impella 5.5 Support. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:46-53. [PMID: 38013250 DOI: 10.1177/15569845231212157] [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] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Impella 5.5 (Abiomed, Danvers, MA, USA) is approved by the US Food and Drug Administration (FDA) for mechanical circulatory support for ≤14 days. It is unknown whether prolonged support is associated with worse outcomes. We sought to review our single-center experience with Impella 5.5 and compare outcomes based on support duration. METHODS We retrospectively reviewed adult patients (≥18 years old) supported with Impella 5.5 at our institution (May 2020 to April 2023). Patients on prolonged support (>14 days) were compared with those supported for ≤14 days. RESULTS There were 31 patients supported with Impella 5.5 including 14 (45.2%) supported >14 days. Median support duration for those on prolonged support was 43.5 (interquartile range [IQR] 25 to 63.5) days versus 8 (IQR 6, 13) days for those who were not (P < 0.001). Overall, the device-related complication rate was 9.7% and did not differ between groups (P = 0.08). Overall, 30-day postimplant survival was 71% and did not differ by support duration (P = 0.2). In-hospital mortality was 32% and did not differ between cohorts (P > 0.99). Among those surviving to explant (n = 22), long-term strategy included bridge to durable ventricular assist device (18%, n = 4), cardiac transplant (55%, n = 12), and cardiac recovery (27%, n = 6). CONCLUSIONS High-risk patients with cardiogenic shock may be supported with Impella 5.5 beyond the FDA-approved duration without increased risk of complications or mortality.
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3
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Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Heart Lung Transplant 2023; 42:e1-e64. [PMID: 36805198 DOI: 10.1016/j.healun.2022.10.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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4
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Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Card Fail 2023; 29:304-374. [PMID: 36754750 DOI: 10.1016/j.cardfail.2022.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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5
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Haddad O, Jacob S, Ung RL, Goswami RM, Patel PC, Pham SM, Sareyyupoglu B. Impella flow pump reinsertion after axillary graft thrombectomy: Technical points in replacing axillary Impella. SAGE Open Med Case Rep 2021; 9:2050313X211032401. [PMID: 34290874 PMCID: PMC8278451 DOI: 10.1177/2050313x211032401] [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: 04/05/2021] [Accepted: 06/24/2021] [Indexed: 11/24/2022] Open
Abstract
Axillary Impella devices are increasingly employed for long-term support of patients with systolic heart failure and shock. Axillary access allows for awake support and ambulation, which carries an inherent risk of disconnection or malposition. We report a series of two cases where device replacement due to dysfunction and malposition can be completed safely through the original axillary graft using axillary graft thrombectomy, given that the clot burden could be a major source of morbidity to the patient.
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Affiliation(s)
- Osama Haddad
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Ryan L Ung
- Departments of Transplantation, Advanced Heart Failure and Transplant Cardiology, Mayo Clinic, Jacksonville, FL, USA
| | - Rohan M Goswami
- Departments of Transplantation, Advanced Heart Failure and Transplant Cardiology, Mayo Clinic, Jacksonville, FL, USA
| | - Parag C Patel
- Departments of Transplantation, Advanced Heart Failure and Transplant Cardiology, Mayo Clinic, Jacksonville, FL, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
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6
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Cannata A, Carrozzini M, Tata G, Russo CF. Thrombosis of the innominate artery during prolonged cardiac support by right transaxillary Impella 5.0 device. EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.9123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We describe an unexpected complication in a 46-years-old man affected by ischemic cardiomyopathy who received a prolonged mechanical cardiac support by means of right transaxillary Impella 5.0. The postoperative course was complicated by recurrent septicemia from multi-durg resistant Acinetobacter baumanii. He underwent implantation of venoarterial extracorporeal membrane oxygenation because of refractory cardiac arrest, followed by Impella removal that has been complicated by embolic stroke. The likely source of the embolus was a large thrombus inside the innominate artery. After a long-standing right transaxillary device implantation, particularly in patients with intercurrent septic episodes, a CT angiographic scan should be planned to exclude arterial thrombosis before removal of the transarterial device.
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7
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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: 1.5] [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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8
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Succar L, Sulaica EM, Donahue KR, Wanat MA. Management of Anticoagulation with Impella® Percutaneous Ventricular Assist Devices and Review of New Literature. J Thromb Thrombolysis 2020; 48:284-291. [PMID: 30877619 DOI: 10.1007/s11239-019-01837-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cardiogenic shock is a life-threatening condition that may occur secondary to a variety of cardiac conditions, and may require temporary support with percutaneous ventricular devices like the Impella®. Anticoagulation in patients with Impella® devices can often be complicated due to unpredictable purge flow rates, pre-existing coagulopathy, or heparin allergies. The purpose of this article is to discuss the various options for anticoagulation in the setting of Impella®. The article will also describe recent updates (2014-current) in literature surrounding anticoagulation therapy for Impella® devices. At total of 228 articles were initially obtained through the PubMed search, with inclusion of 6 articles. A total of 51 patients had data in the six studies that were included in the review. Heparin for anticoagulation in the purge solution, at two different dextrose concentrations (5% and 20%), was associated with similar therapeutic activated partial thromboplastin time rates, thrombotic and bleeding events. One case series described the use of argatroban in the purge solution for anticoagulation in two patients with suspected heparin-induced thrombocytopenia, without bleeding or thrombotic complications. Pump thrombosis was not reported in any of the six studies. Anticoagulation in the setting of mechanical circulatory support devices is a challenging aspect of critical care. Institutions should have set protocols that clearly define the options for anticoagulation. Future studies that look at longer durations of support and possible operation of the Impella® device with a heparin-free purge solution are needed.
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Affiliation(s)
- Luma Succar
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
| | - Elisabeth M Sulaica
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - Kevin R Donahue
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew A Wanat
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA.
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA.
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9
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Bernhardt AM, Hakmi S, Sinning C, Lubos E, Reichenspurner H. A newly developed transaortic axial flow ventricular assist device: Early clinical experience. J Heart Lung Transplant 2019; 38:466-467. [DOI: 10.1016/j.healun.2018.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022] Open
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10
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Bertoglio L, Katsarou M, Scandroglio M, Bertoldi L, Chiesa R, Pappalardo F. Surgical transaxillary placement of the Impella 5.0 ventricular assist device. J Card Surg 2019; 34:92-98. [DOI: 10.1111/jocs.13978] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Luca Bertoglio
- Division of Vascular Surgery; San Raffaele Scientific Institute; “Vita-Salute” University; Milan Italy
| | - Maria Katsarou
- Division of Vascular Surgery; San Raffaele Scientific Institute; “Vita-Salute” University; Milan Italy
| | - Mara Scandroglio
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Vita-Salute San Raffaele University; Milan Italy
| | - Letizia Bertoldi
- Cardiac Intensive Care; Advanced Heart Failure and Mechanical Circulatory Support Program; San Raffaele Scientific Institute; Milan Italy
| | - Roberto Chiesa
- Division of Vascular Surgery; San Raffaele Scientific Institute; “Vita-Salute” University; Milan Italy
| | - Federico Pappalardo
- Department of Anesthesia and Intensive Care; San Raffaele Scientific Institute; Vita-Salute San Raffaele University; Milan Italy
- Cardiac Intensive Care; Advanced Heart Failure and Mechanical Circulatory Support Program; San Raffaele Scientific Institute; Milan Italy
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11
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Percutaneous Mechanical Circulatory Support Using Impella Devices for Decompensated Cardiogenic Shock: A Pediatric Heart Center Experience. ASAIO J 2018; 64:98-104. [PMID: 28394814 DOI: 10.1097/mat.0000000000000581] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Cardiogenic shock remains a significant cause of mortality and morbidity in children with heart failure. Percutaneous mechanical circulatory support may be an additional tool to augment left heart support and decompression in addition to conventional therapies. This report aims to review the clinical and hemodynamic outcomes of the Impella device at a pediatric center. A retrospective review of all implants between October 2014 and November 2016 was conducted. Clinical outcomes, device implant techniques, complications, and hemodynamic data were collected. Statistical analysis was performed on hemodynamic and echocardiographic data. There were 10 Impella device placements in 8 patients with a median age of 17 years (6.5-25) and support duration of 8 days (1-21). Implant diagnosis included 5 patients with either posttransplant rejection or allograft vasculopathy, 2 patients with myocarditis, and 1 patient with refractory ventricular tachycardia. Extracorporeal membrane oxygenation support was required in 4 patients. Significant reduction in pulmonary capillary wedge pressures/left atrial pressures (p = 0.031) and increase in near infrared spectroscopy (p = 0.039) was seen pre- and post-Impella implant. All patients survived to discharge from the intensive care unit with one late death. Percutaneous mechanical circulatory support is a viable option in experienced pediatric centers as a mode to augment cardiac output or to decompress the left heart in patients on extracorporeal membrane oxygenation or with cardiogenic shock.
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12
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Pantin E, Kahan A, Chiricolo A, Levin D, Batsides G, Papp D. Intra-Arterial Fibrinous Sheath Development as a Potential Complication of the Impella Ventricular Assist Device. J Cardiothorac Vasc Anesth 2018; 33:501-505. [PMID: 29580794 DOI: 10.1053/j.jvca.2018.02.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Enrique Pantin
- Department of Anesthesiology, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ.
| | - Alexander Kahan
- Department of Anesthesiology, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Antonio Chiricolo
- Department of Anesthesiology, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Danielle Levin
- Department of Anesthesiology, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ
| | - George Batsides
- Department of Surgery, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Denes Papp
- Department of Anesthesiology, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ
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13
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Use of the Impella 5.0 Device as a Bridge to Recovery in Adult Fulminant Viral Myocarditis. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 10:279-81. [PMID: 26368033 DOI: 10.1097/imi.0000000000000171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a case of a 48-year-old female patient successfully bridged to recovery with the Impella 5.0 microaxial pump (Abiomed, Danvers, MA USA) after presenting with cardiogenic shock secondary to acute fulminant viral myocarditis. After 1 week of flu-like symptoms, the patient presented to her community emergency department with chest pain and hypotension. A diagnosis of inferior ST elevation myocardial infarction was made; subsequent angiography demonstrated normal coronary arteries and a left ventricular ejection fraction of 10%. A provisional diagnosis of viral myocarditis was made. As her condition deteriorated further, she underwent insertion of an Impella 5.0 after failure of supportive medical therapy. Myocardial recovery occurred, and the Impella was removed after 1 week. After a prolonged cardiac intensive care unit stay requiring temporary hemodialysis, the patient recovered sufficiently to tolerate device explant, transfer to the recovery ward, and ultimate discharge home. This case report highlights the benefit of mechanical circulatory support in a patient with cardiogenic shock from viral myocarditis as well as some of the complications that can occur in this critically ill subset of patients.
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14
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Lima B, Kale P, Gonzalez-Stawinski GV, Kuiper JJ, Carey S, Hall SA. Effectiveness and Safety of the Impella 5.0 as a Bridge to Cardiac Transplantation or Durable Left Ventricular Assist Device. Am J Cardiol 2016; 117:1622-1628. [PMID: 27061705 DOI: 10.1016/j.amjcard.2016.02.038] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/18/2016] [Accepted: 02/18/2016] [Indexed: 11/25/2022]
Abstract
Many patients with end-stage heart failure require mechanical circulatory support as a temporizing measure to enable multidisciplinary assessment for the most suitable therapeutic strategy. Impella 5.0 can be used as a bridge to decision to evaluate patients for potential recovery or bridge to next therapy (bridge to heart transplantation [BTHT] or bridge to durable left ventricular assist device or VAD [BLVAD]. Our goal was to examine single-center outcomes with the Impella 5.0 device as a bridge to next therapy (BTHT or BTLVAD). Forty patients underwent Impella 5.0 support from December 2009 to December 2015 with the intent of BTHT (n = 20) or BTLVAD (n = 20). The primary end point was survival to next therapy. Secondary end points included hemodynamic assessments and in-hospital/30-day complications. All patients were inotrope-dependent, with severely depressed left ventricular ejection fraction (12%) and renal insufficiency (creatinine 2.0 mg/dl). Most were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 2 (66%) with biventricular failure (65%). Thirty patients (75%) survived to next therapy, including transplant (n = 13), durable LVAD (n = 15), and recovery of native heart function (n = 2). No strokes or major bleeding events requiring surgery were observed. Acute renal dysfunction, bleeding requiring transfusion, hemolysis, device malfunction, limb ischemia occurred in 13 (33%), 11 (28%), 3 (8%), 4 (10%), and 1 (3%) patients, respectively. Survival rate to discharge and/or 30 days was 68% (27 of 40). Temporary support with the Impella 5.0 allows for an effective bridge to decision strategy for hemodynamic stabilization and multidisciplinary heart team assessment of critically ill patients with heart failure. In conclusion, many of these patients can be subsequently bridged to the next therapy with favorable outcomes.
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Weis RA, Devaleria PA, Koushik S, Ramakrishna H. The increasing importance of percutaneous mechanical circulatory assist device therapy in heart failure management. Ann Card Anaesth 2015; 18:467-73. [PMID: 26440230 PMCID: PMC4881681 DOI: 10.4103/0971-9784.166441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Advances in medical and surgical care have made it possible for an increasing number of patients with Congenital Heart disease (CHD) to live into adulthood. Transposition of the great vessels (TGV) is the most common cyanotic congenital cardiac disease where the right ventricle serves as systemic ventricle. It is not uncommon for these patients to have systemic ventricular failure requiring transplantation. Study Design: Hemodynamic decompensation in these patients can be swift and difficult to manage. Increasingly percutaneous LVAD's such as the Impella (Abiomed, Mass, USA) are gaining popularity in these situations owing to their relative ease of placement, both in and outside of the operating room. Conclusion: In this paper we demonstrate that Impella (IMP) CP placement through the axillary artery approach shows to be suitable option for short term cardiac support and improvement of end organ perfusion in anticipation of cardiac transplantation.
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Affiliation(s)
| | | | | | - Harish Ramakrishna
- Department of Anesthesiology, Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
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16
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Mechanical bridge to long-term device implant: the necessary step for better outcomes. ASAIO J 2015; 61:225-6. [PMID: 25914949 DOI: 10.1097/mat.0000000000000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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