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Dangl M, Albosta M, Butros H, Loebe M. Temporary Mechanical Circulatory Support: Left, Right, and Biventricular Devices. Curr Cardiol Rev 2023; 19:27-42. [PMID: 36918790 PMCID: PMC10518886 DOI: 10.2174/1573403x19666230314115853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/08/2023] [Accepted: 01/16/2023] [Indexed: 03/16/2023] Open
Abstract
Temporary mechanical circulatory support (MCS) encompasses a wide array of invasive devices, which provide short-term hemodynamic support for multiple clinical indications. Although initially developed for the management of cardiogenic shock, indications for MCS have expanded to include prophylactic insertion prior to high-risk percutaneous coronary intervention, treatment of acute circulatory failure following cardiac surgery, and bridging of end-stage heart failure patients to more definitive therapies, such as left ventricular assist devices and cardiac transplantation. A wide variety of devices are available to provide left ventricular, right ventricular, or biventricular support. The choice of a temporary MCS device requires consideration of the clinical scenario, patient characteristics, institution protocols, and provider familiarity and training. In this review, the most common forms of left, right, and biventricular temporary MCS are discussed, along with their indications, contraindications, complications, cannulations, hemodynamic effects, and available clinical data.
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Affiliation(s)
- Michael Dangl
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - Michael Albosta
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - Hoda Butros
- Department of Medicine, Cardiovascular Division, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - Matthias Loebe
- Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
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Simko LC. Cardiogenic Shock and the Use of Percutaneous Mechanical Assist Devices. Crit Care Nurse 2022; 42:56-67. [PMID: 35100629 DOI: 10.4037/ccn2022140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Percutaneous mechanical assist devices are used in patients with cardiogenic shock. The purpose of this article is to familiarize critical care nurses with the various types of percutaneous mechanical assist devices, including the intra-aortic balloon pump, the Impella device, extracorporeal membrane oxygenation, and the TandemHeart device. Each type of device requires specific nursing care. In a patient with cardiogenic shock, the monitoring, care, and interventions provided by an experienced critical care nurse can make the difference between survival and death.
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Affiliation(s)
- Lynn Coletta Simko
- Lynn Coletta Simko is a retired associate professor, North Versailles, Pennsylvania
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Oezkur M, Reda S, Rühl H, Theuerkauf N, Kreyer S, Duerr GD, Charitos E, Silaschi M, Medina M, Zimmer S, Putensen C, Treede H. Role of acquired von Willebrand syndrome in the development of bleeding complications in patients treated with Impella RP devices. Sci Rep 2021; 11:23722. [PMID: 34887445 PMCID: PMC8660831 DOI: 10.1038/s41598-021-02833-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/16/2021] [Indexed: 11/09/2022] Open
Abstract
Axial flow pumps are standard treatment in cases of cardiogenic shock and high-risk interventions in cardiology and cardiac surgery, although the optimal anticoagulation strategy remains unclear. We evaluated whether laboratory findings could predict bleeding complications and acquired von Willebrand syndrome (avWS) among patients who were treated using axial flow pumps. We retrospectively evaluated 60 consecutive patients who received Impella devices (Impella RP: n = 20, Impella CP/5.0: n = 40; Abiomed Inc., Danvers, USA) between January 2019 and December 2020. Thirty-two patients (53.3%) experienced major or fatal bleeding complications (Bleeding Academic Research Consortium score of > 3) despite intravenous heparin being used to maintain normal activated partial thromboplastin times (40–50 s). Extensive testing was performed for 28 patients with bleeding complications (87.5%). Relative to patients with left ventricular support, patients with right ventricular support were less likely to develop avWS (87.5% vs. 58.8%, p = 0.035). Bleeding was significantly associated with avWS (odds ratio [OR]: 20.8, 95% confidence interval [CI]: 3.3–128.5; p = 0.001) and treatment duration (OR: 1.3, 95% CI 1.09–1.55; p = 0.003). Patients with avWS had longer Impella treatment than patients without avWS (2 days [1–4.7 days] vs. 7.3 days [3.2–13.0 days]). Bleeding complications during Impella support were associated with avWS in our cohort, while aPTT monitoring was not sufficient to prevent bleeding complications. A more targeted anticoagulation monitoring might be needed for patients who receive Impella devices.
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Affiliation(s)
- Mehmet Oezkur
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany. .,Department of Cardiovascular Surgery, University Hospital Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Sara Reda
- Department of Haematology, University Hospital of Bonn, Bonn, Germany
| | - Heiko Rühl
- Department of Haematology, University Hospital of Bonn, Bonn, Germany
| | - Nils Theuerkauf
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Stefan Kreyer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Georg Daniel Duerr
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany.,Department of Cardiovascular Surgery, University Hospital Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Efstratios Charitos
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Marta Medina
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Hendrik Treede
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany.,Department of Cardiovascular Surgery, University Hospital Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
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Biventricular Impella (Bi-Pella) in Refractory Cardiogenic Shock: The First Case from the Middle East. Case Rep Med 2021; 2021:6676339. [PMID: 34335787 PMCID: PMC8324370 DOI: 10.1155/2021/6676339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
Cardiogenic shock (CS) associated with biventricular failure (BiVF) carries significant in-hospital morbidity and mortality. We describe here the successful use of percutaneous biventricular Impella (Bi-Pella) for cardiogenic shock secondary to acute biventricular myocardial infarctions (AMI-CS), as guided by parameters such as mixed venous oxygen saturation (SvO2), pulmonary artery pulsatility index (PAPi), central venous pressure (CVP), and cardiac power output (CPO). We aim to highlight the promising outcomes of timely implanted biventricular Impella in (AMI-CS).
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Ankola AA, McAllister J, Turner ME, Zuckerman WA, Richmond ME, Addonizio LJ, Lee TM, Law SP. Biventricular Impella use in pediatric patients with severe graft dysfunction from acute rejection after heart transplantation. Artif Organs 2019; 44:100-105. [PMID: 31429943 DOI: 10.1111/aor.13558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 11/29/2022]
Abstract
Rejection with severe hemodynamic compromise is a significant source of morbidity and mortality for pediatric heart transplant patients. Traditionally, treatment for these patients includes inotropes and escalation to extracorporeal membrane oxygenation (ECMO) when necessary. There is increasing interest in using percutaneous ventricular assistive devices in the pediatric population as a less invasive alternative to ECMO. We report the largest case series to date of biventricular support using percutaneous Impella devices. Retrospective case series was performed by chart review. Hemodynamics, left ventricular ejection fraction (LVEF), and indices of end organ function were collected before and after Impella placement. A 14-year-old male, 18-year-old male, and 19-year-old female, all status post heart transplant, presented with severely decreased biventricular function due to presumed clinical rejection, requiring maximal inotropic support without improvement. In all the three cases, simultaneous Impella CP and RP devices were placed percutaneously. Prior to implantation, LVEFs were 40%, 23%, and 25%, respectively. Hemodynamics measured invasively prior to device placement showed elevated filling pressures. Adverse events while on support included bleeding, hemolysis, and right femoral arterial dissection during implantation. All patients were successfully weaned from the devices and survived to discharge. The average time of right-sided support and total support was 11 days and 13 days, respectively. After device removal, right-sided pressures and echocardiographic measurements showed improvement in all patients. Bilateral Impella configuration (BiPella) is a viable option for temporary mechanical circulatory support in pediatric patients with significant graft dysfunction.
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Affiliation(s)
- Ashish A Ankola
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, New York, New York
| | - Jennie McAllister
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, New York, New York
| | - Mariel E Turner
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, New York, New York
| | - Warren A Zuckerman
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, New York, New York
| | - Marc E Richmond
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, New York, New York
| | - Linda J Addonizio
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, New York, New York
| | - Teresa M Lee
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, New York, New York
| | - Sabrina P Law
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, New York, New York
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