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Samol A, Wiemer M, Kaese S. Comparison of a pulsatile and a continuous flow left ventricular assist device in high-risk PCI. Int J Cardiol 2022; 360:7-12. [PMID: 35597491 DOI: 10.1016/j.ijcard.2022.05.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mechanical circulatory support devices are able to generate additional cardiac output or maintain sufficient circulation during high-risk PCI. We prospectively compared the hemodynamic and clinical performance of the new iVAC2L® device with the Impella 2.5® device during high-risk PCI. MATERIALS AND METHODS In 40 patients [10 female, age 75 ± 8 years, left ventricular ejection fraction (LVEF) 44 ± 11%] high-risk PCIs were performed under iVAC (n = 20) or Impella (n = 20) support. Hemodynamic parameters were collected before and after device placement as well as immediately after PCI. Blood parameters of hemolysis were analyzed before and after support. RESULTS Correct device placement was achieved in 17 patients (85%) under iVAC use and in 19 patients (95%) under Impella use. PCI success was 98%. Under iVAC2L® support, systolic, diastolic and mean aortic blood pressure increased significantly with increasing support time. In contrast, aortic pressure increased directly under Impella support, but the increase was comparable between both devices. Impella support generated a significantly higher additional blood flow, as compared to iVAC support (2.07 ± 0.09 l/min vs. 1.25 ± 0.05 l/min, p < 0.001). Five patients (iVAC n = 3) suffered from critical events during high-risk PCI, but both devices were able to maintain stable hemodynamic conditions. After PCI, one severe bleeding occurred in each group. After Impella support, haptoglobin was significantly decreased, indicating potential hemolysis. CONCLUSIONS High-risk PCIs under support by both devices are feasible and safe and ensure stable hemodynamic conditions also if complications occur. Aortic pressure increases significantly with both devices, but later under iVAC use. Potential hemolysis occurs more frequent under Impella support.
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Affiliation(s)
- Alexander Samol
- Department of Cardiology and Angiology, St. Antonius-Hospital Gronau GmbH, Gronau, Germany; Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Minden, Germany.
| | - Marcus Wiemer
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Minden, Germany
| | - Sven Kaese
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Minden, Germany
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Delmas C, Porterie J, Jourdan G, Lezoualc'h F, Arnaud R, Brun S, Cavalerie H, Blanc G, Marcheix B, Lairez O, Verwaerde P, Mialet-Perez J. Effectiveness and Safety of a Prolonged Hemodynamic Support by the IVAC2L System in Healthy and Cardiogenic Shock Pigs. Front Cardiovasc Med 2022; 9:809143. [PMID: 35211526 PMCID: PMC8861279 DOI: 10.3389/fcvm.2022.809143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background Mechanical circulatory supports are used in case of cardiogenic shock (CS) refractory to conventional therapy. Several devices can be employed, but are limited by their availability, benefit risk-ratio, and/or cost. Aims To investigate the feasibility, safety, and effectiveness of a long-term support by a new available device (IVAC2L) in pigs. Methods Experiments were carried out in male pigs, divided into healthy (n = 6) or ischemic CS (n = 4) groups for a median support time of 34 and 12 h, respectively. IVAC2L was implanted under fluoroscopic and TTE guidance under general anesthesia. CS was induced by surgical ligation of the left anterior descending artery. An ipsilateral lower limb reperfusion was created with the Solopath® system. Reperfusion was started after 1 h of support in healthy pigs and upon IVAC2L insertion in CS pigs. Hemodynamic and biological parameters were monitored before and during the whole period of support in each group. Results Occurrence of an ipsilateral lower limb ischemia was systematic in healthy and CS pigs in a few minutes after IVAC2L implantation, and could be reversed by the arterial reperfusion, as demonstrated by distal transcutaneous pressure in oxygen (TcPO2) and lactate normalization. IVAC2L support decreased pulmonary capillary wedge pressure (PCWP) (15.3 ± 0.3 vs. 7.5 ± 0.9 mmHg, p < 0.001), increased systolic blood pressure (SBP) (70 ± 4.5 vs. 101.3 ± 3.1 mmHg, p < 0.01), and cardiac output (CO) (4.0 ± 0.3 vs. 5.2 ± 0.6 l/min, p < 0.05) in CS pigs; at CS onset and after 12 h of support, without effects on heart rate or pulmonary artery pressure (PAP). Non-sustained ventricular arrhythmias were frequent at implantation (50%). A non-significant hemolysis was observed under support in CS pigs. Bleedings were frequent at the insertion and/or operating sites (30%). Conclusion Long-term support by IVAC2L is feasible and associated with a significant hemodynamic improvement in a porcine model. These preclinical data open the door for a study of IVAC2L in human ischemic CS, keeping in mind the need for systematic reperfusion of the lower limb and the associated risk of bleeding.
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Affiliation(s)
- Clément Delmas
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR1297, National Institute of Health and Medical Research (INSERM), University of Toulouse, Toulouse, France
- Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, Toulouse, France
- *Correspondence: Clément Delmas
| | - Jean Porterie
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR1297, National Institute of Health and Medical Research (INSERM), University of Toulouse, Toulouse, France
- Department of Cardiovascular Surgery, Rangueil University Hospital, Toulouse, France
| | - Géraldine Jourdan
- Critical and Intensive Care Unit, Stromalab UMR 5273 CNRS/UPS-EFS-ENVT-INSERM U1031, Toulouse School of Veterinary Medicine, Toulouse, France
| | - Frank Lezoualc'h
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR1297, National Institute of Health and Medical Research (INSERM), University of Toulouse, Toulouse, France
| | - Romain Arnaud
- Department of Anesthesia, Intensive Care and Perioperative Care Medicine, University Hospital, Toulouse, France
| | - Stéphanie Brun
- Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Hugo Cavalerie
- Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Grégoire Blanc
- Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Bertrand Marcheix
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR1297, National Institute of Health and Medical Research (INSERM), University of Toulouse, Toulouse, France
- Department of Cardiovascular Surgery, Rangueil University Hospital, Toulouse, France
| | - Olivier Lairez
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR1297, National Institute of Health and Medical Research (INSERM), University of Toulouse, Toulouse, France
- Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Patrick Verwaerde
- Critical and Intensive Care Unit, Stromalab UMR 5273 CNRS/UPS-EFS-ENVT-INSERM U1031, Toulouse School of Veterinary Medicine, Toulouse, France
- ENVA/UPEC/IMRB-Inserm U955, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Jeanne Mialet-Perez
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR1297, National Institute of Health and Medical Research (INSERM), University of Toulouse, Toulouse, France
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Bastos MB, van Wiechen MP, Van Mieghem NM. PulseCath iVAC2L: next-generation pulsatile mechanical circulatory support. Future Cardiol 2020; 16:103-112. [PMID: 31934785 DOI: 10.2217/fca-2019-0060] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Contemporary state of the art percutaneous coronary intervention techniques offer treatment strategies and solutions to an increasing number of patients with heart failure and complex coronary artery disease. Percutaneous mechanical circulatory support is intended to alleviate the mechanical and energetic workload imposed to a failing ventricle by reducing left ventricle pressures and volumes and potentially also increasing coronary blood flow. The PulseCath iVAC2L is a transaortic left ventricular assist device that applies a pneumatic driving system to produce pulsatile forward flow. Herein, the essential aspects regarding iVAC2L are discussed with focus on its mechanisms of action and the available clinical experience.
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Affiliation(s)
- Marcelo B Bastos
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maarten P van Wiechen
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Rathod KS, Sirker A, Baumbach A, Mathur A, Jones DA. Management of cardiogenic shock in patients with acute coronary syndromes. Br J Hosp Med (Lond) 2019; 80:204-210. [PMID: 30951425 DOI: 10.12968/hmed.2019.80.4.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiogenic shock remains a major problem affecting a large proportion of patients with acute coronary syndromes, with a persistent high mortality rate. Although mechanical reperfusion with percutaneous coronary intervention has improved outcomes following acute coronary syndromes, there is limited evidence supporting the other current treatments used to manage patients with cardiogenic shock (intra-aortic balloon pumps, percutaneous left ventricular assist devices and extracorporeal membrane oxygenation). This article looks at these options, assessing current evidence and recent advances. It also discusses areas that still require research to ensure there is improvement in these high-risk patients, such as coordinated regionalised approaches to cardiogenic shock management with multidisciplinary care provided in designated tertiary shock centres.
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Affiliation(s)
- Krishnaraj S Rathod
- Interventional Cardiology Specialist Registrar, Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London and Doctoral Research Fellow, NIHR Biomedical Research Centre at Barts, Barts Health NHS Trust and Queen Mary University of London, London
| | - Alexander Sirker
- Consultant Cardiologist, Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London and NIHR Biomedical Research Centre at Barts, Barts Health NHS Trust and Queen Mary University of London, London
| | - Andreas Baumbach
- Consultant Cardiologist, Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London and Professor of Cardiology and Professor for Device Innovation, NIHR Biomedical Research Centre at Barts, Barts Health NHS Trust and Queen Mary University of London, London
| | - Anthony Mathur
- Consultant Cardiologist, Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London and Professor of Cardiology, NIHR Biomedical Research Centre at Barts, Barts Health NHS Trust and Queen Mary University of London, London
| | - Daniel A Jones
- Consultant Cardiologist, Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London EC1A 7BE and Senior Clinical Lecturer, NIHR Biomedical Research Centre at Barts, Barts Health NHS Trust and Queen Mary University of London, London
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Samol A, Schmidt S, Zeyse M, Wiemer M. First successful prevention of cardiopulmonary resuscitation during high-risk percutaneous coronary intervention by use of a pulsatile left ventricular assist device: baptism of fire of the iVAC2L device: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2018; 2:yty005. [PMID: 31020087 PMCID: PMC6426094 DOI: 10.1093/ehjcr/yty005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 01/02/2018] [Indexed: 11/13/2022]
Abstract
Introduction Efforts in percutaneous coronary intervention (PCI) lead to interventional treatment of complex stenoses as an alternative to coronary bypass surgery. Nevertheless, complications during PCI can occur with sudden need for circulatory support. Circulatory support devices are helpful tools during high-risk PCI to generate additional output or maintain sufficient circulation in critical situations. Case description We report the case of the first successful prevention of cardiopulmonary resuscitation by use of transfemoral pulsatile ventricular assist device with up to 2l additional cardiac output during a high-risk PCI in an 80-year old man with complex stenosis and a history of ventricular fibrillation during prior coronary angiography. Discussion The device managed to maintain an adequate circulation during massive vasospasm and bradycardia. The iVAC2L seems to be a useful tool in high-risk PCI. Its general effect on haemodynamics and patients' outcome has to be evaluated in larger multi-centre studies.
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Affiliation(s)
- Alexander Samol
- Department of Cardiology and Critical Care Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Str. 1, 32429 Minden, Germany
| | - Stefanie Schmidt
- Department of Cardiology and Critical Care Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Str. 1, 32429 Minden, Germany
| | - Melanie Zeyse
- Department of Cardiology and Critical Care Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Str. 1, 32429 Minden, Germany
| | - Marcus Wiemer
- Department of Cardiology and Critical Care Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Str. 1, 32429 Minden, Germany
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