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Brooksbank JA, Albert C. Device-based therapies for decompensated heart failure. Curr Opin Cardiol 2023; 38:116-123. [PMID: 36718621 DOI: 10.1097/hco.0000000000001026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW Despite improvements in medical therapies, patients with heart failure continue to suffer significant morbidity and mortality. Acute decompensated heart failure (ADHF) remains a common and serious medical condition with a myriad of implications on patient survival and quality of life, and heart failure related readmissions persist [1-3]. RECENT FINDINGS From the detection of prehospitalization decompensation and inpatient management of ADHF to stabilization of cardiogenic shock and durable mechanical circulatory support, device-based therapies are utilized across the spectrum of heart failure management. At present, there are numerous device-based therapies commonly used in clinical practice and many more devices in the early clinical-trial phase aimed at attenuation of ADHF. SUMMARY In this review, we examine recent updates in the breadth and use of devices-based therapies in these three main domains: ambulatory heart failure, acute decompensated heart failure, and cardiogenic shock. Device-based therapies for decompensated heart failure will continue to grow in number, indication, and complexity, making recognition and familiarity with available technologies of increased importance for research and clinical practice.
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Affiliation(s)
- Jeremy A Brooksbank
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute
| | - Chonyang Albert
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute
- George M. and Linda H. Kaufman Center for Heart Failure and Recovery, Cleveland Clinic, Cleveland, Ohio, USA
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de Oliveira Cardoso C, Elgalad A, Li K, Perin EC. Device-based therapy for decompensated heart failure: An updated review of devices in development based on the DRI2P2S classification. Front Cardiovasc Med 2022; 9:962839. [PMID: 36211544 PMCID: PMC9532699 DOI: 10.3389/fcvm.2022.962839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Congestive heart failure (HF) is a devastating disease leading to prolonged hospitalization, high morbidity and mortality rates, and increased costs. Well-established treatments for decompensated or unstable patients include medications and mechanical cardiac support devices. For acute HF decompensation, new devices are being developed to help relieve symptoms and recover heart and renal function in these patients. A recent device-based classification scheme, collectively classified as DRI2P2S, has been proposed to better describe these new device-based therapies based on their mechanism: dilators (increase venous capacitance), removers (direct removal of sodium and water), inotropes (increase left ventricular contractility), interstitials (accelerate removal of lymph), pushers (increase renal arterial pressure), pullers (decrease renal venous pressure), and selective (selective intrarenal drug infusion). In this review, we describe the new class of medical devices with the most current results reported in preclinical models and clinical trials.
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Affiliation(s)
| | - Abdelmotagaly Elgalad
- Center for Preclinical Surgical and Interventional Research, Texas Heart Institute, Houston, TX, United States
- *Correspondence: Abdelmotagaly Elgalad,
| | - Ke Li
- Center for Preclinical Surgical and Interventional Research, Texas Heart Institute, Houston, TX, United States
| | - Emerson C. Perin
- Center for Clinical Research, Texas Heart Institute, Houston, TX, United States
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Napp LC, Mariani S, Ruhparwar A, Schmack B, Keeble TR, Reitan O, Hanke JS, Dogan G, Hiss M, Bauersachs J, Haverich A, Schmitto JD. First-in-Man Use of the Percutaneous 10F Reitan Catheter Pump for Cardiorenal Syndrome. ASAIO J 2022; 68:e99-e101. [PMID: 35649225 DOI: 10.1097/mat.0000000000001498] [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: 11/26/2022] Open
Abstract
Cardiorenal syndrome worsens outcome in patients with decompensated chronic heart failure, and complicates recompensation by medical therapy. Mechanical circulatory support has the potential to improve renal function, and likely mitigates diuretic resistance in patients with severe cardiorenal syndrome. The Reitan catheter pump (RCP) is a novel temporary percutaneous circulatory support system for reducing cardiac afterload and increasing renal preload. Here, we report on the first-in-man use of the 10F-version of the RCP device, which was associated with favorable effects on hemodynamics and diuresis. Further investigation to evaluate safety and efficacy of this promising approach is warranted.
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Affiliation(s)
- Lars Christian Napp
- From the Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Thomas R Keeble
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals, Basildon, United Kingdom
- Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Faculty of Health, Education, Medicine & Social Care, Anglia Ruskin University, Chelmsford, Essex, United Kingdom
| | - Oyvind Reitan
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Guenes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Marcus Hiss
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- From the Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Abstract
Percutaneous mechanical circulatory support options include intra-aortic balloon pump, transvalvular axial flow pumps, left atrial to femoral artery pumping, and oxygenated right atrium to femoral artery circuits. Percutaneous mechanical circulatory support devices providing greater support have not proven superiority over the intra-aortic balloon pump. Novel counterpulsation devices target durability and ambulatory capability and direct unloading of left ventricle (LV) and right ventricle. Device innovations in transvalvular axial pumping include miniaturization of partial-support devices and development of larger self-expanding devices for near-complete LV support. Aortic entrainment pumping is a novel mode of blood displacement with potential benefits beyond reduced LV afterload.
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Affiliation(s)
- Sandeep Nathan
- Section of Cardiology, Interventional Cardiology, University of Chicago Medicine, 5841 South Maryland Avenue, MC 5076, Chicago, IL 60637, USA.
| | - Jonathan Grinstein
- Section of Cardiology, Advanced Heart Failure, University of Chicago Medicine, 5841 South Maryland Avenue, Room A621-MC2016, Chicago, IL 60637, USA
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