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Hess NR, Ziegler LA, Kaczorowski DJ. The 10 Commandments of Microaxial Temporary Left Ventricular Assist Devices. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:368-376. [PMID: 36524534 DOI: 10.1177/15569845221134514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Nicholas R Hess
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, PA, USA
| | - Luke A Ziegler
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, PA, USA
| | - David J Kaczorowski
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, PA, USA
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Burzotta F, Romagnoli E, Aurigemma C, Bruno P, Cangemi S, Bianchini F, Trani C. A simple technique to obtain postprocedural antegrade angiographic control in single-access Impella-protected PCI. Health Sci Rep 2022; 5:e709. [PMID: 35811585 PMCID: PMC9251842 DOI: 10.1002/hsr2.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Francesco Burzotta
- Dipartimento di Scienze CardiovascolariFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Cardiovascular and Thoracic SciencesUniversità Cattolica del Sacro CuoreRomeItaly
| | - Enrico Romagnoli
- Dipartimento di Scienze CardiovascolariFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Cristina Aurigemma
- Dipartimento di Scienze CardiovascolariFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Piergiorgio Bruno
- Dipartimento di Scienze CardiovascolariFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Cardiovascular and Thoracic SciencesUniversità Cattolica del Sacro CuoreRomeItaly
| | - Stefano Cangemi
- Dipartimento di Scienze CardiovascolariFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Francesco Bianchini
- Dipartimento di Scienze CardiovascolariFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Carlo Trani
- Dipartimento di Scienze CardiovascolariFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Cardiovascular and Thoracic SciencesUniversità Cattolica del Sacro CuoreRomeItaly
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Attinger-Toller A, Bossard M, Cioffi GM, Tersalvi G, Madanchi M, Bloch A, Kobza R, Cuculi F. Ventricular Unloading Using the Impella TM Device in Cardiogenic Shock. Front Cardiovasc Med 2022; 9:856870. [PMID: 35402561 PMCID: PMC8984099 DOI: 10.3389/fcvm.2022.856870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/21/2022] [Indexed: 12/02/2022] Open
Abstract
Cardiogenic shock (CS) remains a leading cause of hospital death. However, the use of mechanical circulatory support has fundamentally changed CS management over the last decade and is rapidly increasing. In contrast to extracorporeal membrane oxygenation as well as counterpulsation with an intraaortic balloon pump, ventricular unloading by the Impella™ device actively reduces ventricular volume as well as pressure and augments systemic blood flow at the same time. By improving myocardial oxygen supply and enhancing systemic circulation, the Impella device potentially protects myocardium, facilitates ventricular recovery and may interrupt the shock spiral. So far, the evidence supporting the use of Impella™ in CS patients derives mostly from observational studies, and there is a need for adequate randomized trials. However, the Impella™ device appears a promising technology for management of CS patients. But a profound understanding of the device, its physiologic impact and clinical application are all important when evaluating CS patients for percutaneous circulatory support. This review provides a comprehensive overview of the percutaneous assist device Impella™. Moreover, it highlights in depth the rationale for ventricular unloading in CS and describes practical aspects to optimize care for patients requiring hemodynamic support.
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Affiliation(s)
- Adrian Attinger-Toller
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland,*Correspondence: Adrian Attinger-Toller
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Gregorio Tersalvi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Andreas Bloch
- Department of Intensive Care Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Richard Kobza
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
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Richarz S, Siegemund M, d'Amico R, Bachofen B, Döbele T, Gürke L, Mujagic E. Temporary extracorporeal femoro-femoral crossover bypass to treat acute limb ischemia due to occlusive femoral transaortic microaxial left ventricular assist device - A novel technique and case series. Ann Vasc Surg 2021; 80:379-385. [PMID: 34780943 DOI: 10.1016/j.avsg.2021.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The Impella transaortic microaxial left ventricular assist device (MLVAD) bears the risk of severe ipsilateral limb ischemia due to its percutaneous insertion through the common femoral artery (CFA). As long as the MLVAD is required for cardio - circulatory support, treatment options are limited. Therefore, we developed a temporary extracorporeal femoral - femoral crossover bypass to restore and maintain perfusion of the affected leg. METHODS From October 2018, we treated all patients with severe limb ischemia due to the MLAVD with a femoral - femoral crossover bypass. For comparison, a consecutive cohort of patients undergoing placement of the MLAVD between January 2011 and October 2018 was identified. The primary outcome is the feasibility and safety of our percutaneously established extracorporeal femoral - femoral crossover bypass. RESULTS Between January 2011 and July 2019, 25 of 245 (10.3%) patients developed a severe ipsilateral limb ischemia following the MLVAD placement. Until October 2018, 20 patients were treated conventionally (C - cohort) and since October 2018, five (consecutive) patients have been treated by an extracorporeal femoral - femoral cross over bypass (BP - Cohort). Following the BP - procedure, an immediate improvement of the perfusion was seen in all patients. Limb salvage was documented in 100% of our patients and 30 - day mortality was 60% in both groups. CONCLUSION This is the first case series reporting on this novel technique. We demonstrated that the percutaneous creation of an extracorporeal crossover bypass is feasible, safe and effective and should therefore be promoted.
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Affiliation(s)
- Sabine Richarz
- Department of Vascular Surgery, University Hospital Basel and University of Basel, Basel, Switzerland.
| | - Martin Siegemund
- Department of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Rosalinda d'Amico
- Department of Vascular Surgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Bernadette Bachofen
- Department of Vascular Surgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Thomas Döbele
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Lorenz Gürke
- Department of Vascular Surgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Edin Mujagic
- Department of Vascular Surgery, University Hospital Basel and University of Basel, Basel, Switzerland
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5
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Chatzis G, Syntila S, Schuett H, Waechter C, Ahrens H, Markus B, Divchev D, Rogmann M, Karatolios K, Bouras G, Schieffer B, Luesebrink U. Left Ventricle Architecture and Valvular Integrity Following Microaxial Mechanical Support: A Two-Year Follow-Up Study. J Clin Med 2021; 10:jcm10061273. [PMID: 33803898 PMCID: PMC8003263 DOI: 10.3390/jcm10061273] [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: 02/07/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/16/2022] Open
Abstract
Although the use of microaxilar mechanical circulatory support systems may improve the outcome of patients with cardiogenic shock (CS), little is known about its effect on the long-term structural integrity of left ventricular (LV) valves as well as on the development of LV-architecture. Therefore, we aimed to study the integrity of the LV valves and architecture and function after Impella support. Thus, 84 consecutive patients were monitored over two years having received ImpellaTM CP (n = 24) or 2.5 (n = 60) for refractory CS (n = 62) or for high-risk percutaneous coronary interventions (n = 22) followed by optimal medical treatment. Beside a significant increase in LV ejection fraction after two years (p ≤ 0.03 vs. pre-implantation), we observed a statistically significant decrease in LV dilation (p < 0.001) and severity of mitral valve regurgitation (p = 0.007) in the two-year follow-up period, suggesting an improved LV architecture. Neither the duration of support, nor the size of the Impella device or the indication for its use revealed any devastating impact on aortic or mitral valve integrity. These findings indicate that Impella device is a safe means of support of LV-function without detrimental long-term effects on the structural integrity of LV valves regardless of the size of the device or the indication of support.
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Affiliation(s)
- Georgios Chatzis
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
- Correspondence: ; Tel.: +49-64-215-861-031
| | - Styliani Syntila
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Harald Schuett
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Christian Waechter
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Holger Ahrens
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Birgit Markus
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Dimitar Divchev
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Marc Rogmann
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Konstantinos Karatolios
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Georgios Bouras
- Yale School of Medicine, Yale University, New Heaven, CT 06510, USA;
| | - Bernhard Schieffer
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Ulrich Luesebrink
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
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Ahmed T, Lodhi SH, Ahmed T, Virk HUH, Nukta ED. Fill Two Needs With One Deed! Single-Access Protected Percutaneous Coronary Intervention With Impella Hemodynamic Support. CJC Open 2020; 2:77-78. [PMID: 32190830 PMCID: PMC7067684 DOI: 10.1016/j.cjco.2020.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/14/2020] [Indexed: 11/18/2022] Open
Abstract
This report describes the case of a 64-year-old man who presented with acute coronary syndrome, depressed left ventricular function, and triple vessel disease on angiogram. The patient refused surgery and underwent high-risk percutaneous coronary intervention through the Impella sheath (Abiomed, Danvers, MA). This is one of the first known cases of single-access protected percutaneous coronary intervention, an innovative technique that brings into consideration the importance of dual vascular access via the Impella sheath.
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Affiliation(s)
| | | | - Talha Ahmed
- University of Maryland Midtown Campus, Baltimore, Maryland, USA
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Russo JJ, Prasad M, Doshi D, Karmpaliotis D, Parikh MA, Ali ZA, Popma JJ, Pershad A, Ohman EM, Douglas PS, O'Neill WW, Leon MB, Moses JW, Kirtane AJ. Improvement in left ventricular function following higher‐risk percutaneous coronary intervention in patients with ischemic cardiomyopathy. Catheter Cardiovasc Interv 2019; 96:764-770. [DOI: 10.1002/ccd.28557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Juan J. Russo
- Columbia University Medical Center New York New York
- University of Ottawa Heart Institute Ottawa Ontario
| | - Megha Prasad
- Columbia University Medical Center New York New York
| | | | | | | | - Ziad A. Ali
- Columbia University Medical Center New York New York
| | | | - Ashish Pershad
- Banner – University Medical Center Phoenix Phoenix Arizona
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8
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Patel N, Sharma A, Dalia T, Rali A, Earnest M, Tadros P, Wiley M, Hockstad E, Mehta A, Thors A, Hance K, Gupta K. Vascular complications associated with percutaneous left ventricular assist device placement: A 10-year US perspective. Catheter Cardiovasc Interv 2019; 95:309-316. [PMID: 31638737 DOI: 10.1002/ccd.28560] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 09/24/2019] [Accepted: 10/09/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Over the last decade, there has been a significant increase in the use of percutaneous left ventricular assist devices(p-LVADs). p-LVADs are being increasingly used during complex coronary interventions and for acute cardiogenic shock. These large bore percutaneous devices have a higher risk of vascular complications. We examined the vascular complication rates from the use of p-LVAD in a national database. METHODS We conducted a secondary analysis of the National In-patient Sample (NIS) dataset from 2005 till 2015. We used the ICD-9-CM procedure codes 37.68 and 37.62 for p-LVAD placement regardless of indications. We investigated common vascular complications, defining them by the validated ICD 9 CM codes. χ2 test and t test were used for categorical and continuous variables, respectively for comparison. RESULTS A total of 31,263 p-LVAD placements were identified during the period studied. A majority of patients were male (72.68%) and 64.44% were white. The overall incidence of vascular complications was 13.53%, out of which 56% required surgical treatment. Acute limb thromboembolism and bleeding requiring transfusion accounted for 27.6% and 21.8% of all vascular complications. Occurrence of a vascular complication was associated with significantly higher in-hospital mortality (37.77% vs. 29.95%, p < .001), length of stay (22.7 vs. 12.2 days, p < .001) and cost of hospitalization ($ 161,923 vs. $ 95,547, p < .001). CONCLUSIONS There is a high incidence of vascular complications with p-LVAD placement including need for vascular surgery. These complications are associated with a higher in-hospital, LOS and hospitalization costs. These findings should be factored into the decision-making for p-LVAD placement.
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Affiliation(s)
- Nilay Patel
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Akshit Sharma
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Tarun Dalia
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Aniket Rali
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Matthew Earnest
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Peter Tadros
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Mark Wiley
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Eric Hockstad
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Ashwani Mehta
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Axel Thors
- Vascular Surgery Division, University of Kansas Medical Center, Kansas City, Kansas
| | - Kirk Hance
- Vascular Surgery Division, University of Kansas Medical Center, Kansas City, Kansas
| | - Kamal Gupta
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
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Burzotta F, Russo G, Ribichini F, Piccoli A, D'Amario D, Paraggio L, Previ L, Pesarini G, Porto I, Leone AM, Niccoli G, Aurigemma C, Verdirosi D, Crea F, Trani C. Long-Term Outcomes of Extent of Revascularization in Complex High Risk and Indicated Patients Undergoing Impella-Protected Percutaneous Coronary Intervention: Report from the Roma-Verona Registry. J Interv Cardiol 2019; 2019:5243913. [PMID: 31772533 PMCID: PMC6739781 DOI: 10.1155/2019/5243913] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/11/2019] [Accepted: 03/25/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To investigate the effect of extent of revascularization in complex high-risk indicated patients (CHIP) undergoing Impella-protected percutaneous coronary intervention (PCI). BACKGROUND Complete revascularization has been shown to be associated with improved outcomes. However, the impact of more complete revascularization during Impella-protected PCI in CHIP has not been reported. METHODS A total of 86 CHIP undergoing elective PCI with Impella 2.5 or Impella CP between April 2007 and December 2016 from 2 high volume Italian centers were included. Baseline, procedural, and clinical outcomes data were collected retrospectively. Completeness of coronary revascularization was assessed using the British Cardiovascular Intervention Society myocardial jeopardy score (BCIS-JS) derived revascularization index (RI). The primary end-point was all-cause mortality. A multivariate regression model was used to identify independent predictors of mortality. RESULTS All patients had multivessel disease and were considered unsuitable for surgery. At baseline, 44% had left main disease, 78% had LVEF ≤ 35%, and mean BCIS-JS score was 10±2. The mean BCIS-JS derived RI was 0.7±0.2 and procedural complications were uncommon. At 14-month follow-up, all-cause mortality was 10.5%. At follow-up, 67.4% of CHIP had LVEF ≥ 35% compared to 22.1% before Impella protected-PCI. Higher BCIS-JS RI was significantly associated with LVEF improvement (p=0.002). BCIS-JS RI of ≤ 0.8 (HR 0.11, 95% CI 0.01- 0.92, and p = 0.042) was an independent predictor of mortality. CONCLUSIONS These results support the practice of percutaneous Impella use for protected PCI in CHIP. A more complete revascularization was associated with significant LVEF improvement and survival.
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Affiliation(s)
- Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giulio Russo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Anna Piccoli
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Domenico D'Amario
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Lazzaro Paraggio
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Leonardo Previ
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Italo Porto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Maria Leone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giampaolo Niccoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Cristina Aurigemma
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Diana Verdirosi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
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10
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Glazier JJ, Kaki A. The Impella Device: Historical Background, Clinical Applications and Future Directions. Int J Angiol 2018; 28:118-123. [PMID: 31384109 DOI: 10.1055/s-0038-1676369] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The Impella device is a catheter-based miniaturized ventricular assist device. Using a retrograde femoral artery access, it is placed in the left ventricle across the aortic valve. The device pumps blood from left ventricle into ascending aorta and helps to maintain a systemic circulation at an upper rate between 2.5 and 5.0 L/min. This results in almost immediate and sustained unloading of the left ventricle, while increasing overall systemic cardiac output. The most common indications for using the Impella device are in the treatment of acute myocardial infarction complicated by cardiogenic shock and to facilitate high risk coronary angioplasty. Other indications include the treatment of cardiomyopathy with acute decompensation, postcardiotomy shock, and off-pump coronary bypass surgery. A growing body of observational and registry data suggest a potentially valuable role for the Impella system in reducing the mortality associated with cardiogenic shock. However, there are, as of yet, no randomized controlled trial data supporting this observation.
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Affiliation(s)
- James J Glazier
- Department of Cardiology, Wayne State University/Detroit Medical Center, Heart Hospital, Detroit, Michigan
| | - Amir Kaki
- Department of Cardiology, Wayne State University/Detroit Medical Center, Heart Hospital, Detroit, Michigan
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De Marzo V, D'amario D, Galli M, Vergallo R, Porto I. High-risk percutaneous coronary intervention: how to define it today? Minerva Cardioangiol 2018; 66:576-593. [DOI: 10.23736/s0026-4725.18.04679-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Becher T, Eder F, Baumann S, Loßnitzer D, Pollmann B, Behnes M, Borggrefe M, Akin I. Unprotected versus protected high-risk percutaneous coronary intervention with the Impella 2.5 in patients with multivessel disease and severely reduced left ventricular function. Medicine (Baltimore) 2018; 97:e12665. [PMID: 30412063 PMCID: PMC6221604 DOI: 10.1097/md.0000000000012665] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Selecting a revascularization strategy in patients with multivessel disease (MVD) and severely reduced left ventricular ejection fraction (LVEF) remains a challenge. PCI with Impella 2.5 may facilitate high-risk PCI, however long-term results comparing unprotected versus protected PCI are currently unknown. We sought to evaluate the outcome of patients undergoing protected compared to unprotected percutaneous coronary intervention (PCI) in the setting of MVD and severely reduced LVEF.We included patients with MVD and severely reduced LVEF (≤35%) in this retrospective, single-centre study. Patients that underwent unprotected PCI before the start of a dedicated protected PCI program with Impella 2.5 were compared to patients that were treated with protected PCI after the start of the program. The primary endpoint was defined as major adverse cardiac and cerebrovascular events (MACCE) during a 1-year follow-up. The secondary endpoints consisted of in-hospital MACCE and adverse events.A total of 61 patients (mean age 70.7 ± 10.9 years, 83.6% male) were included in our study, of which 28 (45.9%) underwent protected PCI. The primary endpoint was reached by 26.7% and did not differ between groups (P = .90). In-hospital MACCE (P = 1.00) and in-hospital adverse events (P = .12) also demonstrated no significant differences. Multivariate logistic regression identified procedural success defined as complete revascularization and absence of in-hospital major clinical complications as protective parameter for MACCE (OR 0.17, 95% CI 0.04-0.70, P = .02).Patients with MVD and severely depressed LVEF undergoing protected PCI with Impella 2.5 demonstrate similar in-hospital and one-year outcomes compared to unprotected PCI.
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Affiliation(s)
- Tobias Becher
- First Department of Medicine-Cardiology, University Medical Centre Mannheim
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Frederik Eder
- First Department of Medicine-Cardiology, University Medical Centre Mannheim
| | - Stefan Baumann
- First Department of Medicine-Cardiology, University Medical Centre Mannheim
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Dirk Loßnitzer
- First Department of Medicine-Cardiology, University Medical Centre Mannheim
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Berit Pollmann
- First Department of Medicine-Cardiology, University Medical Centre Mannheim
| | - Michael Behnes
- First Department of Medicine-Cardiology, University Medical Centre Mannheim
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine-Cardiology, University Medical Centre Mannheim
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine-Cardiology, University Medical Centre Mannheim
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
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13
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Pesarini G, Gratta A, Dolci G, Lunardi M, Ribichini FL. Impella-protected PCI: the clinical results achieved so far. Minerva Cardioangiol 2018; 66:612-618. [PMID: 29642690 DOI: 10.23736/s0026-4725.18.04678-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The ability of interventional cardiologists to identify high-risk percutaneous coronary intervention (PCI) patients, requires the integration of different features belonging to medical history, organ damage, coronary anatomy and the nature of the acute event. The selection of a subgroup of patients that could benefit from mechanical support during interventions is a key feature to success. The introduction of the Impella percutaneous axial pump have added an easy-to-set-up, less invasive and time-consuming active-support device to the interventional toolbox. Up to date, only few (four) randomized clinical trials (RCTs) have tried to address the clinical efficacy of Impella assistance for the treatment of this very high-risk population, but several large registries and multiple observational studies have demonstrated its safety, feasibility and hemodynamic performance. Although the largest RCT (PROTECT II) have been prematurely stopped due to the risk of futility despite the evidence of more complete revascularization in the Impella arm, the need for an adequate operator's learning curve must be considered. More recent insights suggest an effect of the device in optimizing end-organ perfusion and improving crucial parameters like renal function. Furthermore, available data suggest that vary early Impella support may improve patient's outcome in case of cardiogenic shock.
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Affiliation(s)
- Gabriele Pesarini
- Cardiovascular Interventional Unit, Division of Cardiology, University of Verona, Verona, Italy
| | - Andrea Gratta
- Cardiovascular Interventional Unit, Division of Cardiology, University of Verona, Verona, Italy
| | - Giulia Dolci
- Cardiovascular Interventional Unit, Division of Cardiology, University of Verona, Verona, Italy
| | - Mattia Lunardi
- Cardiovascular Interventional Unit, Division of Cardiology, University of Verona, Verona, Italy
| | - Flavio L Ribichini
- Cardiovascular Interventional Unit, Division of Cardiology, University of Verona, Verona, Italy -
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14
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Shoeib O, Burzotta F, Aurigemma C, Paraggio L, Viccaro F, Porto I, Leone AM, Bruno P, Trani C. Percutaneous transcatheter aortic valve replacement induces femoral artery shrinkage: angiographic evidence and predictors for a new side effect. Catheter Cardiovasc Interv 2017; 91:938-944. [DOI: 10.1002/ccd.27248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/22/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Osama Shoeib
- Institute of Cardiology, Catholic University of the Sacred HeartRome Italy
| | - Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred HeartRome Italy
| | - Cristina Aurigemma
- Institute of Cardiology, Catholic University of the Sacred HeartRome Italy
| | - Lazzaro Paraggio
- Institute of Cardiology, Catholic University of the Sacred HeartRome Italy
| | - Fausta Viccaro
- Institute of Cardiology, Catholic University of the Sacred HeartRome Italy
| | - Italo Porto
- Institute of Cardiology, Catholic University of the Sacred HeartRome Italy
| | | | - Piergiorgio Bruno
- Institute of Cardiology, Catholic University of the Sacred HeartRome Italy
| | - Carlo Trani
- Institute of Cardiology, Catholic University of the Sacred HeartRome Italy
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15
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Ait Ichou J, Larivée N, Eisenberg MJ, Suissa K, Filion KB. The effectiveness and safety of the Impella ventricular assist device for high-risk percutaneous coronary interventions: A systematic review. Catheter Cardiovasc Interv 2017; 91:1250-1260. [PMID: 28941078 DOI: 10.1002/ccd.27316] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 07/31/2017] [Accepted: 08/07/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Small randomized controlled trials (RCTs) and observational studies have examined the effectiveness and safety of the Impella device, a percutaneous left ventricular assist device, in the setting of high-risk percutaneous coronary intervention (PCI). However, data are sparse and results are conflicting. Our objective was to evaluate the effectiveness and safety of the Impella device in high-risk patients undergoing PCI via a systematic review of the literature. METHODS We searched Medline, EMBASE, and the Cochrane Library for RCTs and observational studies that evaluated the Impella device in high-risk patients undergoing PCI. Inclusion was restricted to studies in which ≥10 patients received the Impella device; both uncontrolled and controlled (versus intra-aortic-balloon pump [IABP]) studies were included. RESULTS A total of 20 studies (4 RCTs, 2 controlled observational studies, and 14 uncontrolled observational studies; 1,287 patients) were included, with follow-up ranging from 1 to 42 months. The use of Impella resulted in improved procedural and hemodynamic characteristics in controlled and uncontrolled studies. In controlled studies, the 30-day rates of all-cause mortality and MACE were similar across groups. In most uncontrolled studies, the 30-day rates of all-cause mortality were generally low (range: 3.7%-10%), though rates of MACE were slightly higher (range: 5%-20%). CONCLUSION The Impella device was found to improve procedural and hemodynamic parameters, but only limited randomized data are available regarding clinical outcomes associated with its use. Large, multicenter RCTs are needed to definitively establish the effectiveness of the Impella device among high-risk PCI patients.
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Affiliation(s)
- Jamal Ait Ichou
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Natasha Larivée
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Mark J Eisenberg
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Division of Cardiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
| | - Karine Suissa
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Kristian B Filion
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
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16
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Schreiber T, Wah Htun W, Blank N, Telila T, Mercado N, Briasoulis A, Kaki A, Kondur A, Munir A, Grines C. Real-world supported unprotected left main percutaneous coronary intervention with impella device; data from the USpella registry. Catheter Cardiovasc Interv 2017; 90:576-581. [PMID: 28417594 DOI: 10.1002/ccd.26979] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with left main (LM) coronary artery disease are increasingly being treated with percutaneous revascularization (PCI). The safety, feasibility, and efficacy of unprotected LM intervention (ULMI) with hemodynamic support by Impella device have not been evaluated previously. OBJECTIVE Using a large retrospective single center database from the USpella registry, we evaluated the safety, feasibility, and potential benefits of periprocedural left ventricular assist with axial flow Impella 2.5 and Impella CP (Abiomed Inc. Danvers, Mass) during ULMI. METHODS We analyzed a total of 127 consecutive patients who received hemodynamic support with Impella (2.5 or CP) for ULMI from August 2008 to July 2015. Safety, feasibility and efficacy end points included procedural success rates, in-hospital and 30-day major adverse cardiovascular event (MACE) rates. RESULTS Among 127 patients who received hemodynamic support for ULMI (mean age 69.98 ± 10.7 years, 71% men, and mean left ventricular ejection fraction 28.74 ± 15.55%, Society of Thoracic Surgeons' mortality/morbidity 4/23%) the in-hospital and 30 days mortality rates were 1.43% (2/140) and 2.1% (3/141), respectively. The average baseline and post PCI (residual) syntax scores were 31.4 and 7.86, respectively, (P < 0.001). Only one patient (0.8%) had vascular complication that required surgery; 2.36% (3/127) had hematoma and 3.9% (5/127) had bleeding that required transfusion. CONCLUSION This large singe center retrospective evaluation of USpella registry substantiates and strongly supports the feasibility, safety, and hemodynamic usefulness of Impella device for ULMI with acceptable in-hospital and 30-day MACE rates. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Theodore Schreiber
- Wayne State University/Detroit Medical Center, Heart Hospital, Detroit, Michigan
| | - Wah Wah Htun
- Wayne State University/Detroit Medical Center, Heart Hospital, Detroit, Michigan
| | - Nimrod Blank
- Wayne State University/Detroit Medical Center, Heart Hospital, Detroit, Michigan
| | - Tesfaye Telila
- Wayne State University/Detroit Medical Center, Heart Hospital, Detroit, Michigan
| | - Nestor Mercado
- Wayne State University/Detroit Medical Center, Heart Hospital, Detroit, Michigan
| | | | - Amir Kaki
- Wayne State University/Detroit Medical Center, Heart Hospital, Detroit, Michigan
| | - Ashok Kondur
- Wayne State University/Detroit Medical Center, Heart Hospital, Detroit, Michigan
| | - Ahmad Munir
- Wayne State University/Detroit Medical Center, Heart Hospital, Detroit, Michigan
| | - Cindy Grines
- Wayne State University/Detroit Medical Center, Heart Hospital, Detroit, Michigan
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17
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Briasoulis A, Telila T, Palla M, Mercado N, Kondur A, Grines C, Schreiber T. Meta-Analysis of Usefulness of Percutaneous Left Ventricular Assist Devices for High-Risk Percutaneous Coronary Interventions. Am J Cardiol 2016; 118:369-75. [PMID: 27265673 DOI: 10.1016/j.amjcard.2016.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 12/13/2022]
Abstract
High-risk percutaneous coronary intervention (PCI) is often offered to patients with extensive coronary artery disease, decreased left ventricular function, and co-morbid conditions that increase surgical risk. In these settings, percutaneous left ventricular assist devices (PVADs) can be used for hemodynamic support. To assess the effects of PVAD use on mortality, myocardial infarction, and complication rates in patients undergoing high-risk PCI, we systematically searched the electronic databases, MEDLINE, PUBMED, EMBASE, and Cochrane for prospective controlled trials and cohort studies of patients that received hemodynamic support with PVADs for high-risk PCI. The primary outcome measures were 30-day all-cause mortality, 30-day myocardial infarction rates, periprocedural major bleeding, and vascular complications. We included 12 studies with 1,346 participants who underwent Impella 2.5 L device placement and 8 cohort studies with 205 patients that received TandemHeart device for high-risk PCI. Short-term mortality rates were 3.5% and 8% and major bleeding rates were 7.1% and 3.6% with Impella and TandemHeart, respectively. Both devices are associated with comparable periprocedural outcomes in patients undergoing high-risk PCI.
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Affiliation(s)
- Alexandros Briasoulis
- Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
| | - Tesfaye Telila
- Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan
| | - Mohan Palla
- Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan
| | - Nestor Mercado
- Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan
| | - Ashok Kondur
- Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan
| | - Cindy Grines
- Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan
| | - Theodore Schreiber
- Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan
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18
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Burzotta F, Trani C, Doshi SN, Townend J, van Geuns RJ, Hunziker P, Schieffer B, Karatolios K, Møller JE, Ribichini FL, Schäfer A, Henriques JP. Impella ventricular support in clinical practice: Collaborative viewpoint from a European expert user group. Int J Cardiol 2015; 201:684-91. [DOI: 10.1016/j.ijcard.2015.07.065] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/25/2015] [Indexed: 02/03/2023]
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19
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Abaunza M, Kabbani LS, Nypaver T, Greenbaum A, Balraj P, Qureshi S, Alqarqaz MA, Shepard AD. Incidence and prognosis of vascular complications after percutaneous placement of left ventricular assist device. J Vasc Surg 2015; 62:417-23. [DOI: 10.1016/j.jvs.2015.03.040] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/18/2015] [Indexed: 11/25/2022]
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20
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Ouweneel DM, Claessen BE, Sjauw KD, Henriques JP. The Role of Percutaneous Haemodynamic Support in High-risk Percutaneous Coronary Intervention and Cardiogenic Shock. Interv Cardiol 2015; 10:39-44. [PMID: 29588673 DOI: 10.15420/icr.2015.10.1.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The experience and usage of percutaneous cardiac assist devices in cardiogenic shock as well as high-risk percutaneous coronary intervention have increased over the years. Nonetheless, there is still little evidence of clinical benefit of these devices other than immediate haemodynamic improvement. Despite the fact that these devices are used to treat a rather complex patient population, clinical testing remains important in order to evaluate their true impact on clinical outcome before being adopted into clinical practice. Therefore, this review shows an overview of the current experience and evidence of the available percutaneous cardiac assist devices.
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Affiliation(s)
- Dagmar M Ouweneel
- AMC Heartcenter, Academic Medical Center, Amsterdam, The Netherlands
| | - Bimmer E Claessen
- AMC Heartcenter, Academic Medical Center, Amsterdam, The Netherlands
| | - Krischan D Sjauw
- AMC Heartcenter, Academic Medical Center, Amsterdam, The Netherlands
| | - José Ps Henriques
- AMC Heartcenter, Academic Medical Center, Amsterdam, The Netherlands
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21
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Heidlebaugh M, Kurz MC, Turkelson CL, Sawyer KN. Full neurologic recovery and return of spontaneous circulation following prolonged cardiac arrest facilitated by percutaneous left ventricular assist device. Ther Hypothermia Temp Manag 2014; 4:168-72. [PMID: 25184627 DOI: 10.1089/ther.2014.0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sudden cardiac arrest is associated with high early mortality, which is largely related to postcardiac arrest syndrome characterized by an acute but often transient decrease in left ventricular (LV) function. The stunned LV provides poor cardiac output, which compounds the initial global insult from hypoperfusion. If employed early, an LV assist device (LVAD) may improve survival and neurologic outcome; however, traditional methods of augmenting LV function have significant drawbacks, limiting their usefulness in the periarrest period. Full cardiac support with cardiopulmonary bypass is not always readily available but is increasingly being studied as a tool to intensify resuscitation. There have been no controlled trials studying the early use of percutaneous LVADs (pLVADs) in pericardiac arrest patients or intra-arrest as a bridge to return of spontaneous circulation. This article presents a case study and discussion of a patient who arrested while undergoing an elective coronary angioplasty and suffered prolonged cardiopulmonary resuscitation. During resuscitation, treatment included placement of a pLVAD and initiation of therapeutic hypothermia. The patient made a rapid and full recovery.
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Affiliation(s)
- Michael Heidlebaugh
- 1 Department of Emergency Medicine, William Beaumont Hospital , Royal Oak, Michigan
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22
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Dato I, Burzotta F, Trani C, Crea F, Ussia GP. Percutaneous management of vascular access in transfemoral transcatheter aortic valve implantation. World J Cardiol 2014; 6:836-846. [PMID: 25228962 PMCID: PMC4163712 DOI: 10.4330/wjc.v6.i8.836] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/01/2014] [Accepted: 06/18/2014] [Indexed: 02/06/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) using stent-based bioprostheses has recently emerged as a promising alternative to surgical valve replacement in selected patients. The main route for TAVI is retrograde access from the femoral artery using large sheaths (16-24 F). Vascular access complications are a clinically relevant issue in TAVI procedures since they are reported to occur in up to one fourth of patients and are strongly associated with adverse outcomes. In the present paper, we review the different types of vascular access site complications associated with transfemoral TAVI. Moreover, we discuss the possible optimal management strategies with particular attention to the relevance of early diagnosis and prompt treatment using endovascular techniques.
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23
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High-risk acute coronary syndrome in a patient with coronary subclavian steal syndrome secondary to critical subclavian artery stenosis. Case Rep Cardiol 2014; 2014:175235. [PMID: 25161771 PMCID: PMC4137696 DOI: 10.1155/2014/175235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/21/2014] [Indexed: 11/17/2022] Open
Abstract
Patients with multivessel coronary artery disease are more likely to have extensive atherosclerosis that involves other major arteries. Critical subclavian artery (SCA) stenosis can result in coronary subclavian steal syndrome that may present as recurrent ischemia and even myocardial infarction in patients with coronary artery bypass graft (CABG). In patients with concomitant severe native coronary disease, occluded saphenous venous grafts (SVG) to other arteries, percutaneous intervention on critical subclavian artery (SCA) stenosis that will compromise the blood flow to left internal mammary graft (LIMA) and left anterior descending (LAD) artery will be a high-risk procedure and may be associated with cardiogenic shock, especially in patients with preexisting ischemic cardiomyopathy. The use of percutaneous left ventricular (LV) assist device like Impella will offer better hemodynamic support and coronary perfusion and therefore results in decreased myocardial damage, maximized residual cardiac function, and lower incidence of cardiogenic shock.
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24
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25
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Liu W, Mukku VK, Gilani S, Fujise K, Barbagelata A. Percutaneous Hemodynamic Support (Impella) in Patients with Advanced Heart Failure and/or Cardiogenic Shock Not Eligible to PROTECT II Trial. Int J Angiol 2014; 22:207-12. [PMID: 24436614 DOI: 10.1055/s-0033-1349167] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
PROTECT I and II trials have tested the efficacy of Impella in patents with high-risk percutaneous coronary intervention (PCI). However, patients with severe hemodynamic instability such as cardiac arrest, ST-segment elevated myocardial infarction (STEMI), or cardiogenic shock were excluded. The objective was to investigate the efficacy of Impella in sicker patient population who were not included in PROTECT trials. These patients merit high-risk PCI who had cardiogenic shock and unstable or decompensated heart failure (HF). From December 2010 to March 2012, 10 consecutive patients with extremely high surgical risk and hemodynamic instability underwent urgent PCI with Impella 2.5 support (Abiomed Inc., Danvers, MA). These patients were presented with advance HF and/or cardiogenic shock. Among the 10 included patients, 3 patients were with cardiac arrest and 1 patient was with acute myocardial infarction. All patients had successful Impella implantation and remained hemodynamically stable during high-risk PCI. Among the 10 patients 2 patients (20%) died within 1 month and 1 patient developed limb ischemia. In high-risk population nonrandomizable to PROTECT trials with advance HF/cardiogenic shock, Impella could be an important tool for hemodynamic support to PCI or could be a bridge to left ventricle assist device to achieve good recovery. Larger studies need to be conducted on this high-risk population.
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Affiliation(s)
- Wei Liu
- Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Syed Gilani
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
| | - Ken Fujise
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
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26
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Maini B, Gregory D, Scotti DJ, Buyantseva L. Percutaneous cardiac assist devices compared with surgical hemodynamic support alternatives. Catheter Cardiovasc Interv 2014; 83:E183-92. [DOI: 10.1002/ccd.25247] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 10/10/2013] [Indexed: 11/09/2022]
Affiliation(s)
| | - David Gregory
- Presscott Associates-A Division of ParenteBeard LLC; Avon Connecticut
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27
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Engström AE, Piek JJ, Henriques JPS. Percutaneous left ventricular assist devices for high-risk percutaneous coronary intervention. Expert Rev Cardiovasc Ther 2014; 8:1247-55. [DOI: 10.1586/erc.10.93] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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28
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Economic and Operational Implications of a Standardized Approach to Hemodynamic Support Therapy Using Percutaneous Cardiac Assist Devices. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014; 9:38-42. [DOI: 10.1097/imi.0000000000000047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Impella 2.5 has been shown to reduce major adverse events for patients undergoing elective high-risk percutaneous coronary intervention. We performed a single-center retrospective study to compare the costs and resource use of Impella 2.5 and intra-aortic balloon pump (IABP) support. Methods All high-risk patients who received Impella 2.5 (n = 35) and IABP (n = 295) support from December 2008 to July 2011 were included. Propensity score matching identified a balanced 1:1 matched cohort (35 Impella vs 35 IABP) based on indications for implantation, preimplantation hemodynamics, and age. Diagnostic, procedural, financial, and resource use data were collected. Results As compared with IABP, Impella offered a more predictable course of treatment/resource consumption and was not associated with any extreme cost outliers (17.1% vs 0.0%, respectively; P = 0.025). The mean admission and 90-day episode of care total costs for Impella were 5.5% ($67,681 vs $71,608, P = 0.79) and 4.2% ($70,680 vs $73,476, P = 0.85) lesser than that for IABP, respectively. Although not statistically significant, Impella patients had a trend toward lower rehospitalization rates (11.4% vs 20%), lesser mean index length of hospital stay (11.2 vs 13.7), and 90-day (11.7 vs 14.2) episode of care length of hospital stay. Conclusions Impella support was associated with consistent course of treatment/resource consumption with significantly fewer 90-day extreme cost outliers than was IABP. The lower index and 90-day follow-up cost trends observed for Impella were driven by shorter length of hospital stay and fewer rehospitalizations. As providers strive to improve quality of care by reducing variability, these findings have implications for the development of hemodynamic support algorithms.
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29
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Wohns D, Muthusamy P, Davis AT, Khan M, Postma JK, Williams EE, Gile CM, Scotti DJ, Gregory D. Economic and Operational Implications of a Standardized Approach to Hemodynamic Support Therapy Using Percutaneous Cardiac Assist Devices. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014. [DOI: 10.1177/155698451400900107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- David Wohns
- Division of Interventional Cardiology, Department of Cardiology, Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI USA
- Division of Cardiology, Spectrum Health, Grand Rapids, MI USA
| | - Purushothaman Muthusamy
- Internal Medicine Residency, Grand Rapids Medical Education Partners/Michigan State University Program, Grand Rapids, MI USA
| | - Alan T. Davis
- Department of Research, Grand Rapids Medical Education Partners, Grand Rapids, MI USA
- Department of Surgery, Michigan State University, Grand Rapids, MI USA
| | - Mohsin Khan
- Internal Medicine Hospitalist, Spectrum Health, Grand Rapids, MI USA
| | - Joseph K. Postma
- Internal Medicine Residency, Grand Rapids Medical Education Partners/Michigan State University Program, Grand Rapids, MI USA
| | - Elbert E. Williams
- Michigan State University-College of Human Medicine, East Lansing, MI USA
| | - Cynthia M. Gile
- Department of Research, Spectrum Health, Grand Rapids, MI USA
| | - Dennis J. Scotti
- Department of Management, Fairleigh Dickinson University, Teaneck, NJ USA
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30
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Heuser R. The use of PTCA in acute mitral regurgitation and cardiogenic shock: revisited with impella. Catheter Cardiovasc Interv 2013; 82:424. [PMID: 23008167 DOI: 10.1002/ccd.24663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 09/16/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Richard Heuser
- Chief of Cardiology, St. Luke's Medical Center Professor of Medicine, University of Arizona College of Medicine Phoenix, Arizona
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31
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Usage of Percutaneous Left Ventricular Assist Devices in Clinical Practice and High-risk Percutaneous Coronary Intervention. Interv Cardiol Clin 2013; 2:417-428. [PMID: 28582103 DOI: 10.1016/j.iccl.2013.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients who require coronary revascularization and present with poor left ventricular function and complex coronary anatomy are at high risk for percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery. Some of these patients are poor surgical candidates because of previous cardiac surgery or significant comorbidities. The recent approval and availability of percutaneous left ventricular assist devices has created an opportunity for the highest risk patients. This article reviews currently available mechanical circulatory support systems and portable extracorporeal oxygenation, describing hemodynamic and physiologic rationales, indications, strategies, and available evidence for their use in high risk PCI.
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32
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Roos JB, Doshi SN, Konorza T, Palacios I, Schreiber T, Borisenko OV, Henriques JPS. The cost-effectiveness of a new percutaneous ventricular assist device for high-risk PCI patients: mid-stage evaluation from the European perspective. J Med Econ 2013; 16:381-90. [PMID: 23301850 DOI: 10.3111/13696998.2012.762004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE A new and smaller percutaneous ventricular assist device (pVAD, Impella, Abiomed, Danvers, MA) has been developed to provide circulatory support in hemodynamically unstable patients and to prevent hemodynamic collapse during high-risk percutaneous coronary interventions (PCI). The objective of the study was to assess the cost-effectiveness of this specific device compared to the intra-aortic balloon pump (IABP) from the European perspective. Additional analysis on extracorporeal membrane oxygenation was conducted for observational purposes only, given its use in some European countries. METHODS A combination of a decision tree and Markov model was developed to assess the cost-effectiveness of the small, pVAD. The short-term (30-day) effectiveness and safety (early survival, risk of bleeding, and stroke) were modeled, as well as long-term risk of major adverse cardiovascular events (recurrent myocardial infarction, stroke, and heart failure). The short-term effectiveness and safety data for the device were obtained from two registries (the Europella and USpella), both of which are large multi-center studies in high-risk patient groups. Probabilities of long-term major adverse cardiovascular events were obtained from various published clinical studies. The economic analysis was conducted from a German statutory health insurance perspective and only direct medical costs were included. Cost-effectiveness was estimated over a 10-year time horizon. RESULTS Compared with IABP, the pVAD generated an incremental quality-adjusted life-year (QALY) of 0.22 (with Euro-registry data) and 0.27 (with US-registry data). The incremental cost-effectiveness ratio (ICER) of the device varied between €38,069 (with Euro-registry data) and €31,727 (with US-registry data) per QALY compared with IABP. KEY LIMITATIONS Unadjusted, indirect comparisons of short-term effectiveness and safety between the interventions were used in the model. Cost and utility data were retrieved from various sources. Therefore, differences in patient populations may bias the estimated cost-effectiveness. CONCLUSIONS Compared with IABP, the pVAD is a cost-effective intervention for high-risk PCI patients, with ICERs well-below the conventional cost-effectiveness threshold.
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Bella PD, Maccabelli G. Temporary Percutaneous Left Ventricular Support for Ablation of Untolerated Ventricular Tachycardias. Circ Arrhythm Electrophysiol 2012; 5:1056-8. [DOI: 10.1161/circep.112.979013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paolo Della Bella
- From the Arrhythmia Unit and Electrophysiology Laboratories, Cardio-Thoraco-Vascular Department, San Raffaele Hospital, Milan, Italy
| | - Giuseppe Maccabelli
- From the Arrhythmia Unit and Electrophysiology Laboratories, Cardio-Thoraco-Vascular Department, San Raffaele Hospital, Milan, Italy
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Mukku VK, Cai Q, Gilani S, Fujise K, Barbagelata A. Use of impella ventricular assist device in patients with severe coronary artery disease presenting with cardiac arrest. Int J Angiol 2012; 21:163-6. [PMID: 23997562 PMCID: PMC3578627 DOI: 10.1055/s-0032-1324736] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Impella (Abiomed, Danvers, MA) is a percutaneously inserted ventricular assist device (VAD). It has been increasingly used in patients with severe heart failure, cardiogenic shock, and high-risk percutaneous intervention (PCI). However, the use and efficacy of Impella in patients with severe coronary artery disease (CAD) presenting with cardiac arrest has rarely been reported.The objective of this study is to report our center experience in using Impella VAD in CAD patients presenting with cardiac arrest. From December 2010 to March 2011, three patients with severe CAD presented to our center with cardiac arrest underwent PCI with Impella support. We reported three cases of severe CAD presenting with cardiac arrest successfully treated with PCI and Impella support. Our experience demonstrated that Impella VAD may play an adjunctive role in obtaining hemodynamic stability in these high-risk patients undergoing PCI. One of the patients was supported to left VAD implantation, and the other two had excellent neurological and functional recovery. Our reports suggest an important role of Impella in cardiac arrest population. Earlier Impella implantation after cardiac arrest might provide cardiac support and tissue perfusion until recovery or high-risk PCI.
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Affiliation(s)
- Venkata K. Mukku
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
| | - Qiangjun Cai
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
| | - Syed Gilani
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
| | - Ken Fujise
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
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Anusionwu O, Fischman D, Cheriyath P. The Duration of Impella 2.5 Circulatory Support and Length of Hospital Stay of Patients Undergoing High-risk Percutaneous Coronary Interventions. Cardiol Res 2012; 3:154-157. [PMID: 28348680 PMCID: PMC5358206 DOI: 10.4021/cr190e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2012] [Indexed: 12/23/2022] Open
Abstract
Background To evaluate the impact of duration of Impella 2.5 support (Abiomed, Danvers, MA) on hospitalization of patients after high-risk percutaneous coronary intervention (PCI). There has been a continuous increase in prevalence of coronary artery disease with more patients needing PCI during acute myocardial infarction. Some of these patients have to undergo high-risk revascularization with circulatory support like the Impella 2.5 device. Methods This study was a single center retrospective study of patients admitted to our hospital who required Impella circulatory support during percutaneous coronary intervention. Patients’ medical records, cardiac catheterization laboratory and 2-D echocardiography reports were reviewed to ascertain left ventricular ejection fraction, duration of Impella support, Coronary Care Unit (CCU) days and the length of stay in the hospital. A P-value of ≤ 0.05 was considered statistically significant. Results Over a 15-month period, we had 25 patients with 19 males and 6 females. Mean age of the patient cohort was 68 ± 10 years. Mean LVEF of the group was 32 ± 16%. Mean length of hospital stay was 8 ± 8 days and mean CCU stay was 4 ± 4 days. The Impella was successfully inserted in all cases with a median duration of support of 70 minutes (range, 4 - 5760 minutes). Bleeding complication occurred in 8%. Spearman's rank correlation coefficient between the duration of Impella support and hospital stay was 0.49 (P = 0.023) while it was 0.71 (P = 0.001) between Impella support duration and CCU days. Conclusions Our study suggests that there is a positive correlation between the duration of Impella 2.5 circulatory support and hospital stay and/or CCU days. The correlation seems to be stronger with CCU days.
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Affiliation(s)
- Obiora Anusionwu
- Department of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, United States of America
| | - Daniel Fischman
- Department of Internal Medicine, Pinnacle Health Systems, Harrisburg, Pennsylvania 17104, United States of America
| | - Pramil Cheriyath
- Department of Internal Medicine, Pinnacle Health Systems, Harrisburg, Pennsylvania 17104, United States of America
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Palacios IF. Left ventricular assistant device Impella 2.5 usage for patients undergoing high-risk PCI. Catheter Cardiovasc Interv 2012; 79:1135-7. [PMID: 22570078 DOI: 10.1002/ccd.24461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 04/16/2012] [Indexed: 11/12/2022]
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Maini B, Naidu SS, Mulukutla S, Kleiman N, Schreiber T, Wohns D, Dixon S, Rihal C, Dave R, O'Neill W. Real-world use of the Impella 2.5 circulatory support system in complex high-risk percutaneous coronary intervention: The USpella Registry. Catheter Cardiovasc Interv 2012; 80:717-25. [DOI: 10.1002/ccd.23403] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 10/02/2011] [Indexed: 12/11/2022]
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Cubeddu R, Lago R, Horvath S, Vignola P, O’Neill W, Palacios I. Use of the Impella 2.5 system alone, after and in combination with an intra-aortic balloon pump in patients with cardiogenic shock: case description and review of the literature. EUROINTERVENTION 2012; 7:1453-60. [DOI: 10.4244/eijv7i12a226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Shavelle DM, Clavijo L, Matthews RV. Percutaneous devices to support the left ventricle. Expert Rev Med Devices 2011; 8:681-94. [PMID: 22029466 DOI: 10.1586/erd.11.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article will summarize the current status of three percutaneous left ventricular assist devices, review technical details involving device components and device insertion, discuss the hemodynamic changes that occur with device implantation and summarize published and ongoing clinical trials evaluating these devices in patients undergoing high-risk percutaneous coronary intervention and those with cardiogenic shock.
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Affiliation(s)
- David M Shavelle
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, CA, USA.
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Use of the Impella 2.5 for prophylactic circulatory support during elective high-risk percutaneous coronary intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2011; 12:299-303. [DOI: 10.1016/j.carrev.2011.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 02/02/2011] [Accepted: 02/04/2011] [Indexed: 11/22/2022]
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Arroyo D, Cook S. Percutaneous ventricular assist devices: new deus ex machina? Minim Invasive Surg 2011; 2011:604397. [PMID: 22091361 PMCID: PMC3197007 DOI: 10.1155/2011/604397] [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] [Received: 10/05/2010] [Revised: 05/22/2011] [Accepted: 05/25/2011] [Indexed: 11/26/2022] Open
Abstract
The development of ventricular assist devices has broadened the means with which one can treat acute heart failure. Percutaneous ventricular assist devices (pVAD) have risen from recent technological advances. They are smaller, easier, and faster to implant, all important qualities in the setting of acute heart failure. The present paper briefly describes the functioning and assets of the most common devices used today. It gives an overview of the current evidence and indications for left ventricular assist device use in cardiogenic shock and high-risk percutaneous coronary intervention. Finally, extracorporeal life support devices are dealt with in the setting of hemodynamic support.
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Affiliation(s)
- Diego Arroyo
- Cardiology Unit, University Medical Center, University of Fribourg, 1708 Fribourg, Switzerland
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McCulloch B. Use of the Impella 2.5 in high-risk percutaneous coronary intervention. Crit Care Nurse 2011; 31:e1-16. [PMID: 21285459 DOI: 10.4037/ccn2011293] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The Impella 2.5 is a percutaneously placed partial circulatory assist device that is increasingly being used in high-risk coronary interventional procedures to provide hemodynamic support. The Impella 2.5 is able to unload the left ventricle rapidly and effectively and increase cardiac output more than an intra-aortic balloon catheter can. Potential complications include bleeding, limb ischemia, hemolysis, and infection. One community hospital's approach to establishing a multidisciplinary program for use of the Impella 2.5 is described.
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Affiliation(s)
- Brenda McCulloch
- Sutter Heart and Vascular Institute, Sutter Medical Center, 5301 F Street, Suite 304, Sacramento, CA 95819, USA.
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Engström AE, Engström A, Sjauw KD, Sjauw K, Baan J, Remmelink M, Claessen BEPM, Claessen B, Kikkert WJ, Kikkert W, Hoebers LPC, Hoebers L, Vis MM, Vis M, Koch KT, Koch K, Meuwissen MM, Meuwissen M, Tijssen JGP, Tijssen J, De Winter RJ, De Winter R, Piek JJ, Piek J, Henriques JPS, Henriques J. Long-term safety and sustained left ventricular recovery: long-term results of percutaneous left ventricular support with Impella LP2.5 in ST-elevation myocardial infarction. EUROINTERVENTION 2011; 6:860-5. [PMID: 21252021 DOI: 10.4244/eijv6i7a147] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Mechanical left ventricular (LV) unloading may reduce infarct size when combined with primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). The Impella LP2.5 is a novel percutaneous left ventricular assist device. Although the short-term safety and feasibility of this device have been demonstrated, the long-term effects are unknown. The purpose of the current study was to evaluate the long-term effects of the Impella LP2.5 support on the aortic valve and left ventricular ejection fraction (LVEF). METHODS AND RESULTS In 2006, 10 patients with anterior STEMI received 3-day support with the Impella LP2.5 after PCI. The control group consisted of 10 comparable patients, treated according to routine care. For the current study, echocardiography was performed and adverse events were recorded. Mean duration of follow-up was 2.9±0.6 years in the Impella group and 3.0±0.3 years in the control group. No differences in aortic valve abnormalities and LVEF were demonstrated between the groups; nevertheless, LVEF increase from baseline was significantly greater in Impella-treated patients (23.6±8.9% versus 6.7±7.0%, P=0.008). CONCLUSIONS Three-day support with the Impella LP2.5 is not associated with adverse effects on the aortic valve at long-term follow-up. LVEF was similar in both groups; however, recovery was significantly greater in the Impella group.
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Marella PC, Lassetter JE, Heuser RR. The Impella ventricular assist device: use in patients at high risk for coronary interventions: successful multivessel percutaneous coronary intervention in a 62-year-old high-risk patient. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2010; 12:69.e9-12. [PMID: 21036108 DOI: 10.1016/j.carrev.2010.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 09/03/2010] [Accepted: 09/10/2010] [Indexed: 11/25/2022]
Abstract
The Impella Recover LP 2.5 (Abiomed, Danvers, MA, USA) is a ventricular assist device that is easily placed and has low adverse events. It helps unload myocardial demand and enables revascularization in patients who are otherwise at extreme risk for percutaneous coronary intervention (PCI). It breaks the cycle of cardiogenic shock and is indicated in patients with low ejection fraction (EF), acute heart failure, and concurrent high-risk factors for intervention or surgery. Many case reports have been published regarding use of this device in high-risk PCIs, but successful intervention in two high-risk vessels in one setting has rarely been reported. We describe such a case report here where two critical lesions in LAD and circumflex arteries were successfully intervened on with the assistance of this device.
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Affiliation(s)
- Punnaiah C Marella
- Department of Internal Medicine, Banner Estrella Medical Center, 9305 W Thomas Rd, Phoenix, AZ 85037, USA
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Guirgis M, Kumar K, Zieroth S, Philipp R, Menkis AH, Freed DH. Interprovincial spoke-to-hub transport using the Impella Recover LP 5.0 left ventricular assist device as a bridge to long-term circulatory support. Can J Cardiol 2010; 26:320-2. [PMID: 20931101 DOI: 10.1016/s0828-282x(10)70443-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Current hospital administrative practices categorize health care centres in a network of 'spokes' (primary care centres) and 'hubs' (tertiary care centres). For the treatment of cardiogenic shock, long-term left ventricular assist devices (LVADs) and transplant therapies are only used at a few hub centres nationwide and are, thus, only available to patients living in close proximity to these centres. The relatively lower technical requirements of the Impella Recover LP 5.0 LVAD (ABIOMED Inc, USA) translate into greater use by spoke centres for the short-term treatment of cardiogenic shock, and facilitate appropriate stabilization and subsequent transportation to a suitable hub centre. Based on a review of the literature, the present report describes the first case demonstrating successful use of the Impella Recover LP 5.0 LVAD, implanted under local anesthetic, for the purposes of interprovincial spoke-to-hub transport in a bridge-to-bridge-to-transplant procedure. By providing an economical and technically straightforward alternative to traditional extracorporeal membrane oxygenation, the present case demonstrates that less invasive LVADs are valuable to the spoke-and-hub model for delivery of specialized cardiac care.
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Affiliation(s)
- Mina Guirgis
- Institute of Cardiovascular Sciences, St Boniface Hospital Research Centre, University of Manitoba, Canada
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Percutaneous left ventricular assist devices during cardiogenic shock and high-risk percutaneous coronary interventions. Curr Cardiol Rep 2010; 11:369-76. [PMID: 19709497 DOI: 10.1007/s11886-009-0051-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Left ventricular assist devices were developed to support the function of a failing left ventricle. Owing to recent technological improvements, ventricular assist devices can be placed by percutaneous implantation techniques, which offer the advantage of fast implantation in the setting of acute left ventricular failure. This article reviews the growing evidence supporting the clinical use of left ventricular assist devices. Specifically, we discuss the use of left ventricular assist devices in patients with cardiogenic shock, in patients with acute ST-elevation myocardial infarction without shock, and during high-risk percutaneous coronary interventions.
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Sjauw KD, Konorza T, Erbel R, Danna PL, Viecca M, Minden HH, Butter C, Engstrøm T, Hassager C, Machado FP, Pedrazzini G, Wagner DR, Schamberger R, Kerber S, Mathey DG, Schofer J, Engström AE, Henriques JPS. Supported high-risk percutaneous coronary intervention with the Impella 2.5 device the Europella registry. J Am Coll Cardiol 2010; 54:2430-4. [PMID: 20082934 DOI: 10.1016/j.jacc.2009.09.018] [Citation(s) in RCA: 176] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 09/03/2009] [Accepted: 09/14/2009] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This retrospective multicenter registry evaluated the safety and feasibility of left ventricular (LV) support with the Impella 2.5 (Abiomed Europe GmbH, Aachen, Germany) during high-risk percutaneous coronary intervention (PCI). BACKGROUND Patients with complex or high-risk coronary lesions, such as last remaining vessel or left main lesions, are increasingly being treated with PCI. Because periprocedural hemodynamic compromise and complications might occur rapidly, many of these high-risk procedures are being performed with mechanical cardiac assistance, particularly in patients with poor LV function. The Impella 2.5, a percutaneous implantable LV assist device, might be a superior alternative to the traditionally used intra-aortic balloon pump. METHODS The Europella registry included 144 consecutive patients who underwent a high-risk PCI. Safety and feasibility end points included incidence of 30-day adverse events and successful device function. RESULTS Patients were older (62% >70 years of age), 54% had an LV ejection fraction < or = 30%, and the prevalence of comorbid conditions was high. Mean European System for Cardiac Operative Risk Evaluation score was 8.2 (SD 3.4), and 43% of the patients were refused for coronary artery bypass grafting. A PCI was considered high-risk due to left main disease, last remaining vessel disease, multivessel coronary artery disease, and low LV function in 53%, 17%, 81%, and 35% of the cases, respectively. Mortality at 30 days was 5.5%. Rates of myocardial infarction, stroke, bleeding requiring transfusion/surgery, and vascular complications at 30 days were 0%, 0.7%, 6.2%, and 4.0%, respectively. CONCLUSIONS This large multicenter registry supports the safety, feasibility, and potential usefulness of hemodynamic support with Impella 2.5 in high-risk PCI.
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Affiliation(s)
- Krischan D Sjauw
- Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
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Sciahbasi A, Pendenza G, Romagnoli E, Summaria F, Chiappa R, Patrizi R, Caselli G, Lioy E. Successful high-risk percutaneous coronary revascularization using Impella Recover LP 5.0 l/min. J Cardiovasc Med (Hagerstown) 2009; 14:388-92. [PMID: 20035234 DOI: 10.2459/jcm.0b013e328335fc69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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