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Agrawal A, Janjua D, Alsayed Ali Zeyada AA, Taher Elsheikh A. Heart failure in children and adolescents: an update on diagnostic approaches and management. Clin Exp Pediatr 2024; 67:178-190. [PMID: 37350171 PMCID: PMC10990655 DOI: 10.3345/cep.2023.00528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 06/24/2023] Open
Abstract
Cardiac failure is a clinical syndrome that may develop in children owing to cardiac dysfunction or underlying structural heart diseases. Considering the differences in diagnostic and therapeutic approaches for pediatric heart failure (PHF) and adult heart failure, we have reviewed the current literature on PHF. Relevant studies were extracted from MEDLINE/PubMed, Google Scholar, and Clinical Trial Registries using the terms "pediatric heart failure" or "heart failure in children" and "management" or "decongestive therapy." Recent advances in diagnostic approaches, such as cardiac magnetic resonance, speckle-tracking echocardiography, tissue Doppler imaging, and molecular diagnostic techniques, have increased our under -standing of PHF. It is imperative that clinicians evaluate the interrelated factors responsible for the develop ment of PHF, including myocardial function, pulmonary and systemic blood flow, heart rhythm, valve function, and nutritional status. Although recent advances have demon strated the efficacy of many new drugs in adult heart failure trials, it cannot be concluded that these drugs will show similar efficacy in children, considering the heterogeneous nature of the underlying mechanisms and variable pharmacody-namics and pharmacokinetics. Therefore, the underlying pathophysiology of PHF and the mechanisms of action of different drugs should be considered when selecting appropriate therapies. Further trials are needed to establi sh the efficacy and safety of these drugs, and a combined mul-ti disciplinary strategy will help enhance PHF outcomes.
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Affiliation(s)
- Amit Agrawal
- Department of Pediatrics, Gandhi Medical College, Bhopal, MP, India
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Unno K, Sano M, Kaneko Y, Akita K, Sakakibara T, Sato R, Narumi T, Iguchi K, Mogi S, Suwa K, Naruse Y, Ohtani H, Saotome M, Urushida T, Maekawa Y. Safety of a Cardiac Resynchronization Therapy Device Implantation in a Patient with Unstable Heart Failure Who Require Impella-Device Assistance. Int Heart J 2022; 63:623-626. [DOI: 10.1536/ihj.21-616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kyoko Unno
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Makoto Sano
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Yutaro Kaneko
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Keitaro Akita
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Tomoaki Sakakibara
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Ryota Sato
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Taro Narumi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Keisuke Iguchi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Satoshi Mogi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Hayato Ohtani
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Masao Saotome
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Tsuyoshi Urushida
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
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Carcinoid Crisis-Induced Acute Systolic Heart Failure. JACC Case Rep 2020; 2:2068-2071. [PMID: 34317110 PMCID: PMC8299771 DOI: 10.1016/j.jaccas.2020.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 11/26/2022]
Abstract
Carcinoid crisis is a life-threatening manifestation of carcinoid syndrome characterized by profound autonomic instability in the setting of catecholamine release from stress, tumor manipulation, or anesthesia. Here, we present an unusual case of carcinoid crisis leading to acute systolic heart failure requiring mechanical circulatory support. (Level of Difficulty: Intermediate.)
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Bhalla A, Attaran R. Mechanical Circulatory Support to Treat Pulmonary Embolism: Venoarterial Extracorporeal Membrane Oxygenation and Right Ventricular Assist Devices. Tex Heart Inst J 2020; 47:202-206. [PMID: 32997787 DOI: 10.14503/thij-19-7025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Mechanical circulatory support may help patients with massive pulmonary embolism who are not candidates for systemic thrombolysis, pulmonary embolectomy, or catheter-directed therapy, or in whom these established interventions have failed. Little published literature covers this topic, which led us to compare outcomes of patients whose massive pulmonary embolism was managed with the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) or a right ventricular assist device (RVAD). We searched the medical literature from January 1990 through September 2018 for reports of adults hospitalized for massive or high-risk pulmonary embolism complicated by hemodynamic instability, and who underwent VA-ECMO therapy or RVAD placement. Primary outcomes included weaning from mechanical circulatory support and discharge from the hospital. We found 16 reports that included 181 patients (164 VA-ECMO and 17 RVAD). All RVAD recipients were successfully weaned from support, as were 122 (74%) of the VA-ECMO patients. Sixteen (94%) of the RVAD patients were discharged from the hospital, as were 120 (73%) of the VA-ECMO patients. Of note, the 8 RVAD patients who had an Impella RP System were all weaned and discharged. For patients with massive pulmonary embolism who are not candidates for conventional interventions or whose conditions are refractory, mechanical circulatory support in the form of RVAD placement or ECMO may be considered. Larger comparative studies are needed.
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Affiliation(s)
- Aneil Bhalla
- Section of Cardiovascular Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut 06519
| | - Robert Attaran
- Section of Cardiovascular Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut 06519
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Inoue A, Hifumi T, Sakamoto T, Kuroda Y. Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest in Adult Patients. J Am Heart Assoc 2020; 9:e015291. [PMID: 32204668 PMCID: PMC7428656 DOI: 10.1161/jaha.119.015291] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Extracorporeal cardiopulmonary resuscitation (ECPR) followed by targeted temperature management has been demonstrated to significantly improve the outcomes of out-of-hospital cardiac arrest (OHCA) in adult patients. Although recent narrative and systematic reviews on extracorporeal life support in the emergency department are available in the literature, they are focused on the efficacy of ECPR, and no comprehensively summarized review on ECPR for OHCA in adult patients is available. In this review, we aimed to clarify the prevalence, pathophysiology, predictors, management, and details of the complications of ECPR for OHCA, all of which have not been reviewed in previous literature, with the aim of facilitating understanding among acute care physicians. The leading countries in the field of ECPR are those in East Asia followed by those in Europe and the United States. ECPR may reduce the risks of reperfusion injury and deterioration to secondary brain injury. Unlike conventional cardiopulmonary resuscitation, however, no clear prognostic markers have been identified for ECPR for OHCA. Bleeding was identified as the most common complication of ECPR in patients with OHCA. Future studies should combine ECPR with intra-aortic balloon pump, extracorporeal membrane oxygenation flow, target blood pressure, and seizure management in ECPR.
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Affiliation(s)
- Akihiko Inoue
- Department of Emergency, Disaster and Critical Care MedicineFaculty of MedicineKagawa UniversityKagawaJapan
- Department of Emergency and Critical Care MedicineHyogo Emergency Medical CenterKagawaJapan
| | - Toru Hifumi
- Department of Emergency and Critical Care MedicineSt. Luke's International HospitalTokyoJapan
| | | | - Yasuhiro Kuroda
- Department of Emergency, Disaster and Critical Care MedicineFaculty of MedicineKagawa UniversityKagawaJapan
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Faluk M, Hasan SM, Jiang T, Abdelmaseih R, Patel J. Mechanical Circulatory Assist Devices: Available Modalities and Review of Literature. Heart Views 2020; 21:269-275. [PMID: 33986926 PMCID: PMC8104314 DOI: 10.4103/heartviews.heartviews_92_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/03/2020] [Indexed: 11/04/2022] Open
Abstract
Despite advancements in the field interventional cardiology, the prognosis in patients who suffer from cardiogenic shock is poor. Over the years, the use of percutaneous mechanical circulatory support (MCS) devices has increased with the aim to improve short- and long-term outcomes. In this article, we aim to review the different modalities available for MCS devices and current literature comparing their uses.
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Affiliation(s)
- Mohammed Faluk
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA,Ocala Regional Medical Center, Internal Medicine Residency Program, Ocala, Florida, USA
| | - Syed Mustajab Hasan
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA,Ocala Regional Medical Center, Internal Medicine Residency Program, Ocala, Florida, USA,Address for correspondence: Dr. Syed Mustajab Hasan, 1431 SW 1st Ave., Ocala, FL 34471, USA. E-mail:
| | - Tianyu Jiang
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA,Ocala Regional Medical Center, Internal Medicine Residency Program, Ocala, Florida, USA
| | - Ramy Abdelmaseih
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA,Ocala Regional Medical Center, Internal Medicine Residency Program, Ocala, Florida, USA
| | - Jigar Patel
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA,Ocala Regional Medical Center, Internal Medicine Residency Program, Ocala, Florida, USA
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See Hoe LE, Bartnikowski N, Wells MA, Suen JY, Fraser JF. Hurdles to Cardioprotection in the Critically Ill. Int J Mol Sci 2019; 20:E3823. [PMID: 31387264 PMCID: PMC6695809 DOI: 10.3390/ijms20153823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/26/2019] [Accepted: 08/03/2019] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease is the largest contributor to worldwide mortality, and the deleterious impact of heart failure (HF) is projected to grow exponentially in the future. As heart transplantation (HTx) is the only effective treatment for end-stage HF, development of mechanical circulatory support (MCS) technology has unveiled additional therapeutic options for refractory cardiac disease. Unfortunately, despite both MCS and HTx being quintessential treatments for significant cardiac impairment, associated morbidity and mortality remain high. MCS technology continues to evolve, but is associated with numerous disturbances to cardiac function (e.g., oxidative damage, arrhythmias). Following MCS intervention, HTx is frequently the destination option for survival of critically ill cardiac patients. While effective, donor hearts are scarce, thus limiting HTx to few qualifying patients, and HTx remains correlated with substantial post-HTx complications. While MCS and HTx are vital to survival of critically ill cardiac patients, cardioprotective strategies to improve outcomes from these treatments are highly desirable. Accordingly, this review summarizes the current status of MCS and HTx in the clinic, and the associated cardiac complications inherent to these treatments. Furthermore, we detail current research being undertaken to improve cardiac outcomes following MCS/HTx, and important considerations for reducing the significant morbidity and mortality associated with these necessary treatment strategies.
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Affiliation(s)
- Louise E See Hoe
- Critical Care Research Group, The Prince Charles Hospital, Chermside 4032, Australia.
- Faculty of Medicine, University of Queensland, Chermside 4032, Australia.
| | - Nicole Bartnikowski
- Critical Care Research Group, The Prince Charles Hospital, Chermside 4032, Australia
- Science and Engineering Faculty, Queensland University of Technology, Chermside 4032, Australia
| | - Matthew A Wells
- Critical Care Research Group, The Prince Charles Hospital, Chermside 4032, Australia
- School of Medical Science, Griffith University, Southport 4222, Australia
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Chermside 4032, Australia
- Faculty of Medicine, University of Queensland, Chermside 4032, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Chermside 4032, Australia
- Faculty of Medicine, University of Queensland, Chermside 4032, Australia
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Kaufeld T, Beckmann E, Ius F, Koigeldiev N, Sommer W, Mashaqi B, Fleissner FN, Siemeni T, Puntigam JO, Kaufeld J, Haverich A, Kuehn C. Risk factors for critical limb ischemia in patients undergoing femoral cannulation for venoarterial extracorporeal membrane oxygenation: Is distal limb perfusion a mandatory approach? Perfusion 2019; 34:453-459. [PMID: 30736721 PMCID: PMC6732820 DOI: 10.1177/0267659119827231] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Venoarterial extracorporeal membrane oxygenation support is a well-established tool in the care of severe refractory cardiac and respiratory failure. The application of this support may serve as a bridge to transplant, recovery or to implantation of a ventricular assist device. Venoarterial extracorporeal membrane oxygenation support can be administered through an open surgical access via the common femoral or axillary artery or a percutaneous approach using Seldinger technique. Both techniques may obstruct the blood flow to the lower limb and may cause a significant ischemia with possible limb loss. Malperfusion of the distal limb can be avoided using an ipsilateral distal limb perfusion, which may be established by adding a single-lumen catheter during venoarterial extracorporeal membrane oxygenation treatment to overcome the obstruction. The aim of this study is to distinguish the presence or absence of a distal limb perfusion regarding the incidence of distal limb ischemia. Furthermore, expected risk factors of open and percutaneous femoral venoarterial extracorporeal membrane oxygenation installation were evaluated for the development of distal limb ischemia. METHODS Between January 2012 and September 2015, 489 patients received venoarterial extracorporeal membrane oxygenation support at our institution. In total, 307 patients (204 male, 103 female) with femoral cannulation were included in the analysis. The cohort was distinguished by the presence (group A; n = 237) or absence (group B; n = 70) of a distal limb perfusion during peripheral venoarterial extracorporeal membrane oxygenation treatment. Furthermore, a risk factor analysis for the development of distal limb ischemia was performed. RESULTS The main indications for venoarterial extracorporeal membrane oxygenation therapy were a low cardiac output syndrome (LCOS) (53%) and failed weaning of extracorporeal circulation (23%). A total of 23 patients (7.49%) under venoarterial extracorporeal membrane oxygenation support developed severe distal limb malperfusion (3.38% in group A vs 21.42% in group B). Preemptive installation of distal limb perfusion extended the intervention-free intervals to 7.8 ± 19.3 days in group A and 6.3 ± 12.5 in group B. A missing distal limb perfusion (p = 0.001) was identified as a main risk factor for critical limb ischemia. Other comorbidities such as arterial occlusion disease (p = 0.738) were not statistically significantly associated. Surgical intervention due to vascular complications after extracorporeal membrane oxygenation explantation was needed in 14 cases (4.22% in group A and 5.71% in group B). CONCLUSION We were able to identify the absence of distal limb perfusion as an independent risk factor for the development of critical distal limb ischemia during femoral venoarterial extracorporeal membrane oxygenation treatment. The application of a distal limb perfusion should be considered as a mandatory approach in the context of femoral venoarterial extracorporeal membrane oxygenation treatment regardless of the implantation technique.
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Affiliation(s)
- Tim Kaufeld
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
- Tim Kaufeld, Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg
Strasse 1, 30625 Hannover, Germany.
| | - Eric Beckmann
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
| | - Fabio Ius
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
| | - Nurbol Koigeldiev
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
| | - Wiebke Sommer
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
| | - Bakr Mashaqi
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
| | - Felix N Fleissner
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
| | - Thierry Siemeni
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
| | - Jacob Ono Puntigam
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
| | - Jessica Kaufeld
- Department of Nephrology and
Hypertension, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
| | - Christian Kuehn
- Department of Cardiothoracic,
Transplantation and Vascular Surgery, Hannover Medical School, Hannover,
Germany
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Abstract
OBJECTIVES To review temporary percutaneous mechanical circulatory support devices for the treatment of cardiogenic shock, including current evidence, contraindications, complications, and future directions. DATA SOURCES A MEDLINE search was conducted with MeSH terms: cardiogenic shock, percutaneous mechanical circulatory support, extracorporeal membrane oxygenation, Impella, and TandemHeart. STUDY SELECTION Selected publications included randomized controlled trial data and observational studies describing experience with percutaneous mechanical circulatory support in cardiogenic shock. DATA EXTRACTION Studies were chosen based on strength of association with and relevance to cardiogenic shock. DATA SYNTHESIS Until recently, there were few options if cardiogenic shock was refractory to vasopressors or intra-aortic balloon pump counterpulsation. Now, several percutaneous mechanical circulatory support devices, including Impella (Abiomed, Danvers, MA), TandemHeart (CardiacAssist, Pittsburgh, PA), and extracorporeal membrane oxygenation, are more accessible. Compared with intra-aortic balloon pump, Impella provides greater hemodynamic support but no reduction in mortality. Similarly, TandemHeart improves hemodynamic variables but not survival. Comparative studies have been underpowered for mortality because of small sample size. Veno-arterial extracorporeal membrane oxygenation offers the advantage of biventricular circulatory support and oxygenation, but there are significant vascular complications. Comparative studies with extracorporeal membrane oxygenation have not been completed. Despite lack of randomized controlled data, there has been a substantial increase in use of percutaneous mechanical circulatory support. Several ongoing prospective studies with larger sample sizes may provide answers, and newer devices may become smaller, easier to insert, and more effective. CONCLUSIONS Mortality from cardiogenic shock remains unacceptably high despite early coronary revascularization or other therapies. Although evidence is lacking and complications rates are high, improvements and experience with percutaneous mechanical circulatory support may offer the prospect of better outcomes.
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Abstract
Cardiogenic shock is severe, refractory heart failure caused by significant myocardial dysfunction in the setting of adequate preload that is accompanied by systemic hypoperfusion. Progressive end-organ dysfunction is a hallmark of persistent cardiogenic shock and necessitates intervention to overcome altered hemodynamics and restore end-organ perfusion. Temporary percutaneous mechanical circulatory support is an established modality in the treatment of cardiogenic shock and is increasingly used in patients with cardiogenic shock as a bridge to recovery or further definitive therapy. This article reviews the current devices, their effects on left ventricular hemodynamics, and the evidence supporting their continued use.
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Affiliation(s)
- Jessica L Brown
- Houston Methodist Hospital, 6550 Fannin Street, Suite 1901, Houston, TX 77030, USA
| | - Jerry D Estep
- Heart Transplant & LVAD Program, Division of Heart Failure, Houston Methodist Institute of Academic Medicine, Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, 6550 Fannin Street, Suite 1901, Houston, TX 77030, USA.
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12
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Traitement de recours dans l’insuffisance cardiaque avancée. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-015-1134-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The widespread acceptance of left ventricular assist device (LVAD) implantation in the treatment of heart failure has revolutionized the way end stage heart failure is treated. Advances in LVAD technology combined with a better understanding of patient selection has led to unparalleled survival as well as a reduction in the adverse event profile of these pumps. As our understanding of heart failure continues to grow, there is little doubt that LVADs will continue to play a pivotal role as a therapeutic option for those suffering from heart failure.
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Affiliation(s)
- Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center; Columbus, OH, USA
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Ergle K, Parto P, Krim SR. Percutaneous Ventricular Assist Devices: A Novel Approach in the Management of Patients With Acute Cardiogenic Shock. Ochsner J 2016; 16:243-249. [PMID: 27660572 PMCID: PMC5024805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Despite recent advances in the management of heart failure, cardiogenic shock remains a challenging and devastating condition with significant morbidity and mortality. METHODS We review currently available percutaneous mechanical circulatory support (MCS) devices and address each device's characteristics, mechanism of action, specific clinical indications, and contraindications. RESULTS Four types of percutaneous MCS devices are currently available: the intraaortic balloon pump (IABP), Impella devices, the TandemHeart, and extracorporal membrane oxygenation (ECMO). IABPs provide less hemodynamic support compared to the Impella, TandemHeart, and ECMO devices. However, because of its ease of placement and relatively small access catheter size, the IABP remains the most commonly used MCS device for the treatment of cardiogenic shock. When full cardiopulmonary support is needed, ECMO is the best option. CONCLUSION Temporary MCS has emerged as a therapeutic option in the management of patients with acute cardiogenic shock. However, clinician familiarity with the indications, limitations, and benefits of individual MCS devices and enhanced patient comfort with the placement are paramount to improve patient outcomes.
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Affiliation(s)
- Kevin Ergle
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA
| | - Parham Parto
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA
| | - Selim R. Krim
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
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Yeh CF, Wang CH, Tsai PR, Wu CK, Lin YH, Chen YS. Use of Extracorporeal Membrane Oxygenation to Rescue Patients With Refractory Ventricular Arrhythmia in Acute Myocardial Infarction. Medicine (Baltimore) 2015; 94:e1241. [PMID: 26222862 PMCID: PMC4554118 DOI: 10.1097/md.0000000000001241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Refractory ventricular arrhythmia is a serious problem in acute myocardial infarction (AMI), with an extremely high mortality rate and limited effective treatment. Extracorporeal membrane oxygenation (ECMO) is useful to rescue patients with cardiopulmonary collapse. However, little is known about whether ECMO is a potential rescue technique for patients with refractory ventricular arrhythmia in AMI.We retrospectively analyzed prospectively collected data on patients with AMI and refractory ventricular arrhythmia who underwent ECMO as rescue therapy and the bridge to revascularization from February 2001 to January 2013. Primary endpoint was mortality on index admission, and secondary endpoint was mortality on index admission or advanced brain damage at discharge.A total of 69 (62 men) patients were enrolled in this study. During the index admission, 39 patients (56.5%) met primary endpoint, and 45 patients (65.2%) met secondary endpoint, respectively. In multivariate Cox regression analysis, both the presence of profound anoxic encephalopathy and acute renal failure requiring dialysis were significant predictive factors for both primary and secondary endpoints.ECMO is a feasible rescue therapy and bridge to revascularization in patients with refractory ventricular arrhythmia in acute myocardial infarction. The presence of profound anoxic encephalopathy and acute renal failure requiring dialysis were significant prognostic factors.
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Affiliation(s)
- Chih-Fan Yeh
- From the Department of Internal Medicine (C-FY, C-KW, Y-HL); and Department of Surgery(C-HW, Y-SC, P-RT), National Taiwan University Hospital; and National Taiwan University College of Medicine, Taipei, Taiwan (Y-HL, Y-SC)
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