Benefits of a novel percutaneous ventricular assist device for right heart failure: The prospective RECOVER RIGHT study of the Impella RP device

Anderson, Mark; Goldstein, James A.; Milano, Carmelo A.; Morris, L.; Kormos, Robert L.; Bhama, Jay K.; Kapur, Navin K.; Bansal, Aditya; García, José Pérez; Baker, Joshua N.; Silvestry, Scott C.; Holman, William L.; Douglas, Pamela S.; O’Neill, William W.

doi:10.1016/j.healun.2015.08.018

Cited by 350 publications

(209 citation statements)

References 18 publications

Supporting

Mentioning

188

Contrasting

Unclassified

Order By: Relevance

“…It is currently approved for use through a humanitarian device exemption on the basis of the early results of the multicenter RECOVER RIGHT study. 263 The TandemHeart device has also been previously used in an RV support configuration, although data are largely limited to small case series. 264 Future prospective randomized studies are required to evaluate whether these devices can improve clinical outcomes.…”

Section: Rv Supportmentioning

confidence: 99%

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

Self Cite

1,343

1,165

View full text Add to dashboard Cite

Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities. Cardiogenic shock (CS) is a low-cardiac-output state resulting in life-threatening end-organ hypoperfusion and hypoxia.1,2 Acute myocardial infarction (MI) with left ventricular (LV) dysfunction remains the most frequent cause of CS. 1,3 Advances in reperfusion therapy have been associated with improvements in survival, but significant regional disparities in evidence-based care have been reported, and in-hospital mortality remains high (27%-51%).1,4-9 Management recommendations are distributed between disease-specific statements and guidelines, and a dedicated and comprehensive clinical resource in this area is lacking. Thus, consolidating the evidence to define contemporary best medical and surgical CS practices for both MI-associated CS and other types of CS may be an important step in knowledge translation to help attenuate disparities in evidence-based care.Regional systems of care coupled with treatment algorithms have improved survival in high-acuity time-sensitive conditions such as MI, out-of-hospital cardiac arrest (OHCA), and trauma.10-12 Applying a similar framework to CS management may lead to similar improvements in survival, and CS systems of care are emerging within existing regional cardiovascular emergency care networks; however, guidance from a national expert group on structure and systems of care has not been available. 13,14 Accordingly, the purposes of this American Heart Association (AHA) scientific statement on CS are to summarize our contemporary understanding of the epidemiology, pathophysiology, and in-hospital best care practices into a single clinical resource document; to suggest a stepwise management algorithm that integrates medical, surgical, and mechanical circulatory support (MCS) therapies; and to propose a Mission: Lifelinesupported pathway for the development of integrated regionalized CS systems of care. DEFINITION OF CSAcute cardiac hemodynamic instability may result from disorders that impair function of the myocardium, valves, conduction system, or pericardium, either in isolation HISTORICAL PERSPECTIVESBefore the routine use of early revascularization, MIassociated CS had an in-hospital mortality exceeding 80%. A registry trial of 250 patients with acute MI described the association between bedside physical examination (Killip classification) for the as...

show abstract

Section: Rv Supportmentioning

confidence: 99%

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

Self Cite

1,343

1,165

View full text Add to dashboard Cite

show abstract

“…15 In addition, the Impella RP (Right Percutaneous) is available for treatment of right heart failure. 16 The Impella CP provides an intermediate level of support of 3.0–4.0 L/min of blood flow and is now available in the US. 17 The smaller devices are inserted percutaneously via the femoral artery, or infrequently the axillary artery, and are advanced retrograde across the aortic valve.…”

Section: Circulatory Support Devicesmentioning

confidence: 99%

Advanced Percutaneous Mechanical Circulatory Support Devices for Cardiogenic Shock

Miller

Solomon

McAreavey

2017

Critical Care Medicine

View full text Add to dashboard Cite

Objective To review temporary percutaneous mechanical circulatory support devices (pMCS) 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 (ECMO), Impella, and TandemHeart. Study Selection Selected publications included randomized controlled trial data and observational studies describing experience with pMCS 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 (IABP) counterpulsation. Now, several pMCS devices, including Impella®, TandemHeart™, and ECMO, are more accessible. Compared with IABP, 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 ECMO offers the advantage of biventricular circulatory support and oxygenation but there are significant vascular complications. Comparative studies with ECMO have not been completed. Despite lack of randomized controlled data, there has been a substantial increase in use of pMCS. 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. While evidence is lacking and complications rates are high, improvements and experience with pMCS may offer the prospect of better outcomes.

show abstract

“…One of these is the Impella RP, which is a percutaeneous device that has FDA approval for Humanitarian Device Exemption for implantation of up to 14 days in patients with acute right heart failure. It is the first axial flow catheter designed to support the RV 98 99. The RECOVER RIGHT trial was recently published and confirmed the haemodynamic efficacy and safety of the Impella RP 99.…”

Section: Future Perspectivesmentioning

confidence: 99%

“…It is the first axial flow catheter designed to support the RV 98 99. The RECOVER RIGHT trial was recently published and confirmed the haemodynamic efficacy and safety of the Impella RP 99. There have also been reports of the use of both an Impella 5.0 and an Impella RP (referred to as BiPella) to support biventricular failure, which now opens the possibility of biventricular support for CS 100.…”

Section: Future Perspectivesmentioning

confidence: 99%

Percutaneous mechanical circulatory support: current concepts and future directions

Briceno

Kapur

Perera

2016

Heart

View full text Add to dashboard Cite

Benefits of a novel percutaneous ventricular assist device for right heart failure: The prospective RECOVER RIGHT study of the Impella RP device

Cited by 350 publications

References 18 publications

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Advanced Percutaneous Mechanical Circulatory Support Devices for Cardiogenic Shock

Percutaneous mechanical circulatory support: current concepts and future directions

Contact Info

Product

Resources

About