Biventricular Circulatory Support Using 2 Axial Flow Catheters for Cardiogenic Shock Without the Need for Surgical Vascular Access

Aghili, Nima; Bader, Yousef; Vest, Amanda R.; Kiernan, Michael S.; Kimmelstiel, Carey; DeNofrio, David; Kapur, Navin K.

doi:10.1161/circinterventions.116.003636

Cited by 19 publications

(7 citation statements)

References 5 publications

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“…VA‐ECMO alone fails to provide biventricular support and often requires concomitant use of a mechanism to “vent” or reduce LV pressures, which may include an Impella LV catheter, intra‐aortic balloon pump, or drainage cannula in the left atrium . BiPella utilizes 2 axial flow pumps mounted on 11‐Fr (RV) and 9‐Fr (LV) catheters that are deployed by a femoral venous and arterial access site, respectively . We identified a relatively low rate of complications, including hemolysis and Thrombolysis in Myocardial Infarction major bleeding and a single episode of limb ischemia in a patient receiving Impella CP support by percutaneous puncture of the left axillary artery.…”

Section: Discussionmentioning

confidence: 99%

“…[27][28][29] BiPella utilizes 2 axial flow pumps mounted on 11-Fr (RV) and 9-Fr (LV) catheters that are deployed by a femoral venous and arterial access site, respectively. [12][13][14] We identified a relatively low rate of complications, including hemolysis and Thrombolysis in Myocardial Infarction major bleeding and a single episode of limb ischemia in a patient receiving Impella CP support by percutaneous puncture of the left axillary artery. An unresolved limitation of all 3 contemporary percutaneous biventricular support approaches is the requirement for femoral vascular access, which restricts patient mobility.…”

Section: Discussionmentioning

confidence: 99%

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Acute Biventricular Mechanical Circulatory Support for Cardiogenic Shock

Kuchibhotla

Esposito

Breton

et al. 2017

JAHA

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BackgroundBiventricular failure is associated with high in‐hospital mortality. Limited data regarding the efficacy of biventricular Impella axial flow catheters (BiPella) support for biventricular failure exist. The aim of this study was to explore the clinical utility of percutaneously delivered BiPella as a novel acute mechanical support strategy for patients with cardiogenic shock complicated by biventricular failure.Methods and ResultsWe retrospectively analyzed data from 20 patients receiving BiPella for biventricular failure from 5 tertiary‐care hospitals in the United States. Left ventricular support was achieved with an Impella 5.0 (n=8), Impella CP (n=11), or Impella 2.5 (n=1). All patients received the Impella RP for right ventricular (RV) support. BiPella use was recorded in the setting of acute myocardial infarction (n=11), advanced heart failure (n=7), and myocarditis (n=2). Mean flows achieved were 3.4±1.2 and 3.5±0.5 for left ventricular and RV devices, respectively. Total in‐hospital mortality was 50%. No intraprocedural mortality was observed. Major complications included limb ischemia (n=1), hemolysis (n=6), and Thrombolysis in Myocardial Infarction major bleeding (n=7). Compared with nonsurvivors, survivors were younger, had a lower number of inotropes or vasopressors used before BiPella, and were more likely to have both devices implanted simultaneously during the same procedure. Compared with nonsurvivors, survivors had lower pulmonary artery pressures and RV stroke work index before BiPella. Indices of RV afterload were quantified for 14 subjects. Among these patients, nonsurvivors had higher pulmonary vascular resistance (6.8; 95% confidence interval [95% CI], 5.5–8.1 versus 1.9; 95% CI, 0.8–3.0; P<0.01), effective pulmonary artery elastance (1129; 95% CI, 876–1383 versus 458; 95% CI, 263–653; P<0.01), and lower pulmonary artery compliance (1.5; 95% CI, 0.9–2.1 versus 2.7; 95% CI, 1.8–3.6; P<0.05).ConclusionsThis is the largest, retrospective analysis of BiPella for cardiogenic shock. BiPella is feasible, reduces cardiac filling pressures and improves cardiac output across a range of causes for cardiogenic shock. Simultaneous left ventricular and RV device implantation and lower RV afterload may be associated with better outcomes with BiPella. Future prospective studies of BiPella for cardiogenic shock are required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute Biventricular Mechanical Circulatory Support for Cardiogenic Shock

Kuchibhotla

Esposito

Breton

et al. 2017

JAHA

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“…The Bi‐Pella approach mitigates both shortcomings of VA ECMO while providing percutaneous biventricular unloading and haemodynamic support. This approach fulfils the requirements of the acute MCS contemporary concept allowing for (i) ease of access, (ii) rapid deployment, (iii) non‐surgical percutaneous insertion, (iv) potent biventricular support, and (v) stepwise weaning of univentricular or biventricular support ( Table ). The Bi‐Pella approach was initiated mainly to address the systemic anticoagulation contraindication of ECMO in the present case of biventricular failure but also because simultaneous initiation of support with Impella CP and Impella RP has been associated with improved survival outcomes as compared with staged initiation of support .…”

Section: Discussionmentioning

confidence: 97%

Full percutaneous biventricular support with two Impella pumps: the Bi‐Pella approach

2018

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Extracorporeal membrane oxygenation is used for acute respiratory distress syndrome, refractory cardiogenic shock, and out‐of‐hospital cardiac arrest with uncertain neurological status, and, until recently, it was the only minimally invasive option to achieve biventricular support. However, extracorporeal membrane oxygenation increases left ventricular afterload and requires systemic anticoagulation, which is a major contraindication in the context of thrombolytic therapy following an ischaemic stroke. Conversely, the Impella heart pumps by design unload the ventricle and require minimal anticoagulation. We report the first case of mechanical circulatory supported with Impella CP on the left and Impella RP on the right (Abiomed Inc., Danvers, MA) for acute biventricular failure due to suspected acute myocarditis in the context of thrombolytic therapy for ischaemic stroke.

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“… 30 , 31 While Impella pumps are primarily used to provide univentricular support to either the left or right ventricle, several cases have been reported using the pump for biventricular support, including configurations for the Impella 5.0/TandemHeart RVAD, Impella 5.0/Impella RP, and the Impella CP/Impella RP. 32 , 33 , 34 More recently, preclinical data for another axial-flow catheter design, the HeartMate Percutaneous Heart Pump (PHP; St. Jude Inc) was reported. 35 The PHP is approved for use in Europe after completion of the SHIELD I study and is currently undergoing clinical evaluation in the United States as part of the SHIELD II trial ( Fig.…”

Section: Impella In Stemimentioning

confidence: 99%

The role of acute circulatory support in ST-segment elevation myocardial infarction complicated by cardiogenic shock

Esposito

Bader

Pedicini

et al. 2017

Indian Heart Journal

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In the setting of ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock, three primary treatment objectives include providing circulatory support, ventricular unloading, and restoring myocardial perfusion. In addition to primary percutaneous coronary intervention, each of these three objectives can be achieved with appropriate use of an acute mechanical circulatory support (AMCS) pump. Over the past decade, utilization of percutaneously-delivered AMCS devices including the Impella axial-flow catheter, TandemHeart left atrial-to-femoral artery bypass system, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has grown exponentially. In this review, we will discuss the hemodynamic impact of each AMCS device and clinical data surrounding their use in the setting of STEMI complicated by cardiogenic shock.

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Biventricular Circulatory Support Using 2 Axial Flow Catheters for Cardiogenic Shock Without the Need for Surgical Vascular Access

Cited by 19 publications

References 5 publications

Acute Biventricular Mechanical Circulatory Support for Cardiogenic Shock

Acute Biventricular Mechanical Circulatory Support for Cardiogenic Shock

Full percutaneous biventricular support with two Impella pumps: the Bi‐Pella approach

The role of acute circulatory support in ST-segment elevation myocardial infarction complicated by cardiogenic shock

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