Fulminant Myocarditis Managed by Extracorporeal Life Support (Impella® CP): A Rare Case

Fox, Henrik; Farr, Martin; Horstkotte, Dieter; Flottmann, Christian

doi:10.1155/2017/9231959

Cited by 16 publications

(15 citation statements)

References 10 publications

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“…Several case reports have demonstrated successful short-time use of LV-Impella in patients with fulminant myocarditis in which RV function was not significantly impaired and patients were not in need of biventricular support [ 8 – 10 ]. In these prior cases, LV-Impella was used as sole therapy without combined immunosuppressive therapy.…”

Section: Introductionmentioning

confidence: 99%

“…In these prior cases, LV-Impella was used as sole therapy without combined immunosuppressive therapy. In two cases, endomyocardial biopsies (EMB) were not performed [ 8 , 9 ], while in another case, positive EMB did reveal immune cell infiltrates [ 10 ]. In these cases, Impella was used for 5–7 days until the hemodynamics were stabilized and patients could be weaned [ 6 ] or, in one case, were bridged to durable LV mechanical support [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Mechanical Unloading by Fulminant Myocarditis: LV-IMPELLA, ECMELLA, BI-PELLA, and PROPELLA Concepts

Tschöpe

Linthout

Klein

et al. 2018

J. of Cardiovasc. Trans. Res.

143

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Mechanical circulatory support (MCS) is often required to stabilize patients with acute fulminant myocarditis with cardiogenic shock. This review gives an overview of the successful use of left-sided Impella in the setting of fulminant myocarditis and cardiogenic shock as the sole means of MCS as well as in combination with right ventricular (RV) support devices including extracorporeal life support (ECLS) (ECMELLA) or an Impella RP (BI-PELLA). It further provides evidence from endomyocardial biopsies that in addition to giving adequate support, LV unloading by Impella exhibits disease-modifying effects important for myocardial recovery (i.e., bridge-to-recovery) achieved by this newly termed "prolonged Impella" (PROPELLA) concept in which LV-IMPELLA 5.0, implanted via an axillary approach, provides support in awake, mobilized patients for several weeks. Finally, this review addresses the question of how to define the appropriate time point for weaning strategies and for changing or discontinuing unloading in fulminant myocarditis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mechanical Unloading by Fulminant Myocarditis: LV-IMPELLA, ECMELLA, BI-PELLA, and PROPELLA Concepts

Tschöpe

Linthout

Klein

et al. 2018

J. of Cardiovasc. Trans. Res.

143

View full text Add to dashboard Cite

show abstract

“…The purpose is to improve cardiac output sufficiently to prevent secondary organ failure and to unload left ventricle. Among other indications, Impella has been used in acute viral myocarditis 1 , 2 . The standard technique for the implantation of Impella CP involves insertion of the percutaneous femoral artery introducer for the guidewire to be advanced via the aorta and aortic valve into the left ventricle under fluoroscopy.…”

Section: Introductionmentioning

confidence: 99%

Implantation of Impella CP left ventricular assist device under the guidance of three-dimensional intracardiac echocardiography

Yastrebov

Brunel

Paterson

et al. 2020

Sci Rep

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Impella CP is a percutaneously inserted left ventricular assist device indicated for temporary mechanical cardiac support during high risk percutaneous coronary interventions and for cardiogenic shock. The potential application of Impella has become particularly relevant during the current COVID-19 pandemic, for patients with acute severe heart failure complicating viral illness. Standard implantation of the Impella CP is performed under fluoroscopic guidance. Positioning of the Impella CP can be confirmed with transthoracic or transoesophageal echocardiography. We describe an alternative approach to guide intracardiac implantation of the Impella CP using two-dimensional and three-dimensional intracardiac echocardiography. This new technique can be useful in selected groups of patients when fluoroscopy, transthoracic and transoesophageal echocardiography is deemed inapplicable or limited for epidemiological or clinical reasons. Intracardiac three-dimensional echocardiography is a feasible alternative to the traditional techniques for implantation of an Impella CP device but careful consideration must be given to the potential limitations and complications of this technique.

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“…B. LVAD) zugeführt, 15 % verstarben. Einzelfälle zeigen auch die Möglichkeit des Einsatz bei fulminanter Myokarditis [28].…”

Section: Kur Zgefasstunclassified

Hypoperfusionssyndrom und kardiogener Schock

Hennersdorf

Scharpf

2019

Aktuel Kardiol

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ZusammenfassungDer kardiogene Schock stellt nach wie vor ein Krankheitsbild mit hoher Mortalität dar. In dieser Situation entwickelt sich nahezu regelhaft eine Laktatazidose durch Gewebsischämie. Diese wiederum unterstützt den klinischen Gesamteindruck eines Schockzustandes. Das erhöhte Laktat bzw. mehr noch die verzögerte oder fehlende Laktatclearance sind harte Prädiktoren der schlechten Prognose. In dieser Situation ist die hämodynamische Stabilisierung neben der Ursachentherapie oberstes Gebot. Eine balancierte Volumen-/Katecholamintherapie stellt die Basis dar. Früh muss aber eine Entscheidung für oder gegen den Einsatz eines mechanischen Unterstützungssystems fallen. Entscheidungshilfen sind klinische, aber auch laborchemische und interventionelle Faktoren. Das fallende Laktat (die Laktatclearance) ist auch unter extrakorporalem System der wichtigste Ausdruck einer funktionierenden Therapie. Randomisierte Studien, die eine Prognoseverbesserung dieser schwer kranken Patienten beweisen, existieren derzeit nicht. Umso wichtiger ist der rationale, aber frühe Einsatz dieser Systeme nach in Positionspapieren definierten Kriterien.

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Fulminant Myocarditis Managed by Extracorporeal Life Support (Impella® CP): A Rare Case

Cited by 16 publications

References 10 publications

Mechanical Unloading by Fulminant Myocarditis: LV-IMPELLA, ECMELLA, BI-PELLA, and PROPELLA Concepts

Mechanical Unloading by Fulminant Myocarditis: LV-IMPELLA, ECMELLA, BI-PELLA, and PROPELLA Concepts

Implantation of Impella CP left ventricular assist device under the guidance of three-dimensional intracardiac echocardiography

Hypoperfusionssyndrom und kardiogener Schock

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