Left Ventricular Unloading by Impella Device Versus Surgical Vent During Extracorporeal Life Support

Tepper, Sarah; Masood, Muhammad; Garcia, Moises Baltazar; Pisani, M.; Ewald, Gregory A.; Lasala, John M.; Bach, Richard G.; Singh, Jasvindar; Balsara, Keki R.; Itoh, Akinobu

doi:10.1016/j.athoracsur.2016.12.049

Cited by 100 publications

(53 citation statements)

References 25 publications

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“…In the recent years, the peripheral arterial approach in implanting catheter-based VADs has become the predominant technique 5 . Due to the urgency in cardiogenic shock in our patients, we placed the device through a graft sewn to the distal ascending aorta during CPB; a strategy more time sensitive than an axillary or femoral approach.…”

Section: Discussionmentioning

confidence: 99%

Advantages of Surgical Implantation Impella 5.5 SmartAssist in the Management of Acute Post-Infarction Ventricular Septal Defect with Cardiogenic Shock

Madjarov¹,

Katz

Madzharov³

et al. 2020

Preprint

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Background: Despite advances in surgical techniques and aggressive therapy of post-infarction ventricular septal defect (VSD) with cardiogenic shock, the overall morbidity and mortality is frustratingly high. The Impella 5.5 SmartAssist (Abiomed, Danvers, MA) is a surgically implanted temporary device, recently approved by the FDA for treatment of patients in cardiogenic shock, and may fill a technological gap for perioperative patients who require acute circulatory support. Case presentation: We report our initial experience with trans-aortic implantation of the Impella 5.5 SmartAssist for two patients with post myocardial infarction VSD in the setting of cardiogenic shock. First patient had a posterior VSD with a left to right shunt (Qp/Qs ratio of 3.3), right ventricle dysfunction, severe pulmonary arterial hypertension, and severe mitral valve regurgitation. Second patient was admitted for massive MI with large anterior VSD (Qp/Qs ratio of 2.8). Under cardiopulmonary bypass with cardioplegic arrest both patients underwent urgent VSD closure with trans-aortic implantation of the Impella. Minimal postoperative support was required. Patients were discharged on postoperative day 10 and 14 and remained well three months later. Follow-up echocardiogram showed no residual shunt. Conclusions: Early surgical implantation of Impella 5.5 SmartAssist can prevent multiorgan dysfunction and stabilize the patients in cardiogenic shock with post-myocardial infarction VSD.

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Section: Discussionmentioning

confidence: 99%

Advantages of Surgical Implantation Impella 5.5 SmartAssist in the Management of Acute Post-Infarction Ventricular Septal Defect with Cardiogenic Shock

Madjarov¹,

Katz

Madzharov³

et al. 2020

Preprint

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show abstract

“…There are different miniaturized short‐term devices already available on the market or under development for temporary support for a few days (eg, <6 days for Impella 5.0/LD) or extended periods (eg, 14 days for pulmonary circulatory support Impella RP or 30 days for Impella 5.5). Several studies confirm the successful application of such devices . However, several potential complications were reported, such as increase in aortic regurgitation during cardiac support, aortic or mitral valve damage, or thrombus formation .…”

Section: Introductionmentioning

confidence: 86%

“…Several studies confirm the successful application of such devices. 13,14 However, several potential complications were reported, such as increase in aortic regurgitation during cardiac support, 15,16 aortic or mitral valve damage, 17,18 or thrombus formation. 19,20 Transvalvular pumps have even been used in combination with biologic and transcatheter aortic valve replacements.…”

Section: E151mentioning

confidence: 99%

Dynamic measurement of centering forces on transvalvular cannulas

et al. 2019

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In heart failure therapy, minimally invasive devices (transcatheter valves, catheter‐based cannulas or pumps) are increasingly used. The interaction with the valve is of special importance as valve damage, backflow, and thrombus formation are known complications. Therefore, the aim of this in vitro study was to characterize the forces acting on different sized transvalvular cannulas at various transvalvular pressures for four different valves. In a pulsatile setup radial and tangential forces on transvalvular cannulas were measured for bioprosthetic, artificial pericardial tissue, fresh, and fixated porcine valves. The cannula position was varied from a central position to the wall in 10° rotational steps for the whole circular range and the use of different cannula diameters (4, 6, and 8 mm) and transvalvular pressures (40‐100 mmHg). Centering forces of four different aortic valve types were identified and the three leaflets were visible in the force distribution. At the mid of the cusps and at the largest deflection the forces were highest (up to 0.8 N) and lowest in the commissures (up to 0.2 N). Whereas a minor influence of the cannula diameter was found, the transvalvular pressure linearly increased the forces but did not alter the force patterns. Centering forces that act on transvalvular cannulas were identified in an in vitro setup for several valves and valve types. Lowest centering forces were found in the commissures and highest forces were found directly at the cusps. At low pressures, low centering forces and an increased cannula movement can be expected.

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“…Tepper et al 92 retrospectively compared the outcomes of patients supported with VA-ECMO and 2 different approaches to left ventricular decompression, where 23 patients had VA-ECMO and percutaneous Impella support, and 22 patients had VA-ECMO with a surgically placed left ventricular vent. Pulmonary edema and pulmonary artery pressures were reduced in both groups, and there were no significant differences between the 2 groups in 30-day survival, discharge from the intensive care unit, vascular complications, VA-ECMO decannulation, or transition to a durable left ventricular assist device.…”

Section: Impellamentioning

confidence: 99%

Strategies for Left Ventricular Decompression During Venoarterial Extracorporeal Membrane Oxygenation - A Narrative Review

Desai

Hwang

2020

Journal of Cardiothoracic and Vascular Anesthesia

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Left Ventricular Unloading by Impella Device Versus Surgical Vent During Extracorporeal Life Support

Abstract: PVAD use in ECLS patients is an effective means of LV unloading and preventing worsened pulmonary edema, with outcomes and complications that are comparable to surgical LV vent.

Cited by 100 publications

References 25 publications

Advantages of Surgical Implantation Impella 5.5 SmartAssist in the Management of Acute Post-Infarction Ventricular Septal Defect with Cardiogenic Shock

Advantages of Surgical Implantation Impella 5.5 SmartAssist in the Management of Acute Post-Infarction Ventricular Septal Defect with Cardiogenic Shock

Dynamic measurement of centering forces on transvalvular cannulas

Strategies for Left Ventricular Decompression During Venoarterial Extracorporeal Membrane Oxygenation - A Narrative Review

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