Percutaneous Mechanical Assistance for the Failing Heart

Souza, Cristiano Freitas de; Brito, Flávio de Souza; Lima, Valter Correia de; Carvalho, Antônio Carlos

doi:10.1111/j.1540-8183.2010.00536.x

Cited by 38 publications

(29 citation statements)

References 27 publications

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“…1 Three randomized trials [10][11][12] and their metaanalysis 13 compared the Impella or TandemHeart support with intra-aortic balloon pump in the treatment of cardiogenic shock, showing increased cardiac index at the cost of higher incidence of bleeding; there was no difference in mortality. There are, however, clinical conditions in which intra-aortic balloon pump is clearly insufficient for life support, such as recurrent nontolerated VT, electrical storm, serious mechanical complications of acute myocardial infarction, or cardiac arrest, that does not respond to conventional resuscitation approaches.…”

Section: Discussionmentioning

confidence: 99%

“…Their higher hemodynamic effectiveness is, however, counterbalanced by the increased size of catheters and cannulas, which are associated with a higher risk of device-related complications. a life-saving procedure during cardiopulmonary resuscitation or for hemodynamic support in high-risk coronary or electrophysiological interventions, [1][2][3][4][5] particularly in patients with severe left ventricle dysfunction undergoing electrophysiological mapping and tachycardia ablation. [6][7][8][9] To date, only small randomized trials comparing the safety and efficacy of these systems with intra-aortic balloon pump have been published [10][11][12] ; neither clinical nor experimental data on the direct comparison of these circulatory support systems are available.…”

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confidence: 99%

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Direct Comparison of Percutaneous Circulatory Support Systems in Specific Hemodynamic Conditions in a Porcine Model

Ošťádal

Mlček

Holy

et al. 2012

Circ: Arrhythmia and Electrophysiology

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Background-Several percutaneous circulatory support systems have been recently introduced into clinical practice for the treatment of cardiogenic shock or refractory nontolerated ventricular tachycardia, in support of high-risk catheter interventions and, occasionally, cardiopulmonary resuscitation. To date, however, a direct comparison of the available systems has not been performed. Methods and Results-Adult female pigs (weight 50-60 kg) were used throughout the experiment. Under deep anesthesia and mechanical ventilation, 3 percutaneous circulatory support systems were compared: (1) right atrium-aorta, extracorporeal membrane oxygenation (n=4); (2) left atrium-aorta, TandemHeart system (n=4); (3) left ventricle-aorta, Impella 2.5 system (n=4), and (4) left ventricle-aorta with norepinephrine at 0.1 µg/kg per minute (n=4). Hemodynamic efficacy (mean arterial pressure) was measured at 3 specific conditions: ventricular pacing at 200 and 300 beats per minute, and ventricular fibrillation. Although no or only nonsignificant differences were found among the systems at ventricular pacing of 200 and 300 beats per minute, under ventricular fibrillation, the right atrium-aorta system was significantly the most efficacious, followed by the left atrium-aorta system and the left ventricle-aorta system (P<0.001). However, the left ventricle-aorta system with norepinephrine still maintained mean arterial pressure comparable with the left atrium-aorta system. Conclusions-Differences were seen in the hemodynamic efficacy of available percutaneous circulatory support systems, particularly under the most severe hemodynamic condition, ventricular fibrillation. (Circ Arrhythm Electrophysiol. 2012;5:1202-1206.)

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Direct Comparison of Percutaneous Circulatory Support Systems in Specific Hemodynamic Conditions in a Porcine Model

Ošťádal

Mlček

Holy

et al. 2012

Circ: Arrhythmia and Electrophysiology

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“…19 They have been shown to be of potential benefit in select patients undergoing high-risk percutaneous coronary intervention, acute myocardial infarction, acute decompensated heart failure, and cardiogenic shock. [20][21][22][23] Because robust clinical evidence is lacking, the Society for Cardiovascular Angiography and Interventions/American College of Cardiology/Heart Failure Society of America/and Society of Thoracic Surgeons have provided a recent expert consensus statement in terms of patient populations that may derive benefit from these devices. 19 In a small single-center study of patients undergoing ablation for scar-related VT, we previously reported that pLVADs provided sufficient hemodynamic support to allow patients to be maintained in VT 2.5-fold longer, with fewer premature terminations required for hemodynamic instability, and allowed more patients to have termination of VT during ablation without any deleterious effects on end-organ perfusion.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Ventricular Tachycardia Ablation Using Percutaneous Left Ventricular Assist Devices

Kusa

Miller

Whang

et al. 2017

Circ: Arrhythmia and Electrophysiology

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All procedures were performed under general anesthesia with endotracheal intubation. Hemodynamic monitoring was performed using radial or femoral arterial blood pressure monitoring, and bilateral © 2017 American Heart Association, Inc. were all higher in the pLVAD group. During median follow-up of 215 days, the primary end point (recurrent VT, heart transplantation, or death) occurred in 36% of the pLVAD versus 26% of the non-pLVAD groups (P=0.14). After propensity matching for differences between groups, no differences were seen between groups for both acute procedural outcomes and the primary end point. Conclusions-In this large single-center scar-related VT ablation experience, despite the worse clinical status of the patients selected for pLVAD support, clinical outcomes were better than expected and were similar to healthier patients not receiving hemodynamic support. Patients with dilated cardiomyopathy presenting with electrical storm, advanced heart failure, and severe left ventricular dysfunction most frequently received hemodynamic support during VT ablation. (Circ Arrhythm Electrophysiol. 2017;10:e004717.

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“…Since its inception, the IABP has emerged as the single most effective and widely used circulatory assist device for temporary mechanical assistance of the failing myocardium [4]. Presystolic deflation of the balloon reduces afterload and augments diastolic blood pressure and coronary perfusion.…”

Section: Treatmentmentioning

confidence: 99%

“…The incidence of CS in the Global Utilization of Streptokinase and Tissue Plasminogen Activator (TPA) for Occluded Coronary Arteries (GUSTO-I) trial was 7.2%, and CS was associated with an overall in-hospital mortality of 56% and a 1-year mortality of 80% [2], making AMI complicated by CS the leading cause of in-hospital death for patients admitted with acute coronary syndromes [3]. The most important contributor to the high mortality rate associated with CS is irreversible pump failure that impairs systemic circulation and vital-organ perfusion [4].…”

Section: Introductionmentioning

confidence: 98%

Short-Term Mechanical Management of Cardiogenic Shock

Brown¹,

Bogaev²,

O'Connell³

2011

Curr Treat Options Cardio Med

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Cardiogenic shock (CS), a state of cardiac dysfunction that results in systemic hypoperfusion and end-organ dysfunction, is associated with high in-hospital mortality. Various forms of mechanical circulatory support have been used to treat CS. First employed in the 1960s, the intra-aortic balloon pump (IABP) has been a mainstay in the treatment of acute CS. However, the IABP is unable to provide adequate support in many patients, and newer technologies, including extracorporeal membrane oxygenation and percutaneous ventricular assist devices, appear to be more effective in reversing CS. These devices are also useful for supporting patients during complex percutaneous coronary intervention. Perhaps most importantly, they can be used as a bridge to decision or definitive therapy in CS patients who are potential candidates for surgical ventricular assist devices or cardiac transplantation.

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Percutaneous Mechanical Assistance for the Failing Heart

Abstract: (J Interven Cardiol 2010;23:195-202)

Cited by 38 publications

References 27 publications

Direct Comparison of Percutaneous Circulatory Support Systems in Specific Hemodynamic Conditions in a Porcine Model

Direct Comparison of Percutaneous Circulatory Support Systems in Specific Hemodynamic Conditions in a Porcine Model

Outcomes of Ventricular Tachycardia Ablation Using Percutaneous Left Ventricular Assist Devices

Short-Term Mechanical Management of Cardiogenic Shock

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