Significant Valvular Dysfunction and Outcomes in Cardiogenic Shock: Insights From the Randomized DOREMI Trial

Parlow, Simon; Weng, Willy; Santo, Pietro Di; Jung, Richard G.; Lepage-Ratte, Melissa Fay; Motazedian, Pouya; Prosperi-Porta, Graeme; Abdel‐Razek, Omar; Simard, Trevor; Chan, Vincent; Labinaz, Marino; Froeschl, Michael; Mathew, Rebecca; Hibbert, Benjamin

doi:10.1016/j.cjca.2022.04.004

Cited by 12 publications

(5 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The impact of valvular pathology on outcome measures in critically ill patients is well described ( 114 ). “Surgical acumen” instinctively dictates anatomical correction of all cardiac pathology to allow for best chance of myocardial recovery or remodeling.…”

Section: Discussionmentioning

confidence: 99%

Pathophysiology and management of valvular disease in patients with destination left ventricular assist devices

Dimarakis

Callan²,

Khorsandi³

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Over the last two decades, implantable continuous flow left ventricular assist devices (LVAD) have proven to be invaluable tools for the management of selected advanced heart failure patients, improving patient longevity and quality of life. The presence of concomitant valvular pathology, including that involving the tricuspid, mitral, and aortic valve, has important implications relating to the decision to move forward with LVAD implantation. Furthermore, the presence of concomitant valvular pathology often influences the surgical strategy for LVAD implantation. Concomitant valve repair or replacement is not uncommonly required in such circumstances, which increases surgical complexity and has demonstrated prognostic implications both short and longer term following LVAD implantation. Beyond the index operation, it is also well established that certain valvular pathologies may develop or worsen over time following LVAD support. The presence of pre-existing valvular pathology or that which develops following LVAD implant is of particular importance to the destination therapy LVAD patient population. As these patients are not expected to have the opportunity for heart transplantation in the future, optimization of LVAD support including ameliorating valvular disease is critical for the maximization of patient longevity and quality of life. As collective experience has grown over time, the ability of clinicians to effectively address concomitant valvular pathology in LVAD patients has improved in the pre-implant, implant, and post-implant phase, through both medical management and procedural optimization. Nevertheless, there remains uncertainty over many facets of concomitant valvular pathology in advanced heart failure patients, and the understanding of how to best approach these conditions in the LVAD patient population continues to evolve. Herein, we present a comprehensive review of the current state of the field relating to the pathophysiology and management of valvular disease in destination LVAD patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Pathophysiology and management of valvular disease in patients with destination left ventricular assist devices

Dimarakis

Callan²,

Khorsandi³

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…The 2022 SCAI update also included risk factors beyond shock stage that improved mortality risk stratification, allowing for additional subgroup discrimination and improved prognostic utility. A posthoc analysis of the CAPITAL DOREMI trial found that patients with moderate-to-severe or greater valvular stenosis or regurgitation had higher rates of in-hospital mortality [5 ▪ ] – whether significant concomitant valve disease is simply a marker of worsened prognosis or a potential therapeutic target is yet to be determined.…”

Section: Introductionmentioning

confidence: 99%

Inotrope and vasopressor use in cardiogenic shock: what, when and why?

Mathew

2022

Current Opinion in Critical Care

Self Cite

View full text Add to dashboard Cite

Purpose of reviewDespite increasing interest in the management of cardiogenic shock (CS), mortality rates remain unacceptably high. The mainstay of supportive treatment includes vasopressors and inotropes. These medications are recommended in international guidelines and are widely used despite limited evidence supporting safety and efficacy in CS.Recent findingsThe OptimaCC trial further supports that norepinephrine should continue to be the first-line vasopressor of choice in CS. The CAPITAL DOREMI trial found that milrinone is not superior to dobutamine in reducing morbidity and mortality in CS. Two studies currently underway will offer the first evidence of the necessity of inotrope therapy in placebo-controlled trials: CAPITAL DOREMI2 will randomize CS patients to inotrope or placebo in the initial resuscitation of shock to evaluate the efficacy of inotrope therapy and LevoHeartShock will examine the efficacy of levosimendan against placebo in early CS requiring vasopressor therapy.SummaryReview of the current literature fails to show significant mortality benefit with any specific vasopressor or inotropic in CS patients. The upcoming DOREMI 2 and levosimendan versus placebo trials will further tackle the question of inotrope necessity in CS. At this time, inotrope selection should be guided by physician experience, availability, cost, and most importantly, individual patients’ response to therapy.

show abstract

“…Cardiogenic shock secondary from severe mitral valve (MV) regurgitation remains one of the most serious entities in clinical practice, with high mortality and limited options. 1 Data from case series and retrospective studies show that transcatheter therapy is an acceptable alternative approach if the risk of surgical options is prohibitive. 1 , 2 The etiology and initial presentation of cardiogenic shock as well as the extent of preexisting cardiopulmonary remodeling are critical determinants of the benefit of transcatheter edge-to-edge repair, albeit little is known in this regard.…”

Section: Introductionmentioning

confidence: 99%

“… 1 Data from case series and retrospective studies show that transcatheter therapy is an acceptable alternative approach if the risk of surgical options is prohibitive. 1 , 2 The etiology and initial presentation of cardiogenic shock as well as the extent of preexisting cardiopulmonary remodeling are critical determinants of the benefit of transcatheter edge-to-edge repair, albeit little is known in this regard. Here we report a unique case of cardiogenic shock due to acute mitral regurgitation (MR) with histopathology-confirmed degenerative etiology, which was successfully managed by transcatheter MV edge-to-edge repair (TMVEER) and subsequent surgical replacement after recurrence.…”

Section: Introductionmentioning

confidence: 99%

Cardiogenic Shock Secondary to Acute Mitral Regurgitation With Nonischemic Etiology Successfully Stabilized by Transcatheter Intervention

Zhang¹,

Kalil²,

Eubanks³

et al. 2022

CASE

View full text Add to dashboard Cite

Significant Valvular Dysfunction and Outcomes in Cardiogenic Shock: Insights From the Randomized DOREMI Trial

Cited by 12 publications

References 33 publications

Pathophysiology and management of valvular disease in patients with destination left ventricular assist devices

Pathophysiology and management of valvular disease in patients with destination left ventricular assist devices

Inotrope and vasopressor use in cardiogenic shock: what, when and why?

Cardiogenic Shock Secondary to Acute Mitral Regurgitation With Nonischemic Etiology Successfully Stabilized by Transcatheter Intervention

Contact Info

Product

Resources

About