The Percutaneous Ventricular Assist Device in Severe Refractory Cardiogenic Shock

Kar, Biswajit; Gregorič, Igor D.; Basra, Sukhdeep S.; Idelchik, Gary M.; Loyalka, Pranav

doi:10.1016/j.jacc.2010.08.613

Cited by 295 publications

(184 citation statements)

References 26 publications

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“…The optimal duration of short-term MCS in RCSMI is not well defined yet and the decision, whether to discontinue the MCS, depends on meeting the conditions of recovery 19 . Our patient was not able to be weaned after six days of ECMO support, therefore, it was decided to implant LVAD.…”

Section: Discussionmentioning

confidence: 99%

Refractory cardiogenic shock due to extensive anterior STEMI with covered left ventricular free wall rupture treated with awake VA-ECMO and LVAD as a double bridge to heart transplantation - collaboration of three cardiac centres

Kacer¹,

Lindovská²,

Surovčík³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim.To highlight an optimal collaborative strategy of three different levels of specialized care cardiac centres. Background. Refractory cardiogenic shock is a life-threatening condition. A myocardial recovery is not achieved in many cases despite all efforts and subsequently the heart transplantation remains an ultimate option. Thereby, the use of extracorporeal membrane oxygenation (ECMO) followed by a ventricular assist device in staged bridging provides an attractive approach. Case report. We report on an optimal cooperation of PCI (percutaneous coronary intervention) centre with ELSO (extracorporeal life support organization) centre and transplant centre in a patient suffering from refractory cardiogenic shock due to acute myocardial infarction (RCSMI) complicated by left ventricle free wall rupture with pericardial tamponade. Conclusion. The interhospital collaboration can be essential in the context of patients with RCSMI. The use of ECMO enables safe interhospital transport and gains time for further diagnostic and therapeutic steps in such critically ill patients.

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Section: Discussionmentioning

confidence: 99%

Refractory cardiogenic shock due to extensive anterior STEMI with covered left ventricular free wall rupture treated with awake VA-ECMO and LVAD as a double bridge to heart transplantation - collaboration of three cardiac centres

Kacer¹,

Lindovská²,

Surovčík³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…This too facilitates extubation and ambulation. Like the Impella, data is scarce, but reports have demonstrated significant hemodynamic improvements (37). These modalities have all proven to be versatile options for decompensated Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) patients with end organ dysfunction.…”

Section: Mechanical Circulatory Support (Mcs)mentioning

confidence: 99%

The future of cardiac transplantation

Koomalsingh¹,

Kobashigawa²

2018

Ann. Cardiothorac. Surg.

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The first human-to-human heart transplant was performed 50 years ago in 1967. Heart transplantation has now entered an era of tremendous growth and innovation. The future of heart transplantation is bright with the advent of newer immunosuppressive medications and strategies that may even result in tolerance.Much of this progress in heart transplant medicine is predicated on a better understanding of acute and chronic rejection pathways through basic science studies. The future will also include personalized medicine where genomics and molecular science will dictate customized treatment for optimal outcomes. The introduction of mechanical circulatory support (MCS) devices has changed the landscape for patients with severe heart failure to stabilize the most ill patient and make them better candidates for heart transplant.As ex vivo preservation takes hold, we may witness an expansion of the donor pool through the use of donation after cardiac death (DCD) donors. In addition, further geographical donor heart sharing through ex vivo preservation may further decrease waitlist mortality by enabling longer distance donor hearts to be allocated for the sickest waitlist patient. It is no doubt an exciting time to be involved in the field of heart transplantation. In this perspective, we will summarize the present state of heart transplantation and discuss various innovations that are being pursued.

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“…Data from large well powered randomised controlled trials on novel devices in CS management are lacking. The reports available come from observational studies and retrospective analyses or small trials [39][40][41][42][43]. The Impella (Abiomed, Germany) is a catheter-based, percutaneously implanted axial pump facilitating the blood flow from the left ventricle to the aorta.…”

Section: Novel Devices and Areas Of Future Researchmentioning

confidence: 99%

The management of patients with cardiogenic shock

Sadowski¹,

Janion−Sadowska²

2017

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Cardiogenic shock is a life-threatening condition with a very poor prognosis. Many disorders may contribute to the development of shock. Of them, acute myocardial infarction is the main culprit. Despite tremendous progress in the field of interventional cardiology, in-hospital and long-term mortality still exceeds 50%. Data from large controlled trials on cardiogenic shock are scarce due to ethical reasons. Nevertheless, there is a chance for acceptable long-term survival in patients treated aggressively. The aim of this review is to summarise the key points of differential diagnosis and to emphasise that in most cases of shock due to acute myocardial infarction primary coronary intervention is the treatment of choice. StreszczenieWstrząs kardiogenny jest stanem zagrożenia życia o bardzo złym rokowaniu. Wiele sytuacji klinicznych przyczynia się do rozwoju wstrząsu, ale ostry zawał serca stanowi najczęstszą przyczynę. Pomimo olbrzymiego postępu w kardiologii interwencyjnej śmiertelność szpitalna i długoterminowa nadal przekracza 50%. Z powodów etycznych nie dysponujemy danymi z kontrolowanych badań klinicznych. Niemniej agresywne leczenie stwarza szansę na uzyskanie akceptowalnego poziomu śmier-telności w tej grupie chorych. Celem pracy jest próba podsumowania najważniejszych elementów diagnostyki różnicowej oraz wykazanie, że pilna rewaskularyzacja za pomocą angioplastyki wieńcowej jest leczeniem z wyboru w większości przypadków.

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The Percutaneous Ventricular Assist Device in Severe Refractory Cardiogenic Shock

Abstract: The pVAD rapidly reversed the terminal hemodynamic compromise seen in patients with SRCS refractory to IABP and vasopressor support.

Cited by 295 publications

References 26 publications

Refractory cardiogenic shock due to extensive anterior STEMI with covered left ventricular free wall rupture treated with awake VA-ECMO and LVAD as a double bridge to heart transplantation - collaboration of three cardiac centres

Refractory cardiogenic shock due to extensive anterior STEMI with covered left ventricular free wall rupture treated with awake VA-ECMO and LVAD as a double bridge to heart transplantation - collaboration of three cardiac centres

The future of cardiac transplantation

The management of patients with cardiogenic shock

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