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mechanical circulatory support, VAD, Impella,

Konstantinos Karatolios, Georgios Chatzis, Birgit Markus, Ulrich Luesebrink, Anette Richter, Bernhard Schieffer
BACKGROUND: Cardiogenic shock remains a clinical challenge with high mortality rate. Mechanical circulatory support (MCS) devices have become an integral component of the therapeutic armamentarium expanding the treatment options for refractory cardiogenic shock (RCS). METHODS: We included all consecutive patients with biventricular unloading with Impella-2.5 and VA-ECMO admitted for RCS between October 2013 and March 2015. Outcome data included survival to discharge, bridging to VAD and 28-day mortality...
November 1, 2016: International Journal of Cardiology
John R Spratt, Ganesh Raveendran, Kenneth Liao, Ranjit John
Temporary mechanical circulatory support (MCS) is a common supportive therapy in cardiogenic shock and high-risk coronary intervention. The proliferation of new percutaneous MCS devices allows support to be instituted rapidly without surgical cutdown. The recent literature exploring the indications, benefits, and risks of each is reviewed. Areas discussed: Current applications of percutaneous MCS devices, including intra-aortic balloon pumps (IAPB), Impella, TandemHeart, and VA ECMO are discussed. Studies investigating each were identified through a combination of online database queries and direct extraction of single studies cited in previously-identified papers...
October 2016: Expert Review of Cardiovascular Therapy
Brian Lima, Parag Kale, Gonzalo V Gonzalez-Stawinski, Johannes J Kuiper, Sandra Carey, Shelley A Hall
Many patients with end-stage heart failure require mechanical circulatory support as a temporizing measure to enable multidisciplinary assessment for the most suitable therapeutic strategy. Impella 5.0 can be used as a bridge to decision to evaluate patients for potential recovery or bridge to next therapy (bridge to heart transplantation [BTHT] or bridge to durable left ventricular assist device or VAD [BLVAD]. Our goal was to examine single-center outcomes with the Impella 5.0 device as a bridge to next therapy (BTHT or BTLVAD)...
May 15, 2016: American Journal of Cardiology
David Schibilsky, Henning Lausberg, Christoph Haller, Matthias Lenglinger, Barbara Woernle, Helene Haeberle, Peter Rosenberger, Tobias Walker, Christian Schlensak
The catheter-based Impella 5.0 left ventricular assist device (LVAD) is a powerful and less invasive alternative for patients in cardiogenic shock. The use of this device as a primary mechanical circulatory support strategy in INTERMACS II patients should be evaluated. From April 2014 to August 2014, eight Impella 5.0 devices were implanted in seven patients via the axillary artery access (six right and two left). We analyzed the outcome of the four patients in whom the Impella 5.0 device was implanted for the purpose of primary stabilization of cardiogenic shock (INTERMACS II)...
August 2015: Artificial Organs
Frederic Casassus, Jerome Corre, Lionel Leroux, Pierre Chevalereau, Aurelie Fresselinat, Benjamin Seguy, Joachim Calderon, Pierre Coste, Alexandre Ouattara, Xavier Roques, Laurent Barandon
OBJECTIVES: To investigate the outcome of patients with acute myocardial infarction (AMI) complicated by refractory cardiogenic shock (CS) who underwent mechanical circulatory support with Impella 2.5. BACKGROUND: AMI complicated by CS remains a highly fatal condition. A potent and minimally invasive left ventricular assist device might improve patient outcomes. METHODS: We analyzed the procedural characteristics and outcomes of 22 consecutive patients who underwent, between July 2008 and December 2012, a percutaneous coronary intervention and Impella 2...
February 2015: Journal of Interventional Cardiology
Nisha A Gilotra, Gerin R Stevens
Cardiogenic shock remains a challenging disease entity and is associated with significant morbidity and mortality. Temporary mechanical circulatory support (MCS) can be implemented in an acute setting to stabilize acutely ill patients with cardiomyopathy in a variety of clinical situations. Currently, several options exist for temporary MCS. We review the indications, contraindications, clinical applications, and evidences for a variety of temporary circulatory support options, including the intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO), CentriMag blood pump, and percutaneous ventricular assist devices (pVADs), specifically the TandemHeart and Impella...
2014: Clinical Medicine Insights. Cardiology
Xufeng Wei, Pablo G Sanchez, Yang Liu, Tieluo Li, A Claire Watkins, Zhongjun J Wu, Bartley P Griffith
Despite the significant contribution of the Fontan procedure to the therapy of complex congenital heart diseases, many patients progress to failure of their Fontan circulation. The use of ventricular assist devices to provide circulatory support to these patients remains challenging. In the current study, a continuous axial-flow pump was used to support a univentricular Fontan circulation. A modified Fontan circulation (atrio-pulmonary connection) was constructed in six Yorkshire piglets (8-14 kg). A Dacron conduit (12 mm) with two branches was constructed to serve as a complete atrio-pulmonary connection without the use of cardiopulmonary bypass...
March 2015: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Mubashar H Khan, Brian J Corbett, Steven M Hollenberg
Cardiogenic shock complicates about 5% to 8% of all admissions for acute myocardial infarction, and despite advancement in treatment over the past 50 years, mortality remains unacceptably high. Management with vasoactive agents after revascularization can have its limitations and thus mechanical circulatory support is often initiated. Intra-aortic balloon pumps (IABPs) are the devices most commonly used worldwide. IABPs appeared to improve mortality when used along with fibrinolytic therapy but may not when used along with percutaneous coronary interventions...
2014: F1000Prime Reports
Markus Ferrari, Peter Kruzliak, Kyriakos Spiliopoulos
Cardiogenic shock due to acute myocardial infarction, postcardiotomy syndrome following cardiac surgery, or manifestation of heart failure remains a clinical challenge with high mortality rates, despite ongoing advances in surgical techniques, widespread use of primary percutaneous interventions, and medical treatment. Clinicians have, therefore, turned to mechanical means of circulatory support. At present, a broad range of devices are available, which may be extracorporeal, implantable, or percutaneous; temporary or long term...
February 2015: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Anson W Cheung, Christopher W White, Margot K Davis, Darren H Freed
BACKGROUND: Acute right ventricular failure (ARVF) refractory to optimal medical management may require rescue therapy with mechanical circulatory support (MCS). The RV exhibits a greater capacity for rapid recovery than the left ventricle, making devices designed specifically for temporary RV MCS attractive. We report our experience with the Impella Right Direct (RD) and Right Peripheral (RP) temporary ventricular assist devices (Abiomed, Danvers, MA) in patients with ARVF. METHODS: We conducted a retrospective cohort study examining the clinical outcomes of consecutive patients supported with the Impella RD or RP at 2 institutions during a 6-year period...
August 2014: Journal of Heart and Lung Transplantation
Mary E Davis, Nicholas A Haglund, Nicole M Tricarico, Mary E Keebler, Simon Maltais
Percutaneous continuous-flow (CF) micro axial blood pumps, like the Impella 5.0, are commonly used for short-term (ST) mechanical circulatory support in patients with acute decompensated heart failure. The Impella device often serves as a bridge to implantation of a long-term (LT) CF left ventricular assist device (CF-LVAD), such as the centrifugal-flow HeartWare (HVAD). All patients supported with axial CF-LVADs develop acquired von Willebrand syndrome (AVWS) as a result of mechanical shear stress. Increased shear stress leads to excessive proteolysis of von Willebrand factor and loss of high molecular weight multimers, thus contributing to platelet dysfunction and increased gastrointestinal bleeding...
May 2014: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
A E Engström, H Granfeldt, W Seybold-Epting, M Dahm, R Cocchieri, A H G Driessen, K D Sjauw, M M Vis, J Baan, K T Koch, M De Jong, W K Lagrand, J A P Van Der Sloot, J G P Tijssen, R J De Winter, B A J M De Mol, J J Piek, J P S Henriques
AIM: Postcardiotomy cardiogenic shock (PCCS) is associated with high mortality rates, despite full conventional treatment. Although the results of treatment with surgically implantable ventricular assist devices have been encouraging, the invasiveness of this treatment limits its applicability. Several less invasive devices have been developed, including the Impella system. The objective of this study was to describe our three-center experience with the Impella 5.0 device in the setting of PCCS...
October 2013: Minerva Cardioangiologica
Anthony Lemaire, Mark B Anderson, Leonard Y Lee, Peter Scholz, Thomas Prendergast, Andrew Goodman, Ann Marie Lozano, Alan Spotnitz, George Batsides
BACKGROUND: Acute cardiogenic shock is associated with high mortality rates. Mechanical circulatory devices have been increasingly used in this setting for hemodynamic support. The Impella device (Abiomed Inc, Danvers, MA) is a microaxial left ventricular assist device that can be inserted using a less invasive technique. This study was conducted to determine the outcome of patients who have undergone placement of the Impella device for acute cardiogenic shock in our institution. METHODS: A retrospective record review of 47 patients who underwent placement of the Impella device was performed from January 1, 2006, to December 31, 2011...
January 2014: Annals of Thoracic Surgery
Themistokles Chamogeorgakis, Aldo Rafael, Alexis E Shafii, Dave Nagpal, Julie A Pokersnik, Gonzalo V Gonzalez-Stawinski
The purpose of this study is to compare outcomes associated with the use of Impella and TandemHeart short-term support devices with venoarterial extracorporeal membrane oxygenation (ECMO) therapy for postinfarction- or decompensated cardiomyopathy-related cardiogenic shock. Between January 2006 and September 2011, 79 patients were supported with either an Impella axial flow pump (n = 7) or a TandemHeart centrifugal pump (n = 11), or with ECMO (n = 61) therapy for cardiogenic shock in a single institution. Pertinent variables and postprocedural events were analyzed in this cohort of patients using a prospectively maintained clinical database...
November 2013: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Fei Lü, Peter M Eckman, Kenneth K Liao, Ioanna Apostolidou, Ranjit John, Taibo Chen, Gladwin S Das, Gary S Francis, Han Lei, Richard G Trohman, David G Benditt
BACKGROUND: Catheter ablation of hemodynamically unstable ventricular tachycardia (VT) is possible with mechanical circulatory support (MCS), little is known regarding the relative safety and efficacy of different supporting devices for such procedures. METHODS AND RESULTS: Sixteen consecutive patients (aged 63 ± 11 years with left ventricular ejection fraction of 20 ± 9%) who underwent ablation of hemodynamically unstable VT were included in this study. Hemodynamic support included percutaneous (Impella® 2...
October 9, 2013: International Journal of Cardiology
Ali Dodge-Khatami, Paul A Checchia
Partial mechanical support devices are capable of partially unloading only one ventricle, often the systemic one, in the setting of acute circulatory failure. They are rarely used in the pediatric population, as the mode of circulatory failure in patients with congenital heart disease often involves biventricular or a predominantly right ventricular component. The devices include intra-aortic balloon pumping, Impella, TandemHeart, and CentriMag. They are rarely used as a bridge-to-recovery, but more often as a bridge-to-decision, or bridge-to-conversion to full mechanical support systems, such as extracorporeal membrane oxygenation or ventricular assist devices...
June 2013: Pediatric Critical Care Medicine
Anthony Lemaire, Mark B Anderson, Thomas Prendergast, Neil Stockmaster, Andrew Goodman, Ann Marie Lozane, George Batsides
OBJECTIVE: The contribution of cardiogenic shock to in-hospital mortality has not decreased significantly despite prompt revascularization, advances in medical therapy, and mechanical circulatory support. For patients in cardiogenic shock, mechanical circulatory support has been provided by a variety of devices. We report the outcome of the Impella device for acute mechanical circulatory support in cardiogenic shock in a setting of a large-volume single institution. The primary end points include survival to 30 days and recovery of native heart function and survival to 90 days and 1 year...
January 2013: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
(no author information available yet)
Despite rapid revascularisation with circulatory support using inotropes and intra-aortic balloon counterpulsation, the mortality of cardiogenic shock complicating acute myocardial infarction still exceeds 50%. An alternative treatment strategy is restoration of cardiac output by using a ventricular assist device which can be inserted in the acute setting using the Impella device, a catheter-based flow pump. DanShock is a Danish multicentre study that will assess whether circulatory support using the Impella device will improve the outcome of cardiogenic shock compared to conventional management...
January 21, 2013: Ugeskrift for Laeger
Thierry Carrel, Lars Englberger, Michele V Martinelli, Jukka Takala, Claudia Boesch, Vilborg Sigurdadottir, Erich Gygax, Alexander Kadner, Paul Mohacsi
Recent outstanding clinical advances with new mechanical circulatory systems (MCS) have led to additional strategies in the treatment of end stage heart failure (HF). Heart transplantation (HTx) can be postponed and for certain patients even replaced by smaller implantable left ventricular assist devices (LVAD). Mechanical support of the failing left ventricle enables appropriate hemodynamic stabilisation and recovery of secondary organ failure, often seen in these severely ill patients. These new devices may be of great help to bridge patients until a suitable cardiac allograft is available but are also discussed as definitive treatment for patients who do not qualify for transplantation...
2012: Swiss Medical Weekly
Rahul Chandola, Robert Cusimano, Mark Osten, Eric Horlick
The contribution of acute allograft rejection to posttransplant mortality has decreased over time primarily due to improvements in maintenance immunosuppression and in the diagnosis and treatment of rejection. Nevertheless, acute heart allograft rejection remains an important clinical problem.2 In the setting of an acute allograft rejection, mechanical circulatory support has been provided by a variety of devices, ranging from intra-aortic balloon pumps (IABP) to extracorporeal membrane oxygenators (ECMO), left ventricular assist devices (LVADs) and biventricular assist devices (BIVADs)...
June 2012: Thoracic and Cardiovascular Surgeon
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