Aortic Counterpulsation Therapy in Patients with Advanced Heart Failure: Analysis of the TBRIDGE Registry

Bezerra, Cristiano Guedes; Adam, Eduardo Leal; Baptista, Mariana Lins; Ciambelli, Giuliano Serafino; Kopel, Liliane; Bernoche, Claudia; Lopes, Leonardo da Costa; Macatrão-Costa, Milena Frota; Falcão, Breno de Alencar Araripe; Lage, Silvia G.

doi:10.5935/abc.20150147

Cited by 8 publications

(10 citation statements)

References 15 publications

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“…While limited to small, single-center studies, 32–35 IABP therapy in advanced heart failure patients with CS appears to be a reasonable bridge to more advanced therapies.…”

Section: Left Ventricle To Aorta Assist Devices (Lv Volume And/or Prementioning

confidence: 99%

Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock

Mandawat

Rao

2017

Circ: Cardiovascular Interventions

136

124

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Despite a high rate of early revascularization and use of intraaortic balloon pump counterpulsation (IABP) therapy, the prognosis of patients with cardiogenic shock (CS) has remained poor. In the hopes of improving outcomes, clinicians are increasing turning to percutaneous left- and right- mechanical circulatory support devices. Until recently, the evidence base for these devices had consisted only of observational data, meta-analyses, and small feasibility trials. In this manuscript, we describe the contemporary outcomes of patients with CS, the hemodynamics of CS, and hemodynamic effects of percutaneous mechanical circulatory support devices. We then use this discussion to provide clinicians with a useful framework for understanding when selecting between or while managing patients with a percutaneous mechanical circulatory support devices. We critically review the recently published data for and against the use of commercially-available devices – the IABP, the Impella system, the TandemHeart, and V-A ECMO - and highlight gaps in our understanding. Given such gaps, a consensus multidisciplinary approach which combines expertise from interventional cardiologists, heart failure specialists, cardiac surgeons, and cardiac anesthesiologists may help pair the right patient with the right device at the right time.

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“…While limited to small, single-center studies, 32–35 IABP therapy in advanced heart failure patients with CS appears to be a reasonable bridge to more advanced therapies.…”

Section: Left Ventricle To Aorta Assist Devices (Lv Volume And/or Prementioning

confidence: 99%

Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock

Mandawat

Rao

2017

Circ: Cardiovascular Interventions

136

124

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“…After 48 h of IAB, there was a significant improvement in the laboratory parameters of microhemodynamic evaluation, with reduction of serum lactate, increase of SvO 2 and bicarbonate levels. IAB has been shown to be an important therapeutic intervention as a bridge for heart transplantation [ 25 ].…”

Section: Hemodynamic and Metabolic Controlmentioning

confidence: 99%

“…The factors associated with a higher chance of progression to CS after AMI are: age, anterior wall infarction, presence of ST elevation, previous history of angina, infarction and/or heart failure, multiarterial coronary disease, and diabetes mellitus. In the studies, GUSTO I10 and GUSTO III [ 25 ], the main predictors of CS were: age, heart rate, systolic blood pressure (SBP) and Killip functional class. Regarding time as a factor of occurrence of CS, it is worth mentioning that only 20.0% of post-infarction shocks are present at hospital admission.…”

Section: Introductionmentioning

confidence: 99%

Main Considerations of Cardiogenic Shock and Its Predictors: Systematic Review

Braile-Sternieri¹,

Mustafa²,

Ferreira³

et al. 2018

Cardiol Res

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The mortality rate of post-infarction cardiogenic shock (CS) was 80.0-90.0%. Recent studies show a significant reduction of hospital mortality to approximately 50.0%. CS is defined as systemic tissue hypoperfusion resulting from systolic and/or diastolic heart dysfunction, the main cause of which is acute myocardial infarction (AMI). The main predictors are biological markers such as troponin, CKMB and lactate. A systematic literature review and meta-analysis is performed in order to present and correlate the main literary findings on CS and its evolution with possible changes in biomarkers such as troponin, lactate and CKMB. After criteria of literary search with the use of the mesh terms: cardiogenic shock; acute myocardial infarction; biomarkers; troponin; CKMB; lactate; clinical trials and use of the bouleanos “and” between the mesh terms and “or” among the historical findings. In the main databases such as Pubmed, Medline, Bireme, EBSCO, Scielo, etc., a total of 96 papers that were submitted to the eligibility analysis were collated and, after that, 41 studies were selected, following the rules of systematic review - PRISMA (Transparent reporting of systematic reviews and meta-analyzes-http://www.prisma-statement.org/). Some risk factors for its development in AMI are advanced age, female gender, anterior wall infarction, diabetes mellitus, systemic arterial hypertension, previous history of infarction and angina. The CS associated with AMI depends on its extent and its complications, being the main ones: mitral regurgitation, rupture of the interventricular septum and rupture of the free wall of the left ventricule. The diagnosis is based on the clinical manifestations, such as mental confusion, oliguria, hypotension, tachycardia, fine pulse, sweating, and cold extremities; in hemodynamic aspects: systolic blood pressure was < 90.0 mm Hg or 30 mm Hg below baseline, pulmonary capillary pressure was > 18.0 mm Hg and cardiac index was < 2.2 L/min/m2. Laboratory and imaging exams should be requested to evaluate the possible etiology of CS, its systemic repercussions and comorbidities. The treatment aims at the rapid reestablishment of the blood flow in the affected artery, to improve the patient’s prognosis. The biomarkers dosage in the daily clinical practice of the different cardiological centers can facilitate the diagnosis and the conduction of the dubious cases and the best evaluation of the degree of myocardial suffering after CS.

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“…Prophylactic IABP implementation decreases left ventricular preload and therefore RV upload, which could terminate hepatic congestion and dysfunction. On the other hand, IABP support improves renal and gastrointestinal blood supply with significant recovery of dysfunctional organs [56]. This strategy can reduce HF symptoms, signs, and laboratory findings (serum total bilirubin and creatinine, plasma BNP levels), especially in the first 48 hours significantly.…”

Section: Cardiomyopathies -Types and Treatmentsmentioning

confidence: 99%

Invasive Treatment in Advanced (Stage-D) Heart Failure

Kırali¹,

Yerlikhan²,

Hançer³

2017

Cardiomyopathies - Types and Treatments

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Heart failure is a complex, true pandemic clinical syndrome and is responsible for 5% of hospitalizations globally. Severe heart failure can manifest as two lethal clinical entities: (1) acute cardiac decompensation with cardiogenic shock after large acute myocardial infarction with mortality rates approaching 50% or after cardiac surgery with mortality rates higher than 65% and (2) chronic destructive cardiac remodeling or acute decompensative exacerbations of cardiomyopathies with one-year mortality of approximately 80% (worse than most types of cancer). Interventional therapies aim first to improve symptoms and life expectancy in patients with severe heart failure syndrome, second to prevent left ventricular remodeling, and third to bridge patients to long-term mechanical circulatory support or transplantation. Several treatment options can be used to stabilize patients. In particular, new percutaneous mitral valve interventions and short-term circulatory support devices open up a new temporary treatment area in symptomatic Stage-D heart failure. The durable or curable surgical destination treatment will be only permanent ventricular assist devices or heart transplantation. This chapter focuses on the treatment steps and new approaches in hospitalized Stage-D heart failure patients.Keywords: heart failure, heart transplantation, ventricular assist device, ECMO, ECLS At end-stage, any type of cardiomyopathy (CMP) causes a complex clinical heart failure (HF) syndrome, which results from structural and/or functional impairment of ventricular filling or ejection. This dire clinical situation can cause an adverse vicious cycle that is ultimately fatal if not treated by pharmacological or invasive mechanical support or heart transplantation (HTx). Left ventricular functional abnormalities range from normal-sized left ventricle (LV) with preserved left ventricular ejection fraction (LVEF) to severe left ventricular dilatation (LVD) with markedly reduced LVEF. Reduced LVEF is defined as the clinical diagnosis of HF and LVEF ≤40%, which means a clinic and functional association of systolic and/or diastolic LVD.© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Abnormal systolic and/or diastolic functions impair left ventricular contractile and relaxation functions that result in increasing left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV), as well as left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD), with the alteration of the left ventricular shape from conical form to spherical form. Adverse elevation of preload and afterload results in increasing left ventricular end-diastolic pressure (LVEDP) and left ventricular end-systolic pressure (LVESP). Inadequate unloading is the pr...

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Aortic Counterpulsation Therapy in Patients with Advanced Heart Failure: Analysis of the TBRIDGE Registry

Cited by 8 publications

References 15 publications

Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock

Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock

Main Considerations of Cardiogenic Shock and Its Predictors: Systematic Review

Invasive Treatment in Advanced (Stage-D) Heart Failure

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