A retrospective analysis of Impella use in all‐comers: 1‐year outcomes

Lazkani, Mohamad; Murarka, Shishir; Kobayashi, Akihiro; Seibolt, Luke; Yang, Tae Hyun; Pershad, Ashish

doi:10.1111/joic.12409

Cited by 17 publications

(16 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This data also suggests that planned MA‐TMS device insertion concomitantly with CABG as a prophylactic therapy, rather than in response to signs of PCCS, is advantageous. This experience is consistent with a recent study of 262 patients who received percutaneous MA‐TMS devices, which demonstrated that early MA‐TMS device insertion is associated with better in‐hospital and 1‐year outcomes compared to late “bailout” insertion …”

Section: Discussionsupporting

confidence: 90%

“…insertion. 4 The results of this series must be considered in light of other studies evaluating high-risk cardiac surgery, especially in the current era of mechanical circulatory support. Discerning which patients will recover and which will require a durable VAD or heart transplantation will allow us to select the right therapy for the right patient.…”

Section: Resultsmentioning

confidence: 98%

See 1 more Smart Citation

Concomitant temporary mechanical support in high‐risk coronary artery bypass surgery

et al. 2019

View full text Add to dashboard Cite

Objectives: Patients with low left ventricular ejection fraction (LVEF) undergoing high-risk coronary artery bypass grafting (CABG) are at increased risk for postcardiotomy cardiogenic shock. This report describes planned concomitant microaxial temporary mechanical support (MA-TMS) device placement as a viable bridge-to-recovery strategy for high-risk patients receiving surgical revascularization.Methods: A retrospective review was performed for all patients from October 2017 to May 2019 with low LVEF (<30%), New York Heart Association Class III or IV symptoms, and myocardial viability who underwent CABG with prophylactic MA-TMS support at a single institution (n = 13).Results: Mean patient age was 64.8 years, and 12 patients (92%) were male. Eight patients (62%) presented with acute coronary syndrome. Mean predicted risk of mortality was 4.6%, ranging from 0.6% to 15.6%. An average of 3.4 grafts were performed per patient. Greater than 60% of patients were extubated within 48 hours and out-of-bed within 72 hours, and the average duration of MA-TMS was 5.7 days.Mean postoperative length of stay was 16.7 days. There were no postoperative myocardial infarctions or deaths.Conclusions: Prophylactic MA-TMS may allow safe and effective surgical revascularization for patients with severe left ventricular dysfunction who may otherwise be offered a durable ventricular assist device. K E Y W O R D Scoronary artery bypass, mechanical circulatory support, temporary circulatory support

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Resultsmentioning

confidence: 98%

Concomitant temporary mechanical support in high‐risk coronary artery bypass surgery

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In terms of the timing of support, several studies suggest that early implantation of a mechanical assist device would improve survival [30][31][32]. Recent extensive animal studies showed that mechanical unloading of the left ventricle before coronary reperfusion limits the expression of proteolytic enzymes.…”

Section: Discussionmentioning

confidence: 99%

Haemodynamic efficacy of microaxial left ventricular assist device in cardiogenic shock: a systematic review and meta-analysis

et al. 2019

View full text Add to dashboard Cite

The Impella percutaneous mechanical circulatory support device is designed to augment cardiac output and reduce left ventricular wall stress and aims to improve survival in cases of cardiogenic shock. In this meta-analysis we investigated the haemodynamic effects of the Impella device in a clinical setting. We systematically searched all articles in PubMed/ Medline and Embase up to July 2019. The primary outcomes were cardiac power (CP) and cardiac power index (CPI). Survival rates and other haemodynamic data were included as secondary outcomes. For the critical appraisal, we used a modified version of the U.S. Department of Health and Human Services quality assessment form. The systematic review included 12 studies with a total of 596 patients. In 258 patients the CP and/or CPI could be extracted. Our meta-anal-D.I.M. van Dort and K.R.A.H. Peij contributed equally to this manuscript. ysis showed an increase of 0.39 W [95% confidence interval (CI): 0.24, 0.54], (p = 0.01) and 0.22 W/m 2 (95% CI: 0.18, 0.26), (p < 0.01) for the CP and CPI, respectively. The overall survival rate was 56% (95% CI: 0.50, 0.62), (p = 0.09). The quality of the studies was moderate, mostly due to the presence of confounders. Our study suggests that in patients with cardiogenic shock, Impella support seems effective in augmenting CP(I). This study merely investigates the haemodynamic effectiveness of the Impella device and does not reflect the complete clinical impact for the patient. Review Article ConclusionOur meta-analysis shows that short-term MCS with the Impella device is effective in increasing CP and CPI. Despite successfully increased CP with Impella support, the mortality seems to be in line with the survival rate without Impella use.

show abstract

“…[54][55][56][57][58][59] More recently, small single-centre studies (most notably the Detroit Cardiogenic Shock Initiative), international registry data and our own local experience lend some support to the immediate haemodynamic and potential short-term clinical survival benefits of initiation of percutaneous axial flow LV to aorta support as soon as possible after the onset of shock. 36,56,[60][61][62][63][64][65][66] Other investigations, such as the recent IMPella versus IABP Reduces mortality in STEMI patients treated with primary PCI (IMPRESS) trial, suggest that the benefits of percutaneous MCS devices are time-dependent and unlikely to impact outcomes if employed late, once overt multiorgan dysfunction has occurred. 67…”

mentioning

confidence: 99%

‚Combat‛ Approach to Cardiogenic Shock

Truesdell¹,

Tehrani

Singh

et al. 2018

Interventional Cardiology Review

View full text Add to dashboard Cite

The incidence of cardiogenic shock is rising, patient complexity is increasing and patient survival has plateaued. Mirroring organisational innovations of elite military units, our multidisciplinary medical specialists at the INOVA Heart and Vascular Institute aim to combine the adaptability, agility and cohesion of small teams across our large healthcare system. We advocate for widespread adoption of our 'combat' methodology focused on: increased disease awareness, early multidisciplinary shock team activation, group decision-making, rapid initiation of mechanical circulatory support (as appropriate), haemodynamic-guided management, strict protocol adherence, complete data capture and regular after action reviews, with a goal of ending preventable death from cardiogenic shock.

show abstract

A retrospective analysis of Impella use in all‐comers: 1‐year outcomes

Abstract: For patients with need for an Impella device, regardless of the indication, early implantation is associated with better in-hospital and 1-year outcomes as compared to when the device is implanted late as a bailout.

Cited by 17 publications

References 15 publications

Concomitant temporary mechanical support in high‐risk coronary artery bypass surgery

Concomitant temporary mechanical support in high‐risk coronary artery bypass surgery

Haemodynamic efficacy of microaxial left ventricular assist device in cardiogenic shock: a systematic review and meta-analysis

‚Combat‛ Approach to Cardiogenic Shock

Contact Info

Product

Resources

About