Mechanical circulatory support. An expert opinion of the Association of Intensive Cardiac Care and the Association of Cardiovascular Interventions of the Polish Cardiac Society

Tycińska, Agnieszka; Grygier, Marek; Biegus, Jan; Czarnik, Tomasz; Dąbrowski, M; Depukat, Rafał; Gierlotka, Marek; Gil, Monika; Hawranek, Michał; Hirnle, Tomasz; Jemielity, Marek; Kapelak, Bogusław; Kralisz, Paweł; Kuliczkowski, Wiktor; Kuśmierczyk, Mariusz; Ligowski, Marcin; Łopatowska, Paulina; Puslecki, Mateusz; Świątkowski, Andrzej Marian; Trzeciak, Przemysław; Zawiślak, Barbara; Zembala, Michał; Zymliński, Robert

doi:10.33963/kp.a2021.0169

Cited by 9 publications

(11 citation statements)

References 46 publications

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“…Certainly, the rotational mechanism supporting the work of the left ventricle of the heart is also important, as it causes hemolysis and anemization and may also have an impact on impaired coagulation. Several cases and analyzes involving the use of axillary and subclavian vascular access in patients requiring pLVAD, both in acute and stable patients, have been described [32,33]. Based on the published research results, it seems that upper limb accesses are a promising alternative and may be associated with fewer complications and, in some cases, may be the only possible method of percutaneous treatment with pLVAD in advanced atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes in patients undergoing complex, high-risk percutaneous coronary intervention and haemodynamic support with intra-aortic balloon versus Impella pump: Real-life single-centre preliminary results

Januszek

Pawlik²,

Rzeszutko

et al. 2022

Kardiol Pol

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Background: Patients and mechanical circulatory support assortment, as well as periprocedural and post-procedural clinical outcomes in complex high-risk percutaneous coronary interventions (PCIs) underpinned by percutaneous left ventricular assist devices (pLVAD) are the subject of debate. Aims:The study aimed to identify differences between patients qualified for complex high-risk PCIs with an intra-aortic balloon pump (IABP) or Impella pump support and to compare peri-and post-procedural clinical outcomes. Methods:The presented analysis is a single-center study, which comprised consecutive patients undergoing complex high-risk PCIs performed with the pLVAD, either IABP or Impella. Patients included in the current analysis were recruited between January 2018 and December 2021. There were 28 (56%) patients in the Impella group and 22 (44%) in the IABP group. The primary endpoints included overall mortality and major adverse cardiovascular events (MACE) such as all-cause mortality, myocardial infarction, revascularization, and cerebrovascular events.Results: Patients from the IABP group were significantly older, had higher left ventricular ejection fraction (LVEF), and less frequent history of PCI, while the in-hospital risk of death assessed by EuroSCORE II remained similar in the Impella and IABP groups (median interquartile range [IQR] 2.8 [2-3.8] vs. 2.5 [1.8-5.2]; P = 0.73). Patients undergoing complex high-risk PCIs with pLVAD support presented similar results during the follow-up, assessed by log-rank estimates in terms of MACE (P = 0.41) and mortality rate (P = 0.65). Conclusions:The use of pLVAD devices in patients undergoing complex high-risk PCIs, with reduced left ventricular ejection fraction, is a promising treatment option for patients disqualified from surgery by cardiac surgeons.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes in patients undergoing complex, high-risk percutaneous coronary intervention and haemodynamic support with intra-aortic balloon versus Impella pump: Real-life single-centre preliminary results

Januszek

Pawlik²,

Rzeszutko

et al. 2022

Kardiol Pol

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“…These parameters include SBP and MAP in all patients, LVEDP trends, CO and CPO if SmartAssist system with Advanced Metrics is available, and CO, CVP, PAWP, and PAPi in patients with Swan–Ganz catheter. During the weaning period, ventricular function and volume status should be monitored using TTE, arterial blood gas analysis (pH and lactate), and mixed venous oxygen saturation 19,39,41 . Generally, SBP > 90 mmHg, MAP > 60 mmHg, CI > 2.2 L/min/m 2 , CPO > 0.6 W, and LVEDP < 15 mmHg are indicators of haemodynamic recovery, facilitating careful weaning from MCS.…”

Section: Roadmap Towards a High‐risk Percutaneous Coronary Interventi...mentioning

confidence: 99%

Roadmap towards an institutional Impella programme for high‐risk coronary interventions

et al. 2023

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Coronary artery disease (CAD) and its complications remain the main cause of morbidity and mortality worldwide. Patients with extensive CAD and multiple comorbidities who require complex, high‐risk percutaneous coronary intervention (HR‐PCI) are at risk of haemodynamic instability and may require short‐term mechanical circulatory support (MCS) during the procedure to maintain sufficient perfusion and prevent ischaemia. Impella is a microaxial continuous blood flow pump used for percutaneous support of the left ventricle in patients undergoing HR‐PCI. Data from randomized controlled trials and registries suggested an advantage for Impella devices in patients undergoing HR‐PCI, compared with other types of MCS. As a thorough understanding of the benefits and drawbacks of the Impella technology is crucial for patient outcomes, we provide a technological overview of Impella and share our experiences gathered during the implementation of institutional Impella programmes in Poland as a roadmap of selection and periprocedural care for patients treated with Impella in the setting of HR‐PCI. We propose 10 steps for implementation of an institutional Impella programme for HR‐PCI, including (i) dedicated staff training; (ii) standard operating procedure and troubleshooting algorithms prior to the first intervention; (iii) patient selection by the multidisciplinary Heart Team; (iv) patient preparation using multimodality imaging; (v) procedure planning in terms of large‐bore access, equipment, and complete revascularization; (vi) starting with HR‐PCI support; (vii) starting with femoral artery access in a patient without extensive peripheral artery disease; (viii) multidisciplinary care after the procedure; (ix) haemodynamic and laboratory monitoring to ensure immediate diagnosis of access‐site complications, bleeding, haemolysis, acute kidney injury, and infections; and (x) careful revision of every HR‐PCI case with the team.

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“…The most common complications associated with the use of MCDs include lower limb ischemia, bleeding, and hemolysis [ 29 ]. The relatively safe type of device among the listed ones is the IABP [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

Mechanical Circulatory Support in Delayed Surgery of Post-Infarction Ventricular Septal Rupture in Patients in Cardiogenic Shock—A Review

Żbikowska

Wróbel

2022

JCM

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Post-infarction ventricular septal rupture (VSR) is a serious complication of myocardial infarction, which, in its natural course or treated medically, is related to high mortality rate. Surgical intervention remains the treatment of choice. Recent studies have shown that delayed surgery is related to better outcomes in comparison with urgent surgery; however, in many studies the impact of the patients’ initial hemodynamic status on the treatment outcomes often remains unclear. In this review, we analyze the outcomes of delayed surgical treatment of patients in cardiogenic shock in the course of post-infarction ventricular septal defect stabilized with preoperative use of mechanical circulatory support. We evaluate the importance of various types of mechanical circulatory devices (MCD), such as extracorporeal membrane oxygenation, Tandem Heart, Impella, and intra-aortic baloon pump (IABP) in preoperative stabilization of patients, and the most suitable time for surgery, and we also present the features of ideal MCD for patients with VSR. A search of Pubmed to identify studies concerning the use of MCD in patients in cardiogenic shock in the course of VSR qualified for delayed surgery was conducted in January 2022. A total of 16 articles with three or more patients described were analyzed in this study. The preoperative use of MCD in patients in cardiogenic shock and delayed surgery as a main part of treatment seems to be a promising direction, however, it requires further research.

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Mechanical circulatory support. An expert opinion of the Association of Intensive Cardiac Care and the Association of Cardiovascular Interventions of the Polish Cardiac Society

Cited by 9 publications

References 46 publications

Clinical outcomes in patients undergoing complex, high-risk percutaneous coronary intervention and haemodynamic support with intra-aortic balloon versus Impella pump: Real-life single-centre preliminary results

Clinical outcomes in patients undergoing complex, high-risk percutaneous coronary intervention and haemodynamic support with intra-aortic balloon versus Impella pump: Real-life single-centre preliminary results

Roadmap towards an institutional Impella programme for high‐risk coronary interventions

Mechanical Circulatory Support in Delayed Surgery of Post-Infarction Ventricular Septal Rupture in Patients in Cardiogenic Shock—A Review

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