Percutaneous cardiac assist devices compared with surgical hemodynamic support alternatives

Maini, Brijeshwar; Gregory, David A.; Scotti, Dennis J.; Buyantseva, Larisa

doi:10.1002/ccd.25247

Cited by 34 publications

(17 citation statements)

References 47 publications

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“…13 Yet, by comparison with surgically implanted hemodynamic support devices such as ECMO, analysis of a national administrative database (MedPAR) suggests that use of percutaneous VADs in cardiogenic shock are associated with lower cost (p<0.001). 51 They also reported better survival and shorter length of stay with pVADS, but interpretation of these results are limited by the study’s observational design.…”

Section: Current Trendsmentioning

confidence: 95%

Advanced Percutaneous Mechanical Circulatory Support Devices for Cardiogenic Shock

Miller

Solomon

McAreavey

2017

Critical Care Medicine

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Objective To review temporary percutaneous mechanical circulatory support devices (pMCS) for the treatment of cardiogenic shock, including current evidence, contraindications, complications, and future directions. Data Sources A MEDLINE search was conducted with MeSH terms: cardiogenic shock, percutaneous mechanical circulatory support, extracorporeal membrane oxygenation (ECMO), Impella, and TandemHeart. Study Selection Selected publications included randomized controlled trial data and observational studies describing experience with pMCS in cardiogenic shock. Data Extraction Studies were chosen based on strength of association with and relevance to cardiogenic shock. Data synthesis Until recently, there were few options if cardiogenic shock was refractory to vasopressors or intra-aortic balloon pump (IABP) counterpulsation. Now, several pMCS devices, including Impella®, TandemHeart™, and ECMO, are more accessible. Compared with IABP, Impella provides greater hemodynamic support, but no reduction in mortality. Similarly, TandemHeart improves hemodynamic variables, but not survival. Comparative studies have been underpowered for mortality because of small sample size. Veno-arterial ECMO offers the advantage of biventricular circulatory support and oxygenation but there are significant vascular complications. Comparative studies with ECMO have not been completed. Despite lack of randomized controlled data, there has been a substantial increase in use of pMCS. Several ongoing prospective studies with larger sample sizes may provide answers, and newer devices may become smaller, easier to insert, and more effective. Conclusions Mortality from cardiogenic shock remains unacceptably high despite early coronary revascularization or other therapies. While evidence is lacking and complications rates are high, improvements and experience with pMCS may offer the prospect of better outcomes.

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Section: Current Trendsmentioning

confidence: 95%

Advanced Percutaneous Mechanical Circulatory Support Devices for Cardiogenic Shock

Miller

Solomon

McAreavey

2017

Critical Care Medicine

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“…Additionally, ECMO requires the bedside presence of highly trained specialized personnel, which bilateral Impella devices do not. This could result in more cost effectiveness for Impella use compared to ECMO, which has been demonstrated in an adult study . These characteristics make this modality desirable, particularly for pediatric patients who could be more vulnerable to the negative effects of ECMO.…”

Section: Discussionmentioning

confidence: 97%

Biventricular Impella use in pediatric patients with severe graft dysfunction from acute rejection after heart transplantation

et al. 2019

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Rejection with severe hemodynamic compromise is a significant source of morbidity and mortality for pediatric heart transplant patients. Traditionally, treatment for these patients includes inotropes and escalation to extracorporeal membrane oxygenation (ECMO) when necessary. There is increasing interest in using percutaneous ventricular assistive devices in the pediatric population as a less invasive alternative to ECMO. We report the largest case series to date of biventricular support using percutaneous Impella devices. Retrospective case series was performed by chart review. Hemodynamics, left ventricular ejection fraction (LVEF), and indices of end organ function were collected before and after Impella placement. A 14‐year‐old male, 18‐year‐old male, and 19‐year‐old female, all status post heart transplant, presented with severely decreased biventricular function due to presumed clinical rejection, requiring maximal inotropic support without improvement. In all the three cases, simultaneous Impella CP and RP devices were placed percutaneously. Prior to implantation, LVEFs were 40%, 23%, and 25%, respectively. Hemodynamics measured invasively prior to device placement showed elevated filling pressures. Adverse events while on support included bleeding, hemolysis, and right femoral arterial dissection during implantation. All patients were successfully weaned from the devices and survived to discharge. The average time of right‐sided support and total support was 11 days and 13 days, respectively. After device removal, right‐sided pressures and echocardiographic measurements showed improvement in all patients. Bilateral Impella configuration (BiPella) is a viable option for temporary mechanical circulatory support in pediatric patients with significant graft dysfunction.

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“…Indeed, recently Ross et al showed that from the European perspective, Impella is a cost‐effective intervention when compared with IABP, in high risk PCI patients. Also, Maini et al presented a cost‐effectiveness analysis of pVAD therapy in emergent setting compared with traditional surgical hemodynamic support alternatives in the United States; it showed that pVAD therapy offers a less invasive alternative resulting in better outcomes, shorter length of stay and lower costs.…”

Section: Discussionmentioning

confidence: 99%

The Use of Impella 2.5 in Severe Refractory Cardiogenic Shock Complicating an Acute Myocardial Infarction

Casassus

Corré

Leroux

et al. 2015

J Interven Cardiology

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Percutaneous cardiac assist devices compared with surgical hemodynamic support alternatives

Cited by 34 publications

References 47 publications

Advanced Percutaneous Mechanical Circulatory Support Devices for Cardiogenic Shock

Advanced Percutaneous Mechanical Circulatory Support Devices for Cardiogenic Shock

Biventricular Impella use in pediatric patients with severe graft dysfunction from acute rejection after heart transplantation

The Use of Impella 2.5 in Severe Refractory Cardiogenic Shock Complicating an Acute Myocardial Infarction

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