Short-term mechanical circulatory support for recovery from acute right ventricular failure: Clinical outcomes

Cheung, Anson; White, C.H.; Davis, Margot K.; Freed, Darren H.

doi:10.1016/j.healun.2014.02.028

Cited by 136 publications

(85 citation statements)

References 14 publications

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“…The Impella RP System (Abiomed, USA) is a RVAD that provides peripherally placed mechanical circulatory support for up to 14 days in patients with refractory RV shock. The pump is inserted via the femoral vein, into the right atrium, and through to the pulmonary artery, and can provide flow of up to 5 l/min at a maximal speed of 32,000 rpm 85 . The TandemHeart right ventricular support device (CardiacAssist, Inc., USA) is a centrifugal flow pump that can be implanted percutaneously via a bifemoral or right internal jugular approach, surgically by direct cannulation of the right atrium and pulmonary artery, or by peripheral cannulation of the femoral vein and direct cannulation of the pulmonary artery.…”

Section: Nature Reviews | Cardiologymentioning

confidence: 99%

Management of refractory cardiogenic shock

Reyentovich

Barghash

Hochman³

2016

Nat Rev Cardiol

121

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Cardiogenic shock is a life-threatening condition that occurs in response to reduced cardiac output in the presence of adequate intravascular volume and results in tissue hypoxia. Cardiogenic shock has several underlying aetiologies, with the most common being acute myocardial infarction (AMI). Refractory cardiogenic shock presents as persistent tissue hypoperfusion despite administration of adequate doses of two vasoactive medications and treatment of the underlying aetiology. Investigators of the SHOCK trial reported a long-term mortality benefit of emergency revascularization for shock complicating AMI. Since the publication of the SHOCK trial and subsequent guideline recommendations, the increase in community-based use of percutaneous coronary intervention for this condition has resulted in a significant decline in mortality. Despite these successes in the past 15 years, mortality still remains exceptionally high, particularly in patients with refractory cardiogenic shock. In this Review, we discuss the aetiology and pathophysiology of cardiogenic shock and summarize the data on the available therapeutics and their limitations. Although new mechanical circulatory support devices have been shown to improve haemodynamic variables in patients with shock complicating AMI, they did not improve clinical outcomes and are associated with high costs and complications.

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Section: Nature Reviews | Cardiologymentioning

confidence: 99%

Management of refractory cardiogenic shock

Reyentovich

Barghash

Hochman³

2016

Nat Rev Cardiol

121

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“…Although there is no standardized weaning protocol in the setting of RV dysfunction secondary to PH, one can adapt protocols from weaning VA-ECMO and RV assist devices used in other scenarios. [44][45][46] Typically, the ECMO flow rate is decreased by 0.5 L/min with observation of the systemic blood pressure, PA pressure, central venous pressure, heart rate, and heart rhythm. Mixed venous oxygen saturation and systemic Pao 2 levels may also inform clinical decision making.…”

Section: Clinical Experience With Chronic Thromboembolic Pulmonary Hymentioning

confidence: 99%

“…Puente a la recuperación post-endarterectomía pulmonar ECMO-VV función VD secundaria a HP, pueden adaptarse protocolos de desconexión de ECMO VA y dispositivos de asistencia VD usados en otros escenarios. [44][45][46] Comúnmente, el caudal de la ECMO se reduce 0,5 L/min observando la presión arterial sistémica, la presión de la AP, la presión venosa central, la frecuencia cardíaca y el ritmo cardíaco. La saturación de oxígeno venoso mixto y los niveles sistémicos de Pao 2 también pueden proporcionar información para la toma de decisiones clínicas.…”

Section: Experiencia Clínica Con La Hipertensión Pulmonar Tromboembólunclassified

Mechanical Support for the Failing Right Ventricle in Patients With Precapillary Pulmonary Hypertension

Machuca

Perrot

2015

Circulation

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526R ight ventricular (RV) dysfunction is the principal predictor of adverse outcome in pulmonary hypertension (PH).1,2 For those PH patients requiring inpatient intensive care because of acutely decompensated heart failure, mortality estimates can range as high as 30% to 48%. [3][4][5] Hyponatremia, renal insufficiency, systemic hypotension, and severe tricuspid regurgitation are worrisome clinical characteristics that prognosticate poor outcome in this PH patient subpopulation. 3,5,6 Effective strategies to optimize cardiopulmonary hemodynamics and support RV function are paramount; clinical responsiveness to pulmonary vascular/RV-specific treatment is likely to decrease the probability of requiring surgical intervention and, ultimately, improve outcome. This review will discuss existing evidence pertaining to the timing and utility of mechanical support in patients with RV failure attributable to pulmonary vascular disease. Pathophysiology of RV Failure in PHConstrictive pericardial disease, selected forms of congenital heart disease, inflow obstruction, primary myocardial disease, and pressure or volume overload are each well-described causes of adverse RV remodeling, RV systolic dysfunction, and cor pulmonale.7 Among patients with RV dysfunction as a result of pressure overload, precapillary PH and left-sided heart failure are the most common etiologies.The first adaptive response of the RV to pressure overload is hypertrophy. If untreated, the RV dilates to compensate for increased RV preload and, according to the Frank-Starling principle, to maintain stroke volume. When further increases in RV end-diastolic filling volume do not offset progressive RV contractile dysfunction, clinically evident RV failure ensues. In advanced stages, RV cavitary dilation may also impair left ventricular (LV) diastolic filling kinetics and contribute further to global pump dysfunction and, consequently, to the congestive heart failure syndrome.Mechanical support in the setting of RV dysfunction aims to stabilize and therapeutically improve several key mechanisms underpinning RV decompensation and heart failure by reducing RV preload and afterload, and by improving RV cardiac output, as well. As a consequence of achieving these goals, a number of additional beneficial effects may occur to stabilize RV performance, including (1) decreased pulmonary artery (PA) diameter and prevention of left-sided coronary artery compression 8 ; (2) decreased tricuspid regurgitation attributable to attenuated RV cavitary dilation 9 and improved interventricular septal bowing; and (3) decreased free-wall stress that maintains favorable RV myocardial oxygen demand/perfusion dynamics.10 Addressing the aforementioned contributors to RV failure is conceptually important in the management of RV failure, because, although the RV is less adaptable to pressure overload, it carries a substantial potential of recovery once its afterload is normalized. 11 Mechanical Circulatory Support for the Failing RV: Patient SelectionIf pharmacological therapies a...

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“…Impella right percutaneous (RP) is a similar axial pump recently approved for right ventricular (RV) support. This is inserted through the femoral vein, and it pumps blood from the inferior vena cava into the pulmonary artery (PA) to decompress the RV [14].…”

Section: Impellamentioning

confidence: 99%

Mechanical circulatory support

Subramaniam

2015

Best Practice & Research Clinical Anaesthesiology

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Short-term mechanical circulatory support for recovery from acute right ventricular failure: Clinical outcomes

Cited by 136 publications

References 14 publications

Management of refractory cardiogenic shock

Management of refractory cardiogenic shock

Mechanical Support for the Failing Right Ventricle in Patients With Precapillary Pulmonary Hypertension

Mechanical circulatory support

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