The Impella Microaxial Flow Catheter Is Safe and Effective for Treatment of Myocarditis Complicated by Cardiogenic Shock: An Analysis From the Global cVAD Registry

Annamalai, Shiva; Esposito, Michele; Jorde, Lena; Schreiber, Theodore; Hall, Shelley; O’Neill, William W.; Kapur, Navin K.

doi:10.1016/j.cardfail.2018.09.007

Cited by 21 publications

(19 citation statements)

References 11 publications

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“…In theory, the use of devices that reduce LV afterload, such as centrifugal pumps or intra-aortic axial pumps, alone or in combination with venoarterial extracorporeal membrane, could favor myocardial recovery more than venoarterial extracorporeal membrane alone, through both hemodynamic and anti-inflammatory mechanisms. 116 Nonetheless, a multicenter registry on intra-aortic axial pump use for FM (34 patients from 2009 to 2016) showed a survival to discharge of 62%, 117 not different from the 61% discharge rate reported among 185 patients supported with venoarterial extracorporeal membrane in Taiwan from 2001 to 2011. 118 If there is no weaning from MCS after 2 to 3 weeks, long-term LV assist device or urgent HTx may be considered.…”

Section: Mcs and Htxmentioning

confidence: 87%

Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy

Ammirati

Frigerio

Adler

et al. 2020

Circ: Heart Failure

467

601

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Myocarditis is an inflammatory disease of the heart that may occur because of infections, immune system activation, or exposure to drugs. The diagnosis of myocarditis has changed due to the introduction of cardiac magnetic resonance imaging. We present an expert consensus document aimed to summarize the common terminology related to myocarditis meanwhile highlighting some areas of controversies and uncertainties and the unmet clinical needs. In fact, controversies persist regarding mechanisms that determine the transition from the initial trigger to myocardial inflammation and from acute myocardial damage to chronic ventricular dysfunction. It is still uncertain which viruses (besides enteroviruses) cause direct tissue damage, act as triggers for immune-mediated damage, or both. Regarding terminology, myocarditis can be characterized according to etiology, phase, and severity of the disease, predominant symptoms, and pathological findings. Clinically, acute myocarditis (AM) implies a short time elapsed from the onset of symptoms and diagnosis (generally <1 month). In contrast, chronic inflammatory cardiomyopathy indicates myocardial inflammation with established dilated cardiomyopathy or hypokinetic nondilated phenotype, which in the advanced stages evolves into fibrosis without detectable inflammation. Suggested diagnostic and treatment recommendations for AM and chronic inflammatory cardiomyopathy are mainly based on expert opinion given the lack of well-designed contemporary clinical studies in the field. We will provide a shared and practical approach to patient diagnosis and management, underlying differences between the European and US scientific statements on this topic. We explain the role of histology that defines subtypes of myocarditis and its prognostic and therapeutic implications.

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Section: Mcs and Htxmentioning

confidence: 87%

Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy

Ammirati

Frigerio

Adler

et al. 2020

Circ: Heart Failure

467

601

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“…MCS can be used regardless of initiation of immunosuppressive therapy. Different MCS devices are effective for temporary haemodynamic stabilization and can serve as a bridge-to-transplant in patients with fulminant myocarditis, including veno-arterial extracorporeal membrane oxygenation (V-A ECMO) 290 , 291 , intra-aortic balloon pumps (IABPs) 291 , 292 , the percutaneous ventricular assist devices TandemHeart 291 and ProtekDuo 293 , and the Impella microaxial flow catheters 291 , 292 , 294 . These devices differ in their mode of action, especially their effect on afterload modification.…”

Section: Therapymentioning

confidence: 99%

“…Fewer data are available on the efficacy of the RP Impella system and/or its combination with the LV Impella in unloading both ventricles (BIPELLA-concept) in patients with fulminant myocarditis 300 , 303 . In patients with primarily LV failure and preserved RV function, use of the LV Impella system for unloading might be favourable 159 , 294 , 295 , 300 . More research is needed to understand the mechanisms underlying the anti-inflammatory effects of prolonged LV unloading (PROPELLA concept) 295 with the use of percutaneous LV support devices, which can serve as a bridge-to-recovery or bridge-to-transplant.…”

Section: Therapymentioning

confidence: 99%

Myocarditis and inflammatory cardiomyopathy: current evidence and future directions

et al. 2020

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Inflammatory cardiomyopathy is defined as myocarditis in association with cardiac dysfunction and ventricular remodelling 1,2. Despite extensive research and improved diagnosis and understanding of the pathogenesis of inflammatory cardiomyopathy, this disorder is still associated with a poor prognosis when complicated by left ventricular (LV) dysfunction, heart failure (HF) or arrhythmia 3. Furthermore, fulminant myocarditis, a rare, sudden and severe cardiac inflammation, is one of the main causes of cardiogenic shock in young adults 4,5. Prompt diagnosis and specific treatment strategies are needed to reduce mortality and the need for heart transplantation in these patients 4,5. Many questions remain unanswered regarding the pathogenesis of inflammatory cardiomyopathy and the role of the viral infection, the immune system, the host genetic background and the environment in disease progression and prognosis. These gaps in knowledge highlight the need for advanced experimental systems that can better model the human immune system and the need to improve the characterization and classification of the patients, for example, with the use of phenomapping and phenomics, which involve detailed evaluation of immune status, viral presence and/or other biomarkers. In this Review, we discuss the available evidence and identify the gaps in our understanding of the pathogenesis, diagnosis, treatment and prognosis of myocarditis and inflammatory cardiomyopathy, appraise the available animal and cell models of these conditions and propose future directions for the field. We discuss the role

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“…However, CS has a broad scope of aetiology. In some very specific indications, such as a biopsy-proven myocarditis, there is growing evidence of improved survival with Impella support [25]. In other indications for Impella support, such as the post-cardiotomy population (5% in our study), evidence is still limited and in need of further research.…”

Section: Discussionmentioning

confidence: 65%

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

et al. 2019

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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.

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The Impella Microaxial Flow Catheter Is Safe and Effective for Treatment of Myocarditis Complicated by Cardiogenic Shock: An Analysis From the Global cVAD Registry

Cited by 21 publications

References 11 publications

Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy

Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy

Myocarditis and inflammatory cardiomyopathy: current evidence and future directions

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

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