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Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience
BACKGROUND: Patients with cardiogenic shock (CS) are routinely treated with intra-aortic balloon pumps (IABPs). The utility of 2 new percutaneous left ventricular assist devices (PLVADs), the Impella and TandemHeart, is unknown. The objective of this study was to describe the use of PLVADs for patie...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elmer Press
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5358142/ https://www.ncbi.nlm.nih.gov/pubmed/28348673 http://dx.doi.org/10.4021/cr121w |
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author | Schwartz, Bryan G. Ludeman, Daniel J. Mayeda, Guy S. Kloner, Robert A. Economides, Christina Burstein, Steven |
author_facet | Schwartz, Bryan G. Ludeman, Daniel J. Mayeda, Guy S. Kloner, Robert A. Economides, Christina Burstein, Steven |
author_sort | Schwartz, Bryan G. |
collection | PubMed |
description | BACKGROUND: Patients with cardiogenic shock (CS) are routinely treated with intra-aortic balloon pumps (IABPs). The utility of 2 new percutaneous left ventricular assist devices (PLVADs), the Impella and TandemHeart, is unknown. The objective of this study was to describe the use of PLVADs for patients with CS at our institution. METHODS: All cases involving PLVADs in patients with CS between between January 1, 2008 and June 30, 2010 at a private, tertiary referral hospital were reviewed retrospectively. RESULTS: All 76 cases were identified (50 IABP only, 7 Impella, 19 TandemHeart). Most Impella (5/7) and TandemHeart (10/19) patients were initially treated with an IABP before "upgrading" for increased hemodynamic support. All 76 devices (100%) were initiated successfully. Percutaneous revascularization was attempted in 63 patients with angiographic success in 57 (90%). The incidences of major complications were similar between groups, except bleeding occurred less frequently with the IABP. Mean ejection fraction on presentation was 30.4±16.5% and increased by a mean of 6.6±11.4% (P < 0.001). With the institutional approach of treating patients with CS initially with vasopressors and IABPs, then upgrading to an Impella or TandemHeart device for patients refractory to IABP therapy, the overall mortality rate was 40%. CONCLUSION: The Impella and TandemHeart devices can be initiated successfully in patients with CS, are associated with high rates of angiographic success during high risk percutaneous interventions and may benefit the myocardium during myocardial infarction. Randomized trials are warranted investigating use of the Impella and TandemHeart devices in patients with CS and in patients refractory to conventional IABP therapy. |
format | Online Article Text |
id | pubmed-5358142 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | Elmer Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-53581422017-03-27 Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience Schwartz, Bryan G. Ludeman, Daniel J. Mayeda, Guy S. Kloner, Robert A. Economides, Christina Burstein, Steven Cardiol Res Original Article BACKGROUND: Patients with cardiogenic shock (CS) are routinely treated with intra-aortic balloon pumps (IABPs). The utility of 2 new percutaneous left ventricular assist devices (PLVADs), the Impella and TandemHeart, is unknown. The objective of this study was to describe the use of PLVADs for patients with CS at our institution. METHODS: All cases involving PLVADs in patients with CS between between January 1, 2008 and June 30, 2010 at a private, tertiary referral hospital were reviewed retrospectively. RESULTS: All 76 cases were identified (50 IABP only, 7 Impella, 19 TandemHeart). Most Impella (5/7) and TandemHeart (10/19) patients were initially treated with an IABP before "upgrading" for increased hemodynamic support. All 76 devices (100%) were initiated successfully. Percutaneous revascularization was attempted in 63 patients with angiographic success in 57 (90%). The incidences of major complications were similar between groups, except bleeding occurred less frequently with the IABP. Mean ejection fraction on presentation was 30.4±16.5% and increased by a mean of 6.6±11.4% (P < 0.001). With the institutional approach of treating patients with CS initially with vasopressors and IABPs, then upgrading to an Impella or TandemHeart device for patients refractory to IABP therapy, the overall mortality rate was 40%. CONCLUSION: The Impella and TandemHeart devices can be initiated successfully in patients with CS, are associated with high rates of angiographic success during high risk percutaneous interventions and may benefit the myocardium during myocardial infarction. Randomized trials are warranted investigating use of the Impella and TandemHeart devices in patients with CS and in patients refractory to conventional IABP therapy. Elmer Press 2012-04 2012-03-20 /pmc/articles/PMC5358142/ /pubmed/28348673 http://dx.doi.org/10.4021/cr121w Text en Copyright 2012, Schwartz et al. http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Schwartz, Bryan G. Ludeman, Daniel J. Mayeda, Guy S. Kloner, Robert A. Economides, Christina Burstein, Steven Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience |
title | Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience |
title_full | Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience |
title_fullStr | Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience |
title_full_unstemmed | Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience |
title_short | Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience |
title_sort | treating refractory cardiogenic shock with the tandemheart and impella devices: a single center experience |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5358142/ https://www.ncbi.nlm.nih.gov/pubmed/28348673 http://dx.doi.org/10.4021/cr121w |
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