scholarly journals Can mechanical circulatory support be an effective treatment for HFpEF patients?

2021 ◽  
Author(s):  
Einar Gude ◽  
Arnt E. Fiane
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Cavity ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
Mechanical Pressure ◽  
Entry Points

AbstractHeart failure with preserved ejection fraction (HFpEF) is increasing in prevalence and represents approximately 50% of all heart failure (HF) patients. Patients with this complex clinical scenario, characterized by high filling pressures, and reduced cardiac output (CO) associated with progressive multi-organ involvement, have so far not experienced any significant improvement in quality of life or survival with traditional HF treatment. Left ventricular assist devices (LVAD) have offered a new treatment alternative in terminal heart failure patients with reduced ejection fraction (HFrEF), providing a unique combination of significant pressure and volume unloading together with an increase in CO. The small left ventricular cavity in HFpEF patients challenges left-sided pressure unloading, and new anatomical entry points need to be explored for mechanical pressure and volume unloading. Optimized and pressure/volume-adjusted mechanical circulatory support (MCS) devices for HFrEF patients may conceivably be customized for HFpEF anatomy and hemodynamics. We have developed a long-term MCS device for HFpEF patients with atrial unloading in a pulsed algorithm, leading to a significant reduction of filling pressure, maintenance of pulse pressure, and increase in CO demonstrated in animal testing. In this article, we will discuss HFpEF pathology, hemodynamics, and the principles behind our novel MCS device that may improve symptoms and prognosis in HFpEF patients. Data from mock-loop hemolysis studies, acute, and chronic animal studies will be presented.

scholarly journals 700 The role of Impella CP in the management of malignant arrhythmias: a case of asymptomatic ventricular fibrillation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Rodolfo Caminiti ◽  
Luigi Colarusso ◽  
Antonio Parlavecchio ◽  
Giampaolo Vetta ◽  
Nastasia Mancini ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Fibrillation ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Ejection ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
Ventricular Ejection Fraction ◽  
Optimal Position

Abstract Introduction The Impella Heart Pump device (Abiomed, Danvers, MA, USA) is commonly used to provide mechanical circulatory support during high-risk percutaneous coronary intervention (PCI) and has demonstrated both efficacy and safety in patients with cardiogenic shock. Left ventricular assist devices (LVADs) alter the pathophysiological impact of ventricular arrhythmias in advanced heart failure; for example, life-threatening arrhythmias such as ventricular fibrillation (VF). We present a case of sustained VF tolerance in a patient with IMPELLA CP® support. Methods and results A 64-year-old man was admitted with typical chest pain that began 3 days earlier and an anterior myocardial infarction with ST-segment elevation. Urgent coronary angiogram showed a left anterior descending artery treated with angioplasty and stent implantation (TIMI 3). An initial echocardiogram, performed after PCI, showed a reduced left ventricular ejection fraction (LVEF) of approximately 35% with good right ventricular function. Two days later, the ECG tracing showed persistence of the ST elevation, and the patient developed recurrent ventricular tachycardia and an episode of acute pulmonary oedema; the echocardiogram showed a significant worsening of LVEF (15%). A percutaneous mechanical circulatory support device (Impella CP; Abiomed) was inserted through the right common femoral artery in order to preserve adequate systemic perfusion (Figure 1A). Twelve hours later, the patient developed rapid VT degenerating into VF without loss of consciousness (Figure 1C). During the arrhythmia, the patient was alert and his mental status was normal, Impella flow was 2.4–3.0 l/min, and invasive blood pressure (IBP) was 80/65 mmHg (Figure 1D). Intravenous lidocaine was administered without effect. After approximately 10 min of incessant VF, the patient received sedation with propofol from the anesthesiologist. A single unsynchronized DC shock of 200 J converted the patient to sinus rhythm. A bedside transthoracic echocardiogram was performed to check the optimal position of the Impella device (Figure 1B). In the following days, the patient had two new episodes of asymptomatic VF treated with DC-shock after sedation and was transferred to the cardiac surgery department to undergo urgent LVAD implantation. Conclusions Impella CP was helpful in the management of this patient with severe heart failure and malignant ventricular tachyarrhythmias, reducing the hemodynamic and neurological impact of this latter catastrophic arrhythmic event.

Mechanical circulatory support

2018 ◽  
pp. 197-222
Author(s):  
William E. Stansfield ◽  
Antigone Koliopoulou ◽  
Stephen H. McKellar ◽  
Craig H. Selzman
Keyword(s):  
Heart Failure ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
1960S And 1970S ◽  
Dramatic Shift

The 1950s, 1960s, and 1970s saw the transition of mechanical circulatory support (MCS) from the necessary extension of cardiopulmonary bypass to the development of durable devices. Within the last 20 years, enhanced pumps as well as surgical and medical experience have allowed MCS to become a routine part of the armamentarium for treating heart failure patients. Most recently, within the last 10 years, there has been a dramatic shift from the use of large, pulsatile left ventricular assist devices (LVADs) to smaller continuous flow devices. In this chapter, the current state of MCS for treating advanced heart failure as well as the detail of the surgically related issues with LVADs are reviewed.

Mechanical circulatory support with the Impella 5.0 and the Impella Left Direct pumps for postcardiotomy cardiogenic shock at La Pitié-Salpêtrière Hospital

2019 ◽  
Vol 57 (1) ◽  
pp. 183-188 ◽  
Author(s):  
Charles-Henri David ◽  
Astrid Quessard ◽  
Ciro Mastroianni ◽  
Guillaume Hekimian ◽  
Julien Amour ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Heart Function ◽  
Left Ventricular ◽  
Survival Outcome ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
The Mean ◽  
Postcardiotomy Cardiogenic Shock

Abstract OBJECTIVES Postcardiotomy cardiogenic shock (PCCS) is associated with high mortality rates of 50–80%. Although veno-arterial extracorporeal membrane oxygenation has been used as mechanical circulatory support in patients with PCCS, it is associated with a high rate of complications and poor quality of life. The Impella 5.0 and Impella Left Direct (LD) (Impella 5.0/LD) are minimally invasive left ventricular assist devices that provide effective haemodynamic support resulting in left ventricular unloading and systemic perfusion. Our goal was to describe the outcome of patients with PCCS supported with the Impella 5.0/LD at La Pitié-Salpêtrière Hospital. METHODS We retrospectively reviewed consecutive patients supported with the Impella 5.0/LD for PCCS between December 2010 and June 2015. Survival outcome and in-hospital complications were assessed. RESULTS A total of 29 patients (63 ± 14 years, 17% women) with PCCS were supported with the Impella 5.0/LD. At baseline, 69% experienced chronic heart failure, 66% had dilated cardiomyopathy and 57% had valvular disease. The mean EuroSCORE II was 22 ± 17 and the ejection fraction was 28 ± 11%. Most of the patients underwent isolated valve surgery (45%) or isolated coronary artery bypass grafting (38%). The mean duration of Impella support was 9 ± 7 days. Weaning from the Impella was successful in 72.4%, and 58.6% survived to discharge. Recovery of native heart function was observed in 100% of discharged patients. Survival to 30 days and to 1 year from Impella implant was 58.6% and 51.7%, respectively. CONCLUSIONS The Impella 5.0 and the Impella LD represent an excellent treatment option for critically ill patients with PCCS and are associated with favourable survival outcome and native heart recovery.

Development of Mechanical Circulatory Support Devices: 55 Years and Counting

2021 ◽  
Vol 32 (4) ◽  
pp. 424-433
Author(s):  
Emalie Petersen
Keyword(s):  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist ◽  
Mechanical Circulatory Support Devices ◽  
Support Devices

Heart failure is a leading cause of morbidity and mortality in the United States. Treatment of this condition increasingly involves mechanical circulatory support devices. Even with optimal medical therapy and use of simple cardiac devices, heart failure often leads to reduced quality of life and a shortened life span, prompting exploration of more advanced treatment approaches. Left ventricular assist devices constitute an effective alternative to cardiac transplantation. These devices are not without complications, however, and their use requires careful cooperative management by the patient’s cardiology team and primary care provider. Left ventricular assist devices have undergone many technological advancements since they were first introduced, and they will continue to evolve. This article reviews the history of different types of left ventricular assist devices, appropriate patient selection, and common complications in order to increase health professionals’ familiarity with these treatment options.

Neuroprotection for Mechanical Circulatory Support

2017 ◽  
Author(s):  
Lauren E Dunn ◽  
Joshua Z Willey ◽  
Ronald M Lazar
Keyword(s):  
Mechanical Circulatory Support ◽  
Management Strategies ◽  
Air Embolism ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
Cerebral Air Embolism ◽  
Cerebral Hyperperfusion ◽  
Clinical Scenarios

This chapter examines the adverse neurological events associated with mechanical circulatory support (MCS), which includes left ventricular assist devices (LVAD) and percutaneous devices for cardiac disease. The most frequently encountered neurological events are ischemic and hemorrhagic stroke, as well as intracerebral hemorrhage (ICH), heart failure and cardiovascular disease. The management of acute cerebrovascular conditions in this population poses unique challenges, given concomitant anticoagulation usage, hemodynamically unstable patients, and lack of randomized controlled trials investigating these clinical scenarios. Other acute neurological events include cerebral hyperperfusion and cerebral air embolism. This chapter describes these complications and their risk factors, and the available evidence-based and institutional management strategies.

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