Mechanical Circulatory Support in Patients with Acute Decompensated Heart Failure; Consideration of Optimal Indication, Timing, and Patient Selection

2012 ◽  
Vol 18 (10) ◽  
pp. S127
Author(s):  
Tomoko Kato
Keyword(s):  
Heart Failure ◽  
Patient Selection ◽  
Mechanical Circulatory Support ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Circulatory Support

scholarly journals Implementation of a Cardiogenic Shock Team and Clinical Outcomes (INOVA-SHOCK Registry): Observational and Retrospective Study (Preprint)

2018 ◽  
Author(s):  
Behnam Tehrani ◽  
Alexander Truesdell ◽  
Ramesh Singh ◽  
Charles Murphy ◽  
Patricia Saulino
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Clinical Outcomes ◽  
Mechanical Circulatory Support ◽  
Acute Decompensated Heart Failure ◽  
Survival Rates ◽  
Decompensated Heart Failure ◽  
Circulatory Support

BACKGROUND The development and implementation of a Cardiogenic Shock initiative focused on increased disease awareness, early multidisciplinary team activation, rapid initiation of mechanical circulatory support, and hemodynamic-guided management and improvement of outcomes in cardiogenic shock. OBJECTIVE The objectives of this study are (1) to collect retrospective clinical outcomes for acute decompensated heart failure cardiogenic shock and acute myocardial infarction cardiogenic shock, and compare current versus historical survival rates and clinical outcomes; (2) to evaluate Inova Heart and Vascular Institute site specific outcomes before and after initiation of the Cardiogenic Shock team on January 1, 2017; (3) to compare outcomes related to early implementation of mechanical circulatory support and hemodynamic-guided management versus historical controls; (4) to assess survival to discharge rate in patients receiving intervention from the designated shock team and (5) create a clinical archive of Cardiogenic Shock patient characteristics for future analysis and the support of translational research studies. METHODS This is an observational, retrospective, single center study. Retrospective and prospective data will be collected in patients treated at the Inova Heart and Vascular Institute with documented cardiogenic shock as a result of acute decompensated heart failure or acute myocardial infarction. This registry will include data from patients prior to and after the initiation of the multidisciplinary Cardiogenic Shock team on January 1, 2017. Clinical outcomes associated with early multidisciplinary team intervention will be analyzed. In the study group, all patients evaluated for documented cardiogenic shock (acute decompensated heart failure cardiogenic shock, acute myocardial infarction cardiogenic shock) treated at the Inova Heart and Vascular Institute by the Cardiogenic Shock team will be included. An additional historical Inova Heart and Vascular Institute control group will be analyzed as a comparator. Means with standard deviations will be reported for outcomes. For categorical variables, frequencies and percentages will be presented. For continuous variables, the number of subjects, mean, standard deviation, minimum, 25th percentile, median, 75th percentile and maximum will be reported. Reported differences will include standard errors and 95% CI. RESULTS Preliminary data analysis for the year 2017 has been completed. Compared to a baseline 2016 survival rate of 47.0%, from 2017 to 2018, CS survival rates were increased to 57.9% (58/110) and 81.3% (81/140), respectively (P=.01 for both). Study data will continue to be collected until December 31, 2018. CONCLUSIONS The preliminary results of this study demonstrate that the INOVA SHOCK team approach to the treatment of Cardiogenic Shock with early team activation, rapid initiation of mechanical circulatory support, hemodynamic-guided management, and strict protocol adherence is associated with superior clinical outcomes: survival to discharge and overall survival when compared to 2015 and 2016 outcomes prior to Shock team initiation. What may limit the generalization of these results of this study to other populations are site specific; expertise of the team, strict algorithm adherence based on the INOVA SHOCK protocol, and staff commitment to timely team activation. Retrospective clinical outcomes (acute decompensated heart failure cardiogenic shock, acute myocardial infarction cardiogenic shock) demonstrated an increase in current survival rates when compared to pre-Cardiogenic Shock team initiation, rapid team activation and diagnosis and timely utilization of mechanical circulatory support. CLINICALTRIAL ClinicalTrials.gov NCT03378739; https://clinicaltrials.gov/ct2/show/NCT03378739 (Archived by WebCite at http://www.webcitation.org/701vstDGd)

scholarly journals Levosimendan Plus Dobutamine in Acute Decompensated Heart Failure Refractory to Dobutamine

2020 ◽  
Vol 9 (11) ◽  
pp. 3605
Author(s):  
William Juguet ◽  
Damien Fard ◽  
Laureline Faivre ◽  
Athanasios Koutsoukis ◽  
Camille Deguillard ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mechanical Circulatory Support ◽  
Acute Decompensated Heart Failure ◽  
Superior Vena ◽  
Vena Cava ◽  
Decompensated Heart Failure ◽  
Circulatory Support ◽  
Low Cardiac Output ◽  
Major Cardiovascular Events ◽  
Single Center Study

Randomized studies showed that Dobutamine and Levosimendan have similar impact on outcome but their combination has never been assessed in acute decompensated heart failure (ADHF) with low cardiac output. This is a retrospective, single-center study that included 89 patients (61 ± 15 years) admitted for ADHF requiring inotropic support. The first group consisted of patients treated with dobutamine alone (n = 42). In the second group, levosimendan was administered on top of dobutamine, when the superior vena cava oxygen saturation (ScVO2) remained <60% after 3 days of dobutamine treatment (n = 47). The primary outcome was the occurrence of major cardiovascular events (MACE) at 6 months, defined as all cause death, heart transplantation or need for mechanical circulatory support. Baseline clinical characteristics were similar in both groups. At day-3, the ScVO2 target (>60%) was reached in 36% and 32% of patients in the dobutamine and dobutamine-levosimendan group, respectively. After adding levosimendan, 72% of the dobutamine-levosimendan-group reached the ScVO2 target value at dobutamine weaning. At six months, 42 (47%) patients experienced MACE (n = 29 for death). MACE was less frequent in the dobutamine-levosimendan (32%) than in the dobutamine-group (64%, p = 0.003). Independent variables associated with outcome were admission systolic blood pressure and dobutamine-levosimendan strategy (OR = 0.44 (0.23–0.84), p = 0.01). In conclusion, levosimendan added to dobutamine may improve the outcome of ADHF refractory to dobutamine alone.

scholarly journals Inotropes Are Linked to Increased Mortality in Heart Failure

2015 ◽  
Author(s):  
M Chadi Alraies ◽  
Bill Tran ◽  
Sirtaz Adatya
Keyword(s):  
Heart Failure ◽  
Mechanical Circulatory Support ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Supplemental Oxygen ◽  
Circulatory Support ◽  
Organ Perfusion ◽  
The Usa ◽  
End Stage

With the advancement of technology and availability of mechanical circulatory support (MCS) devices for the treatment of acute decompensated systolic HF in the 21st century, the role of inotropes is becoming obsolete. Medical therapy for acute decompensated heart failure (HF) has not changed since 1960’s, we still use supplemental oxygen, diuretics, vasodilators and inotropes to improve congestion, cardiac output, end organ perfusion and symptoms related to elevate filling pressures1 . Despite demonstrated improvements in hemodynamics, the uses of inotropes have not demonstrated any improvements in mortality. Mechanical circulatory support (MCS) use is growing rapidly in the USA, in patients with stage D HF both as destination therapy and as a bridge to cardiac transplantation. In both, transplant-eligible and non-transplant-eligible patients, improvement in end-organ perfusion, functional capacity, quality of life and most importantly mortality have been demonstrated. In this perspective paper we are going to discuss the current lack of evidence for inotropic therapy and the evolving benefit of MCS in end-stage systolic HF patients.

Percutaneous (short-term) mechanical circulatory support

2021 ◽  
pp. 351-359
Author(s):  
Holger Thiele ◽  
Pascal Vranckx
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Mechanical Circulatory Support ◽  
Decompensated Heart Failure ◽  
Coronary Intervention ◽  
Circulatory Support ◽  
Percutaneous Coronary ◽  
Acute Heart Failure Syndromes ◽  
Artery Disease ◽  
Invasive Management

Coronary artery disease (CAD) has emerged as the dominant aetiologic factor in acute heart failure syndromes (AHFS) and cardiogenic shock (CS). The invasive management of the complex cardiac patient with advanced (decompensated) heart failure, CS, and/or potential haemodynamic compromise during and/after percutaneous coronary intervention (PCI) has become the remit of specialty myocardial intervention centres. Such centres provide state-of the art facilities for PCI, including experienced senior operators and critical care physicians who are available 24 hours per day, 7 days per week, with immediate access to cardiac surgery and mechanical circulatory support (MCS) systems.

A role for the Reitan catheter pump for percutaneous cardiac circulatory support of patients presenting acute congestive heart failure with low output and renal dysfunction?

2020 ◽  
Vol 16 (3) ◽  
pp. 159-164
Author(s):  
Julien Regamey ◽  
Nicolas Barras ◽  
Marco Rusca ◽  
Roger Hullin
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Impaired Renal Function ◽  
Acute Decompensated Heart Failure ◽  
Vascular Complications ◽  
Decompensated Heart Failure ◽  
Circulatory Support ◽  
Heart Failure Patients

Outcomes in acute decompensated heart failure remain poor, in particular when patients present with impaired renal function. Recent results indicate that treatment of acute decompensated heart failure patients with the Reitan catheter pump not only increases cardiac index, but also improves renal function resulting in maintained increase of diuresis. These favorable effects were achieved without significant hemolysis, bleeding or vascular complications suggesting that Reitan catheter pump treatment has the potential to facilitate recovery from acute decompensated heart failure with low output and complicated by renal dysfunction.

Heart Failure

2020 ◽  
Author(s):  
Sachin P Shah ◽  
Mandeep R. Mehra
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Heart Association ◽  
Decompensated Heart Failure ◽  
Advanced Heart Failure ◽  
Circulatory Support ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction

Heart failure is a syndrome related to abnormal cardiac performance with a consequence of impaired cardiac output at rest or with exertion and/or congestion, which usually leads to symptoms of fatigue, dyspnea, and edema. The syndrome is characterized by various phenotypes related to a vast array of etiologies with diverse management targets. The current broad categorization of heart failure separates patients based on ejection fraction. Further description of the phenotype beyond ejection fraction is imperative to correctly identify the etiology of heart failure and, ultimately, to choose medical, device, and surgical therapies appropriately. This review covers the epidemiology of heart failure, defining the phenotype and etiology of heart failure, recognition and management of acute decompensated heart failure, management of chronic heart failure with a reduced ejection fraction, implantable cardioverter-defibrillators in heart failure with a reduced ejection fraction, management of heart failure with a preserved ejection fraction, and advanced heart failure. Figures show the evolution of therapy in chronic heart failure from the symptom-directed model, the complex pathophysiology and principal aberrations underlying heart failure with preserved ejection fraction, and concepts underlying surgical therapy in advanced heart failure using Laplace’s law. Tables list various etiologies of heart failure; sensitivity and specificity of clinical, biomarker, and radiographic data in the diagnosis of acute decompensated heart failure; drugs and devices with a demonstrated survival benefit in heart failure with a reduced ejection fraction; neurohormonal antagonist dosing in heart failure with a reduced ejection fraction; randomized, placebo-controlled trials in heart failure with a preserved ejection fraction; categorization of heart failure according to American Heart Association/American College of Cardiology heart failure stage, New York Heart Association functional class, and Interagency Registry for Mechanically Assisted Circulatory Support level; and poor prognostic indicators in heart failure. This review contains 4 highly rendered figures, 8 tables, and 114 references.

Heart Failure

2018 ◽  
Author(s):  
Sachin P Shah ◽  
Mandeep R. Mehra
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Heart Association ◽  
Decompensated Heart Failure ◽  
Advanced Heart Failure ◽  
Circulatory Support ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction

Heart failure is a syndrome related to abnormal cardiac performance with a consequence of impaired cardiac output at rest or with exertion and/or congestion, which usually leads to symptoms of fatigue, dyspnea, and edema. The syndrome is characterized by various phenotypes related to a vast array of etiologies with diverse management targets. The current broad categorization of heart failure separates patients based on ejection fraction. Further description of the phenotype beyond ejection fraction is imperative to correctly identify the etiology of heart failure and, ultimately, to choose medical, device, and surgical therapies appropriately. This review covers the epidemiology of heart failure, defining the phenotype and etiology of heart failure, recognition and management of acute decompensated heart failure, management of chronic heart failure with a reduced ejection fraction, implantable cardioverter-defibrillators in heart failure with a reduced ejection fraction, management of heart failure with a preserved ejection fraction, and advanced heart failure. Figures show the evolution of therapy in chronic heart failure from the symptom-directed model, the complex pathophysiology and principal aberrations underlying heart failure with preserved ejection fraction, and concepts underlying surgical therapy in advanced heart failure using Laplace’s law. Tables list various etiologies of heart failure; sensitivity and specificity of clinical, biomarker, and radiographic data in the diagnosis of acute decompensated heart failure; drugs and devices with a demonstrated survival benefit in heart failure with a reduced ejection fraction; neurohormonal antagonist dosing in heart failure with a reduced ejection fraction; randomized, placebo-controlled trials in heart failure with a preserved ejection fraction; categorization of heart failure according to American Heart Association/American College of Cardiology heart failure stage, New York Heart Association functional class, and Interagency Registry for Mechanically Assisted Circulatory Support level; and poor prognostic indicators in heart failure. This review contains 3 highly rendered figures, 7 tables, and 113 references.

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