Impact of COVID-19 lockdown on the procedural and intra-hospital outcome of STEMI patients

Abstract Background While during the COVID-19 pandemic the number of patients presenting with ST-segment elevation myocardial infarction (STEMI) decreased, no change in patient or system delay could be shown due to local lockdown (LD) policy. Not much is known about the influence of LD on procedural details and intrahospital outcome of these patients. Methods Data was obtained from 511 patients treated for acute STEMI (24hours from symptom onset) from January 2019 to March 8th 2021 at two primary PCI (pPCI) centers in Germany. Patients presenting as intra-hospital STEMI, patients showing no culprit lesion and patients undergoing direct CABG were excluded. Overall, 456 patients (74% male, mean age 64±12) were included. These patients were divided into two groups: complete lockdown (LD; n=58; March 21st–April 20th 2020 and December 16th 2020–March 7th 2021) and no complete lockdown (No-LD; n=398)). Results There were no differences in pre-hospital care between the groups: Telemedicine (LD 23.5% vs. No-LD 34.9%; p=0.11), pre-alarm of the cath-lab staff (LD 59.6% vs. 66.6%, p=0.32) and direct admission to the cath-lab (LD 44.8% vs. No-LD 49.8%, p=0.58) were performed as often as in No-LD times. Neither the pain to first medical contact (LD 188±272 Min vs. No-LD 236±317 Min, p=0.29) nor the door to balloon time (55±54 Min vs. No-LD 49±58 Min, p=0.470) as well as other periods showed any difference. All over cardio-pulmonary resuscitation (CPR; LD 19.0% vs. No-LD 14.3%, p=0.35) or presentation with cardiogenic shock (25.9% vs 23.9%, p=0.74) was equally presented in both groups. However, left ventricular assist devices were implanted more often during LD (6.9% vs. No-LD 1.8%; p=0.017). Primary radial access was performed in the majority of the cases (LD 60.3% vs. No-LD 58.8%, p=0.82). During LD the culprit lesion was RCA in most cases (46.6% vs. No-LD LAD 46.7%, p=0.341). Stent thrombosis was not more common in out-of-hospital STEMI patients during LD (6.9% vs. 8.0%, p=0.76). Thrombus aspiration was performed in 10.3% during lockdown (vs. No-LD 4.5%, p=0.06), GP-IIb-IIIa inhibitors were not administered more often (LD 19.0% vs. No-LD 19.4%, p=0.92) and no reflow phenomenon was not seen more frequent (LD 20.7% vs. No-LD 21.3% p=0.91). TIMI III flow could be established in the majority of the cases (LD 86.0% vs. No-LD 91.5%, p=0.20). During further hospital stay, neither the frequency of ventilator (LD 17.2% vs. No-LD 17.0%, p=0.98) nor vasopressor use (LD 20.7% vs. No-LD 20.1% p=0.925) differed. Left ventricular function (47±13% vs. No-LD 45±12%; p=0.34) and maximum creatinkinase (LD 1827±1687 U/l vs. No-LD: 2292±4100 U/l, p=0.40) showed no difference between the groups as did intrahospital death (LD 10.3% vs. No-LD 11.6%, p=0.79). Conclusion Despite the known decline in STEMI patients during LD periods, patient care, procedural details and inta-hospital outcome of the ones presenting to a pPCI hospital do not change during LD periods. FUNDunding Acknowledgement Type of funding sources: None.

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Innovations in Ventricular Assist Devices for End-Stage Heart Failure

Annual Review of Medicine ◽

10.1146/annurev-med-041217-011015 ◽

2019 ◽

Vol 70 (1) ◽

pp. 33-44 ◽

Cited By ~ 4

Author(s):

Robert J.H. Miller ◽

Jeffrey J. Teuteberg ◽

Sharon A. Hunt

Keyword(s):

Heart Failure ◽

Patient Management ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Ventricular Assist ◽

Assist Devices ◽

Number Of Patients ◽

End Stage Heart Failure ◽

End Stage

The number of patients with end-stage heart failure (HF) continues to increase over time, but there has been little change in the availability of organs for cardiac transplantation, intensifying the demand for left ventricular assist devices (LVADs) as a bridge to transplantation. There is also a growing number of patients with end-stage HF who are not transplant candidates but may be eligible for long-term support with an LVAD, known as destination therapy. Due to this increasing demand, LVAD technology has evolved, resulting in transformative improvements in outcomes. Additionally, with growing clinical experience patient management continues to be refined, leading to iterative improvements in outcomes. With outcomes continuing to improve, the potential benefit from LVAD therapy is being considered for patients earlier in their course of advanced HF. We review recent changes in technology, patient management, and implant decision making in LVAD therapy.

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Manual Compression Versus MANTA Device for Access Management After Impella Removal on the ICU

10.21203/rs.3.rs-1176070/v1 ◽

2022 ◽

Author(s):

Florim Cuculi ◽

Philipp Burkart ◽

Giacomo Cioffi ◽

Federico Moccetti ◽

Mehdi Madanchi ◽

...

Keyword(s):

Vascular Complications ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Closure Device ◽

Left Ventricular Assist Devices ◽

Manual Compression ◽

Access Management ◽

Ventricular Assist ◽

Number Of Patients ◽

Significant Difference

Abstract Objective: To compare the safety and efficacy of manual compression versus use of the MANTA® closure device for access management after Impella® removal on the intensive care unit (ICU).Background: The number of patients treated with percutaneous left ventricular assist devices (pLVAD), namely Impella® and ECMO, for complex cardiac procedures or shock, is growing. However, removal of pLVAD and large bore arteriotomy closure among such patients on the ICU remains challenging, since it is associated with a high risk for bleeding and vascular complications. Methods: Patients included in a prospective registry between 2017 and 2020 were analyzed. Bleeding and vascular access site complications were assessed and adjudicated according to VARC-2 criteria. Results: We analyzed a cohort of 87 consecutive patients, who underwent access closure after Impella® removal on ICU by using either the MANTA® device or manual compression. The cohort´s mean age was 66.1±10.7 years and 76 patients (87%) were recovering from CS. Mean support time was 40 hours (Interquartile range 24–69 hours). MANTA® was used in 31 patients (35.6%) and manual compression was applied in 56 patients (64.4%). Overall access related bleedings were significantly lower in the MANTA® group (6.5% versus 39.3%(odds ratio (OR) 0.10, 95% CI 0.01–0.50; p=0.001), and there was no significant difference in vascular complications between the two groups(p=0.55).Conclusions: Our data suggests that the application of the MANTA® device directly on the ICU is safe. In addition, it seems to reduce access related bleeding without increasing the risk of vascular complications.

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Vascular procedures in patients with left ventricular assist devices: single-center experience

Indian Journal of Thoracic and Cardiovascular Surgery ◽

10.1007/s12055-021-01192-3 ◽

2021 ◽

Author(s):

Saad Rustum ◽

Julia Neuser ◽

Jan Dieter Schmitto ◽

Thomas Aper ◽

Jasmin Sarah Hanke ◽

...

Keyword(s):

Vascular Surgery ◽

Perioperative Complications ◽

Left Ventricular ◽

Demographic Variables ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Ventricular Assist ◽

Single Center Experience ◽

Number Of Patients ◽

Left Ventricular Assist

Abstract Objective A growing number of patients suffering from heart failure is living with a left ventricular assist device (LVAD) and is in the need for non-cardiac surgery. Vascular procedures due to ischemia, bleeding, or other device-related complications may be required and pose a challenge to the caregivers in terms of monitoring and management of these patients. Therefore, we reviewed our experience with LVAD patients undergoing vascular surgery. Methods From January 2010 until March 2017, a total of 54 vascular procedures were performed on 41 LVAD patients at our institution. Patient records were reviewed retrospectively in terms of incidence of LVAD-related complications, including thrombosis, stroke, bleeding, wound healing, and survival associated with vascular surgery. The type of surgery was recorded, as well as various clinical demographic variables. Results Vascular procedures were performed in 35 men (85.4%) and 6 women (14.6%) with LVADs. There were no perioperative strokes, device thromboses, or device malfunctions. Thirty-day mortality overall was 26.8% (eleven patients), with most patients dying within 30 days after LVAD implantation due to multi-organ failure. In 25 procedures (46.3%), a blood transfusion was necessary. Conclusion Patients on LVAD support are a complex cohort with a high risk for perioperative complications. In a setting where device function and anticoagulation are monitored closely, vascular surgery in these patients is feasible with an acceptable perioperative risk.

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A Comprehensive Review of Risk Factor, Mechanism, and Management of Left Ventricular Assist Device–Associated Stroke

Seminars in Neurology ◽

10.1055/s-0041-1726328 ◽

2021 ◽

Author(s):

Sung-Min Cho ◽

Pouya Tahsili-Fahadan ◽

Ahmet Kilic ◽

Chun Woo Choi ◽

Randall C. Starling ◽

...

Keyword(s):

Current Knowledge ◽

Management Strategies ◽

Treatment Strategies ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Ventricular Assist ◽

Number Of Patients ◽

Left Ventricular Assist ◽

Underlying Mechanisms

AbstractThe use of left ventricular assist devices (LVADs) has been increasing in the last decade, along with the number of patients with advanced heart failure refractory to medical therapy. Ischemic stroke and intracranial hemorrhage remain the leading causes of morbidity and mortality in LVAD patients. Despite the common occurrence and the significant outcome impact, underlying mechanisms and management strategies of stroke in LVAD patients are controversial. In this article, we review our current knowledge on pathophysiology and risk factors of LVAD-associated stroke, outline the diagnostic approach, and discuss treatment strategies.

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Left Ventricular Assist Devices and the Kidney

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.04670417 ◽

2017 ◽

Vol 13 (2) ◽

pp. 348-355 ◽

Cited By ~ 17

Author(s):

Daniel W. Ross ◽

Gerin R. Stevens ◽

Rimda Wanchoo ◽

David T. Majure ◽

Sandeep Jauhar ◽

...

Keyword(s):

Cardiorenal Syndrome ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Destination Therapy ◽

Left Ventricular Assist Devices ◽

Ventricular Assist ◽

Assist Devices ◽

Refractory Heart Failure ◽

Number Of Patients ◽

Left Ventricular Assist

Left ventricular assist devices (LVADs) are common and implantation carries risk of AKI. LVADs are used as a bridge to heart transplantation or as destination therapy. Patients with refractory heart failure that develop chronic cardiorenal syndrome and CKD often improve after LVAD placement. Nevertheless, reversibility of CKD is hard to predict. After LVAD placement, significant GFR increases may be followed by a late return to near baseline GFR levels, and in some patients, a decline in GFR. In this review, we discuss changes in GFR after LVAD placement, the incidence of AKI and associated mortality after LVAD placement, the management of AKI requiring RRT, and lastly, we review salient features about cardiorenal syndrome learned from the LVAD experience. In light of the growing number of patients using LVADs as a destination therapy, it is important to understand the effect of these devices on the kidney. Additional research and long-term data are required to better understand the relationship between the LVAD and the kidney.

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