One-year outcome and survival analysis of deferred ventricular septal repair in cardiogenic shock supported with mechanical circulatory support

Background and objective The effectiveness of deferred surgical repair of ventricular septal rupture (VSR) post-myocardial infarction (MI) with cardiogenic shock remains limited to case reports. Our study aimed to investigate the outcomes and survival analysis following mechanical circulatory support (MCS) in patients after VSR who develop cardiogenic shock. Methods We analyzed 27 patients with post-MI VSR and cardiogenic shock who received deferred surgical repair while stabilized on MCS between January 2018 and March 2020. After normality test adjustments, continuous variables were expressed as mean ± standard deviation (SD). These were compared using the Mann-Whitney U test and Student’s t-test. Categorical variables were compared using chi-square or Fisher’s exact test. To identify predictors of operative mortality, univariate analysis of clinical characteristics and interventions followed by logistic regression was carried out. P-value of < 0.05 was considered significant. Results All patients had preoperative MCS. Emergency repair was avoided in all the patients. The mean age of the participants was 64.96 with the majority being males (74.1%). On average, the mean time from MI to VSR repair was 18.85 days. Delayed revascularization was associated with increased mortality (OR 17.500, 95% CI 2.365–129.506, P = 0.005). Other factors associated with increased mortality were ejection fraction (EF), three-vessel disease, Killip class, early surgery, and prolonged use of inotropes. The operative mortality was 11% with an overall mortality of 33.3%. The one-year survival rate was 66.7%. Conclusion The use of MCS in adjunct to a deferred surgical approach shows an improved survival outcome of patients with VSR complicated by cardiogenic shock. Further investigations are required regarding the optimal time for MCS and surgical repair.

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

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz179 ◽

2019 ◽

Vol 57 (1) ◽

pp. 183-188 ◽

Cited By ~ 6

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.

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Mechanical circulatory support for early surgical repair of postinfarction ventricular septal defect with cardiogenic shock

Artificial Organs ◽

10.1111/aor.13808 ◽

2020 ◽

Author(s):

Maximilian Vondran ◽

Mahmoud S. Wehbe ◽

Christian Etz ◽

Tamer Ghazy ◽

Ardawan J. Rastan ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Cardiogenic Shock ◽

Mechanical Circulatory Support ◽

Septal Defect ◽

Surgical Repair ◽

Circulatory Support ◽

Postinfarction Ventricular Septal Defect

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Delayed surgery after mechanical circulatory support for ventricular septal rupture with cardiogenic shock

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa185 ◽

2020 ◽

Vol 31 (6) ◽

pp. 868-873

Author(s):

Hayato Morimura ◽

Minoru Tabata

Keyword(s):

Myocardial Infarction ◽

Cardiogenic Shock ◽

Mechanical Circulatory Support ◽

Operative Mortality ◽

Circulatory Support ◽

Ventricular Septal Rupture ◽

Organ Perfusion ◽

Delayed Surgery ◽

Optimal Duration ◽

Late Survival

Abstract OBJECTIVES The effectiveness of delayed surgery for ventricular septal rupture (VSR) following myocardial infarction (MI) in patients with cardiogenic shock remains unknown. We aimed to investigate the outcomes of delayed surgery following mechanical circulatory support for patients in cardiogenic shock after VSR. METHODS We reviewed 8 patients with post-MI VSR and cardiogenic shock who underwent delayed surgery at our institution between July 2015 and November 2017. Surgery was delayed until haemodynamic stabilization and improved organ ischaemia were achieved by initiating intra-aortic balloon pumping with or without veno-arterial extracorporeal membrane oxygenation (ECMO). We investigated the operative mortality, morbidity and late survival. RESULTS All 8 patients had preoperative intra-aortic balloon pump support, and 5 had additional veno-arterial ECMO support. Emergency repair was successfully avoided in all cases. The median time from the onset of MI to operation was 7.1 (3.7–9.9) days, and that from the diagnosis of VSR to operation was 1.9 (1.3–2.3) days. The operative mortality was 12.5%, and complications related to mechanical circulatory support occurred in 1 case (12.5%). The 2-year survival rate was 62.5%. CONCLUSIONS A combination of preoperative mechanical circulatory support and delayed surgery may improve the outcomes of patients with post-MI VSR, which was complicated by cardiogenic shock. The key to a better surgical outcome may be delaying the surgery for improving end-organ perfusion. This requires further investigation, especially for determining the optimal duration of support.

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Maximum level of mobility with axillary deployment of the Impella 5.0 is associated with improved survival

The International Journal of Artificial Organs ◽

10.1177/0391398817752575 ◽

2018 ◽

Vol 41 (4) ◽

pp. 236-239 ◽

Cited By ~ 10

Author(s):

Michele L Esposito ◽

Janelle Jablonski ◽

Allison Kras ◽

Sara Krasney ◽

Navin K Kapur

Keyword(s):

Cardiogenic Shock ◽

Acute Care ◽

Mechanical Circulatory Support ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Circulatory Support ◽

The Mean ◽

Acute Mechanical Circulatory Support ◽

Activity Measure ◽

Post Acute Care

Mobility is an important prognostic indicator for patients with cardiogenic shock. No studies have quantified peak mobility for patients with cardiogenic shock who are supported with the Impella 5.0 acute mechanical circulatory support device. The purpose of our study was to evaluate mobility levels among patients with cardiogenic shock being treated with an axillary Impella 5.0 pump. We retrospectively analyzed data from 19 patients receiving an Impella 5.0 device for cardiogenic shock at our institution from 2013 to 2016. We used the Johns Hopkins Highest Level of Mobility Scale to quantify maximum mobility level achieved during active Impella 5.0 support. Higher scores on a scale of 1–8 indicated more mobility. Activity Measure for Post Acute Care Scores were quantified for each patient to assess activity limitations, with a maximum score 24. The mean age of the total cohort was 60 ± 12 years, and the mean left ventricular ejection fraction was 16% ± 6%. In-hospital mortality was 47% (n = 9). Of the 19 Impella 5.0 implants, 10 survived, 6 died from withdrawal of care, and 3 died from worsening heart failure/cardiogenic shock. Similar rates of mobilization during the time of Impella implant were seen between groups. Compared to non-survivors, survivors achieved a higher maximum Johns Hopkins Highest Level of Mobility level, but similar Activity Measure for Post Acute Care scores. In conclusion, maximum mobility after Impella 5.0 implantation may be associated with improved survival. The clinical utility of exercise as a therapeutic intervention for patients requiring prolonged acute mechanical circulatory support requires further study.

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Outcome of the Impella Device for Acute Mechanical Circulatory Support

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e31828e0a8a ◽

2013 ◽

Vol 8 (1) ◽

pp. 12-16 ◽

Cited By ~ 9

Author(s):

Anthony Lemaire ◽

Mark B. Anderson ◽

Thomas Prendergast ◽

Neil Stockmaster ◽

Andrew Goodman ◽

...

Keyword(s):

Cardiogenic Shock ◽

Mechanical Circulatory Support ◽

Heart Function ◽

Retrospective Chart Review ◽

Left Ventricular ◽

Circulatory Support ◽

End Points ◽

Ventricular Assist ◽

The Mean ◽

Acute Mechanical Circulatory Support

Objective The contribution of cardiogenic shock to in-hospital mortality has not decreased significantly despite prompt revascularization, advances in medical therapy, and mechanical circulatory support. For patients in cardiogenic shock, mechanical circulatory support has been provided by a variety of devices. We report the outcome of the Impella device for acute mechanical circulatory support in cardiogenic shock in a setting of a large-volume single institution. The primary end points include survival to 30 days and recovery of native heart function and survival to 90 days and 1 year. The secondary end points include device complications. Methods We performed a retrospective chart review of 36 consecutive patients who underwent placement of the Impella device from February 6, 2006, to December 31, 2010. The charts were evaluated for data relative to the patients’ demographics, hemodynamics, operative details, 30-day outcome including the patients’ native heart function recovery, and 90-day and 1-year survival. Results Thirty-six consecutive patients were included in our study. The mean ± SD age was 60.3 ± 13 years, and 69% were men. The indication for placement of the Impella device included postcardiotomy cardiogenic shock in 23 patients (64%), acute myocardial infarction complicated with cardiogenic shock in 10 patients (28%), acute decompensated ischemic cardiomyopathy in 2 patients (6%), and myocarditis with cardiogenic shock in 1 patient (3%). The mean ± SD duration of the Impella support was 4.5 ± 3.9 days (range, 1–18). The 30-day survival rate was 72% (26/36), and, of those, 96% (25/26) recovered their native heart function and one (4%) was bridged to long-term left ventricular assist device (HeartMate II; Thoratec, Inc, Pleasanton, CA USA). The 90-day and 1-year survival was 64% and 61%, respectively. Conclusions The Impella devices yielded a very favorable outcome in patients with cardiogenic shock.

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