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The Impella® Recover mechanical assist device in acute cardiogenic shock: a single-centre experience of 66 patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
2016 (English)In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 22, no 4, p. 452-458Article in journal (Refereed) Published
Resource type
Text
Abstract [en]

OBJECTIVES: Short-term ventricular assist devices are more frequently used in patients with acute cardiogenic shock. The aim of this study was to evaluate its effect on haemodynamic parameters, as well as the short- and long-term outcome and complication rate associated with the device. METHODS: All patients treated with the ImpellaA (R) Recover device at our centre from 2003 to 2014 (n = 66) were included in this study, and follow-up time was 2.9 (+/- 0.4) years. Data were obtained through patient records and the population register. Patient-related factors, preimplantation and early postimplantation haemodynamic and biochemical parameters were analysed. Characteristics of survivors and non-survivors were compared. RESULTS: The device was implanted in 66 patients and 58% (38/66) were alive at 30 days post-implantation. The mean duration of support was 7.4 (+/- 0.8) days. Mean time in the intensive care unit was 24 (+/- 4) days. Following device implantation, patients' cardiac index improved from 2.1 l/min/m(2) (+/- 0.20) to 3.8 l/min/m(2) (+/- 0.20) at Day 7, mixed venous saturation increased from 56% (+/- 2.0) to 68% (+/- 1.2) and diuresis increased from 69 ml/h (+/- 9) at device insertion to 105 ml/h (+/- 19) at Day 7 on support. Central venous pressure, lactate levels and inotropic support decreased on support. No difference between survivors and non-survivors was established. No correlation was established between preimplant parameters and 30-day mortality. CONCLUSIONS: The ImpellaA (R) Recover device improved haemodynamics in patients with acute cardiogenic shock. Still, 30-day mortality remains high and future studies must focus on the optimal timing of placement of the device.

Place, publisher, year, edition, pages
2016. Vol. 22, no 4, p. 452-458
Keywords [en]
Heart failure, Acute cardiogenic shock, Left ventricular assist device
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-296864DOI: 10.1093/icvts/ivv305ISI: 000374228700013PubMedID: 26763043OAI: oai:DiVA.org:uu-296864DiVA, id: diva2:940152
Available from: 2016-06-20 Created: 2016-06-20 Last updated: 2018-04-12Bibliographically approved
In thesis
1. Mechanical Circulatory Support in Left Ventricular Heart Failure
Open this publication in new window or tab >>Mechanical Circulatory Support in Left Ventricular Heart Failure
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Short-term mechanical circulatory support (MCS) with ventricular assist devices or veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the standard treatment in patients with cardiogenic shock unresponsive to pharmacological treatment. However, the haemodynamic effects of these devices are not yet fully described, nor are their effects on ventricular function and myocardial recovery.

The aims of this thesis are to increase knowledge of the haemodynamic changes during MCS in different settings and to provide new insights into how MCS therapy should be guided in the specific patient.

In Studies I and II, we developed experimental animal models to investigate the effect of VA ECMO on left ventricular (LV) performance and size of myocardial infarction in different cannulation strategies. In Study I, we found that the LV performance was negatively affected by VA ECMO in both centrally and peripherally cannulated animals. In Study II, we specifically studied the effect of VA ECMO with and without the addition of LV drainage on the size of experimentally induced myocardial infarction. The results showed that active LV decompression had no effect on infarct size in the acute setting.

Studies III and IV are retrospective studies on patients in cardiogenic shock treated with short-term mechanical support with either Impella® (Studies III and IV) or VA ECMO (Study IV). In Study IV, we concluded that treatment with Impella® has excellent effects on haemodynamic parameters and an acceptable mortality and complication rate. The studied pre-implantation patient parameters did not significantly affect outcome. In Study IV, we compared the outcome of patients treated with Impella® with those treated with VA ECMO. After adjustment for pre-implantation patient status, as defined by SAVE score, no difference in short- or long-term mortality was seen between the two groups.

In conclusion, VA ECMO, whether central or peripheral, negatively affects the LV, and the addition of a LV drain has no effect on infarct size in these experimental models. Both Impella® and VA ECMO offer good haemodynamic results with acceptable mortality and complication rates in patients with refractory cardiogenic shock. When adjusted for the SAVE score, the outcomes of both treatment modalities are comparable.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 68
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1464
Keywords
Mechanical Circulatory Support, Left Ventricular Heart Failure, Left Ventricular Assist Device, Extracorporeal Membrane Oxygenation, ECMO
National Category
Surgery Cardiac and Cardiovascular Systems
Research subject
Thorax Surgery
Identifiers
urn:nbn:se:uu:diva-347427 (URN)978-91-513-0330-7 (ISBN)
Public defence
2018-06-06, Enghoffsalen, Ingång 50 bv, Akademiska sjukhuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2018-05-14 Created: 2018-04-12 Last updated: 2018-05-14

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Schiller, PetterVikholm, PerHellgren, Laila

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