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Belfioretti L, Francioni M, Battistoni I, Angelini L, Matassini MV, Pongetti G, Shkoza M, Piangerelli L, Piva T, Nicolini E, Maolo A, Muçaj A, Compagnucci P, Munch C, Dello Russo A, Di Eusanio M, Marini M. Evolution of Cardiogenic Shock Management and Development of a Multidisciplinary Team-Based Approach: Ten Years Experience of a Single Center. J Clin Med 2024; 13:2101. [PMID: 38610866 PMCID: PMC11012883 DOI: 10.3390/jcm13072101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The management of cardiogenic shock (CS) after ACS has evolved over time, and the development of a multidisciplinary team-based approach has been shown to improve outcomes, although mortality remains high. Methods: All consecutive patients with ACS-CS admitted at our CICU from March 2012 to July 2021 were included in this single-center retrospective study. In 2019, we established a "shock team" consisting of a cardiac intensivist, an interventional cardiologist, an anesthetist, and a cardiac surgeon. The primary outcome was in-hospital mortality. Results: We included 167 patients [males 67%; age 71 (61-80) years] with ischemic CS. The proportion of SCAI shock stages from A to E were 3.6%, 6.6%, 69.4%, 9.6%, and 10.8%, respectively, with a mean baseline serum lactate of 5.2 (3.1-8.8) mmol/L. Sixty-six percent of patients had severe LV dysfunction, and 76.1% needed ≥ 1 inotropic drug. Mechanical cardiac support (MCS) was pursued in 91.1% [65% IABP, 23% Impella CP, 4% VA-ECMO]. From March 2012 to July 2021, we observed a significative temporal trend in mortality reduction from 57% to 29% (OR = 0.90, p = 0.0015). Over time, CS management has changed, with a significant increase in Impella catheter use (p = 0.0005) and a greater use of dobutamine and levosimendan (p = 0.015 and p = 0.0001) as inotropic support. In-hospital mortality varied across SCAI shock stages, and the SCAI E profile was associated with a poor prognosis regardless of patient age (OR 28.50, p = 0.039). Conclusions: The temporal trend mortality reduction in CS patients is multifactorial, and it could be explained by the multidisciplinary care developed over the years.
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Affiliation(s)
- Leonardo Belfioretti
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Matteo Francioni
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Ilaria Battistoni
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Luca Angelini
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Maria Vittoria Matassini
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Giulia Pongetti
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Matilda Shkoza
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Luca Piangerelli
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Tommaso Piva
- Intervention Cardiology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (T.P.); (E.N.)
| | - Elisa Nicolini
- Intervention Cardiology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (T.P.); (E.N.)
| | - Alessandro Maolo
- Intervention Cardiology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (T.P.); (E.N.)
| | - Andi Muçaj
- Intervention Cardiology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (T.P.); (E.N.)
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (P.C.); (A.D.R.)
| | - Christopher Munch
- Cardiac Anaesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy;
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (P.C.); (A.D.R.)
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy;
| | - Marco Marini
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
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Nguyen KM, Tran HPN, Dang VT, Hoang SV. Has the role of veno-arterial extracorporeal membrane oxygenation in patients with cardiogenic shock following acute myocardial infarction been fully determined? A case report. Eur Heart J Case Rep 2024; 8:ytae125. [PMID: 38572014 PMCID: PMC10990060 DOI: 10.1093/ehjcr/ytae125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/24/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024]
Abstract
Background The persistent challenge of high mortality rates in acute myocardial infarction-induced cardiogenic shock endures notwithstanding advancements in the diagnosis and treatment of this disease over the past two decades. While recent studies present conflicting evidence on the efficacy of veno-arterial extracorporeal membrane oxygenation (VA ECMO), observational research supports the benefits of early VA ECMO initiation. However, the current lack of robust support from randomized clinical trials for VA ECMO use in this context highlights the ongoing uncertainty surrounding its effectiveness. Case summary A 52-year-old male with sudden, intense chest pain was diagnosed with cardiogenic shock due to non-ST-elevation acute myocardial infarction at a local hospital. Initial treatment included aspirin, clopidogrel, and noradrenaline. Upon transfer to our hospital, the patient's condition deteriorated, leading to acute respiratory distress and severe hypotension. Prior to emergent percutaneous coronary intervention, peripheral VA ECMO was initiated. Coronary angiography revealed left main coronary artery occlusion, and a successful intervention was performed. Post-intervention, the patient's haemodynamic parameters significantly improved, and after 7 days, ECMO was successfully discontinued. The patient was discharged in stable condition after 25 days, with favourable outcomes persisting at the 30-day mark. Continuous monitoring is planned during outpatient follow-up. Discussion The clinical case illustrates a successful treatment outcome achieved through teamwork by the heart team, supporting the efficacy of the VA ECMO pre-percutaneous coronary intervention approach. The careful selection of appropriate candidates and strategic initiation of VA ECMO may play a role in enhancing outcomes for individuals experiencing acute myocardial infarction complicated by challenging cardiogenic shock.
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Affiliation(s)
- Kha Minh Nguyen
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, No. 217, Hong Bang Street, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam
- Department of Cardiology, Cho Ray Hospital, No. 201B, Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City 700000, Vietnam
| | | | - Vi Tuong Dang
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, No. 217, Hong Bang Street, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam
| | - Sy Van Hoang
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, No. 217, Hong Bang Street, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam
- Department of Cardiology, Cho Ray Hospital, No. 201B, Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City 700000, Vietnam
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Alsagaff MY, Revianto O, Sembiring YE, Ilman MI, Intan RE. Intra-aortic balloon pump still has a role in late-onset myocardial infarction complicated by ventricular septal rupture with intractable heart failure: a case report. J Med Case Rep 2024; 18:8. [PMID: 38184640 PMCID: PMC10771645 DOI: 10.1186/s13256-023-04284-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 11/24/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND The current guidelines have discouraged the routine use of intra-aortic balloon pump (IABP) in cardiogenic shock complicating acute coronary syndrome (ACS). Since then, the trend of IABP utilization in ACS has been declining. Nevertheless, the guidelines still preserve the recommendation of IABP use in hemodynamic instability or cardiogenic shock caused by post myocardial infarction (MI) ventricular septal rupture (VSR). CASE PRESENTATION A 46-years-old diabetic Southeast Asian female was referred from a peripheral facility with intractable heart failure despite treatment with vasoactive agents and diuretics for five days. The ECG suggested a recent anteroseptal myocardial infarction with normal high-sensitivity troponin-I value. The echocardiography detected a regional wall motion abnormality and a 10 mm wide ventricular septal defect. Invasive coronary angiography revealed a severe two-vessel coronary artery disease. We planned a delayed surgical strategy with preoperative optimization using IABP as a bridge to surgery. IABP implantation followed by significant hemodynamic improvement and rapid resolution of heart failure without any inotrope support. Afterwards, coronary artery bypass grafting (CABG) and VSR surgical repair were performed. We safely removed IABP on the third postoperative day with proper weaning and minimal vasoactive support. CONCLUSION We report a case where IABP still provided benefits for a patient with intractable heart failure caused by undetermined onset MI complicated by VSR. The use of IABP in such a case is in accordance with the recommendation of the current guidelines. Several studies showed that IABP use during preoperative optimization in the case of post-MI VSR was associated with survival benefits.
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Affiliation(s)
- Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Academic Hospital, Surabaya, East Java, 60286, Indonesia.
| | - Oky Revianto
- Department of Cardiovascular Thoracic Surgery, Faculty of Medicine, Airlangga University-RSUD Dr. Soetomo General Hospital Surabaya, Surabaya, East Java, 60286, Indonesia
| | - Yan Efrata Sembiring
- Department of Cardiovascular Thoracic Surgery, Faculty of Medicine, Airlangga University-RSUD Dr. Soetomo General Hospital Surabaya, Surabaya, East Java, 60286, Indonesia
| | - Muhammad Insani Ilman
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Academic Hospital, Surabaya, East Java, 60286, Indonesia
| | - Ryan Enast Intan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Academic Hospital, Surabaya, East Java, 60286, Indonesia
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Sandoval Y, Basir MB, Lemor A, Lichaa H, Alasnag M, Dupont A, Hirst C, Kearney KE, Kaki A, Smith TD, Vallabhajosyula S, Kayssi A, Firstenberg MS, Truesdell AG. Optimal Large-Bore Femoral Access, Indwelling Device Management, and Vascular Closure for Percutaneous Mechanical Circulatory Support. Am J Cardiol 2023; 206:262-276. [PMID: 37717476 DOI: 10.1016/j.amjcard.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/30/2023] [Accepted: 08/05/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Yader Sandoval
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Mir B Basir
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Alejandro Lemor
- Department of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Hady Lichaa
- Ascension Saint Thomas Heart, Ascension Saint Thomas Rutherford, Murfreesboro, Tennessee
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | - Colin Hirst
- Department of Cardiology, Ascension St. John Hospital-Detroit, Detroit, Michigan
| | | | - Amir Kaki
- Department of Cardiology, Ascension St. John Hospital-Detroit, Detroit, Michigan
| | - Timothy D Smith
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Division of Public Health Sciences, Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Somaschini A, Cornara S, Leonardi S, Demarchi A, Mandurino-Mirizzi A, Fortuni F, Ferlini M, Crimi G, Camporotondo R, Gnecchi M, Oltrona Visconti L, De Servi S, De Ferrari GM. Beneficial Effects of IABP in Anterior Myocardial Infarction Complicated by Cardiogenic Shock. Medicina (Kaunas) 2023; 59:1806. [PMID: 37893524 PMCID: PMC10608192 DOI: 10.3390/medicina59101806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives. Recent guidelines have downgraded the routine use of the intra-aortic balloon pump (IABP) in patients with cardiogenic shock (CS) due to ST-elevation myocardial infarction (STEMI). Despite this, its use in clinical practice remains high. The aim of this study was to evaluate the prognostic impact of the IABP in patients with STEMI complicated by CS undergoing primary PCI (pPCI), focusing on patients with anterior MI in whom a major benefit has been previously hypothesized. Materials and Methods. We enrolled 2958 consecutive patients undergoing pPCI for STEMI in our department from 2005 to 2018. Propensity score matching and mortality analysis were performed. Results. CS occurred in 246 patients (8.3%); among these patients, 145 (60%) had anterior AMI. In the propensity-matched analysis, the use of the IABP was associated with a lower 30-day mortality (39.3% vs. 60.9%, p = 0.032) in the subgroup of patients with anterior STEMI. Conversely, in the whole group of CS patients and in the subgroup of patients with non-anterior STEMI, IABP use did not have a significant impact on mortality. Conclusions. The use of the IABP in cases of STEMI complicated by CS was found to improve survival in patients with anterior infarction. Prospective studies are needed before abandoning or markedly limiting the use of the IABP in this clinical setting.
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Affiliation(s)
- Alberto Somaschini
- Cardiac Intensive Care Unit, Division of Cardiology, San Paolo Hospital, 17100 Savona, Italy;
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy (A.D.)
| | - Stefano Cornara
- Cardiac Intensive Care Unit, Division of Cardiology, San Paolo Hospital, 17100 Savona, Italy;
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy (A.D.)
| | - Sergio Leonardi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy (A.D.)
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.F.); (R.C.); (L.O.V.)
| | - Andrea Demarchi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy (A.D.)
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Alessandro Mandurino-Mirizzi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy (A.D.)
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy
| | - Federico Fortuni
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy (A.D.)
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.F.); (R.C.); (L.O.V.)
| | - Gabriele Crimi
- Interventional Cardiology Unit, CardioThoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Rita Camporotondo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.F.); (R.C.); (L.O.V.)
| | - Massimiliano Gnecchi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy (A.D.)
- Cardiolgia Traslazionale, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Luigi Oltrona Visconti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.F.); (R.C.); (L.O.V.)
| | - Stefano De Servi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy (A.D.)
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
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Hamdan R, Kadri Z, Abdallah H, Hamadeh A, Alsaedi E, Al Baba B, Shoka WA, Yassine N, Al Aila F, Gafar S, Mansour A, Lozon H, Daka LA, Soukieh F, Hamadi O, Jayyousi WA, Chah I, Balchi M, Abdallah Y, Nooryani AA. [Place du ballon de contre pulsion intra aortique dans l'infarctus aigu du myocarde compliqué par état de choc cardiogénique]. Ann Cardiol Angeiol (Paris) 2023; 72:101635. [PMID: 37639738 DOI: 10.1016/j.ancard.2023.101635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/01/2023] [Accepted: 08/05/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND METHODS Cardiogenic shock remains one of the leading causes of death in patients with myocardial infarction. The Intra-aortic balloon pump (IABP) has been widely used as a treatment for acute myocardial infarction (AMI), despite recommendations against its routine use. In this paper, our aim is to analyze and share our own experience with IABP in the setting of AMI. We retrospectively reviewed the files of patients admitted with AMI and cardiogenic shock and for whom IABP was inserted between June 2016 and December 2022. RESULTS 300 patients with AMI and cardiogenic shock were admitted and benefited from IABP insertion and primary coronary revascularization. The overall mortality rate was 62.3%, the site related complication rate was 0.6%, and the overall complications rate (including site related and major bleeding) was 10.6%. There was a significantly higher mortality in the group of patients where the Left Anterior Descending artery (LAD) was the culprit lesion, in the group of patients who required dialysis, the group who had creatinine levels greater than 200 um/L compared to the group who had creatinine lower than 200 um/L, and in patients older than 70 years. Interestingly, no difference in mortality was observed between men and women, single versus multiple vessel disease, and between STEMI and non-STEMI patients. CONCLUSION Mortality of AMI complicated by cardiogenic shock and treated by IABP remains high. However, IABP usage is associated with a low complication rate. Better selection criteria for IABP usage versus other more powerful mechanical circulatory support devices in such patients might improve the outcome for the patient.
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Affiliation(s)
- Righab Hamdan
- Cardiology department, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates.
| | - Zena Kadri
- Cardiology Department, Hotel Dieu de France, Beirut, Lebanon
| | | | - Ahmad Hamadeh
- University of Sharjah, Sharjah, United Arab Emirates
| | - Ehab Alsaedi
- Cardiology department, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Bassam Al Baba
- Cardiology department, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Wael Abo Shoka
- Cardiology department, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Noha Yassine
- Cardiology department, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Farah Al Aila
- Cardiology department, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Salma Gafar
- Cardiology department, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Anoop Mansour
- Cardiology department, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Hadeel Lozon
- Cardiology department, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Loai Abo Daka
- Cardiology department, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Farah Soukieh
- University of Sharjah, Sharjah, United Arab Emirates
| | - Omar Hamadi
- University of Sharjah, Sharjah, United Arab Emirates
| | | | - Islam Chah
- Cardiology department, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | | | | | - Arif Al Nooryani
- Head of Cardiology Department, CEO, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
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Garg P, Hussain MWA, Sareyyupoglu B. Role of acute mechanical circulatory support devices in cardiogenic shock. Indian J Thorac Cardiovasc Surg 2023; 39:25-46. [PMID: 37525710 PMCID: PMC10387030 DOI: 10.1007/s12055-023-01484-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 03/30/2023] Open
Abstract
Cardiogenic shock is a state of low cardiac output that is associated with significant morbidity and mortality. A considerable proportion of patients with cardiogenic shock respond poorly to medical management and require acute mechanical circulatory support (AMCS) devices to improve tissue perfusion as well as to support the heart. In the last two decades, many new AMCS devices have been introduced to support the right, left, and both ventricles. All these devices vary in terms of the support they provide to the body and heart, mechanism of functioning, method of insertion, and adverse events. In this review, we compare and contrast the available percutaneous and surgically placed AMCS devices used in cardiogenic shock and discuss the associated clinical and hemodynamic data to make a conscious decision about choosing a device.
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Affiliation(s)
- Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Md Walid Akram Hussain
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
- Cardiothoracic Surgery, Heart and Lung Transplant Program, Mayo Clinic, 4500 San Pablo Road, FL 32224 Jacksonville, USA
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