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Choy JS, Berwick ZC, Kalasho BD, Fu L, Bhatt DL, Navia JA, Kassab GS. Selective Autoretroperfusion Provides Substantial Cardioprotection in Swine: Incremental Improvements With Mild Hypothermia. ACTA ACUST UNITED AC 2020; 5:267-278. [PMID: 32215349 PMCID: PMC7091507 DOI: 10.1016/j.jacbts.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 11/28/2022]
Abstract
SARP of coronary veins alone or in combination with focal MH-SARP provided cardioprotection following occlusion of the left anterior descending artery. Significant reduction in infarct size was achieved with MH-SARP and SARP with preservation of myocardial function and cell integrity. MH-SARP or SARP may provide a clinically relevant percutaneous short-term option of cardiac support to high-risk patients undergoing percutaneous coronary intervention.
Mild hypothermia (MH) and retroperfusion are 2 techniques proposed to reduce infarct size due to myocardial infarction. The authors evaluated the effects of focal MH combined with selective coronary venous autoretroperfusion (SARP) as an acute cardioprotective modality before percutaneous coronary intervention (PCI) in a swine model of left ventricular myocardial infarction. Significant reduction in infarct size with preservation of cardiac function and cardiomyocyte viability were achieved. The authors propose that SARP alone or in combination with MH may provide a clinically relevant percutaneous short-term option of cardiac support to high-risk patients undergoing PCI.
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Key Words
- AMI, acute myocardial infarction
- EF, ejection fraction
- GCV, great cardiac vein
- IABP, intra-aortic balloon pump
- LAD, left anterior descending coronary artery
- LV, left ventricle/ventricular
- MH, mild hypothermia
- PCI, percutaneous coronary intervention
- PO2, partial pressure of oxygen
- SARP, selective autoretroperfusion
- STEMI, ST-segment elevation myocardial infarction
- acute myocardial infarction
- cTnI, cardiac troponin I
- cardioprotection
- focal mild-hypothermia
- miR, microRNA
- selective autoretroperfusion
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Affiliation(s)
- Jenny S Choy
- California Medical Innovations Institute, San Diego, California
| | | | | | - Lijuan Fu
- California Medical Innovations Institute, San Diego, California
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Jose A Navia
- Department of Surgery, Austral University, Buenos Aires, Argentina
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, California.,3DT Holdings, San Diego, California
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Xie J, Xie DX, Gan YR, Li J, Wang YZ, Kou ZK, Mao R, Liang TX, Zhang YL. The curative effect of synthetic treatment for refractory acute myocardial infarction. J Thorac Dis 2018; 10:1732-1737. [PMID: 29707327 DOI: 10.21037/jtd.2018.03.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aims to investigate the curative effect of synthetic treatment for refractory acute myocardial infarction (AMI). Methods A total of 76 patients with coronary AMI accompanied by shock, who were treated with combined therapy from August 1999 to April 2017, were included into this study. Sixty patients received emergency percutaneous coronary intervention (PCI). Among these patients, 39 patients received intra-aortic balloon counterpulsation (IABP), eight patients had failed PCI underwent emergency off-pump coronary artery bypass (E-OPCAB), and eight patients were treated by hybrid cardiac surgery. Results All patients were successfully rescued. However, two patients died afterward due to postoperative complications. Conclusions For AMI patients complicated with shock, especially when emergency PCI fails or is difficult to perform, PCI + IABP, emergency E-OPCAB and hybrid cardiac surgery should be carried out, in order to achieve a good outcome and improve the success rate of rescue for this group of patients. Keywords Acute myocardial infarction (AMI); emergency percutaneous coronary intervention (PCI); intra-aortic balloon counterpulsation (IABP); emergency off-pump coronary artery bypass (E-OPCAB); hybrid cardiac surgery.
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Affiliation(s)
- Jing Xie
- Gansu Cardiovascular Institute, Lanzhou 730050, China
| | | | - Yi-Rong Gan
- Gansu Cardiovascular Institute, Lanzhou 730050, China
| | - Jiong Li
- Gansu Cardiovascular Institute, Lanzhou 730050, China
| | - Yan-Zhen Wang
- Gansu Cardiovascular Institute, Lanzhou 730050, China
| | - Zong-Ke Kou
- Gansu Cardiovascular Institute, Lanzhou 730050, China
| | - Rui Mao
- Gansu Cardiovascular Institute, Lanzhou 730050, China
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Ait Ichou J, Larivée N, Eisenberg MJ, Suissa K, Filion KB. The effectiveness and safety of the Impella ventricular assist device for high-risk percutaneous coronary interventions: A systematic review. Catheter Cardiovasc Interv 2017; 91:1250-1260. [PMID: 28941078 DOI: 10.1002/ccd.27316] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 07/31/2017] [Accepted: 08/07/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Small randomized controlled trials (RCTs) and observational studies have examined the effectiveness and safety of the Impella device, a percutaneous left ventricular assist device, in the setting of high-risk percutaneous coronary intervention (PCI). However, data are sparse and results are conflicting. Our objective was to evaluate the effectiveness and safety of the Impella device in high-risk patients undergoing PCI via a systematic review of the literature. METHODS We searched Medline, EMBASE, and the Cochrane Library for RCTs and observational studies that evaluated the Impella device in high-risk patients undergoing PCI. Inclusion was restricted to studies in which ≥10 patients received the Impella device; both uncontrolled and controlled (versus intra-aortic-balloon pump [IABP]) studies were included. RESULTS A total of 20 studies (4 RCTs, 2 controlled observational studies, and 14 uncontrolled observational studies; 1,287 patients) were included, with follow-up ranging from 1 to 42 months. The use of Impella resulted in improved procedural and hemodynamic characteristics in controlled and uncontrolled studies. In controlled studies, the 30-day rates of all-cause mortality and MACE were similar across groups. In most uncontrolled studies, the 30-day rates of all-cause mortality were generally low (range: 3.7%-10%), though rates of MACE were slightly higher (range: 5%-20%). CONCLUSION The Impella device was found to improve procedural and hemodynamic parameters, but only limited randomized data are available regarding clinical outcomes associated with its use. Large, multicenter RCTs are needed to definitively establish the effectiveness of the Impella device among high-risk PCI patients.
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Affiliation(s)
- Jamal Ait Ichou
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Natasha Larivée
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Mark J Eisenberg
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Division of Cardiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
| | - Karine Suissa
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Kristian B Filion
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
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Efficacy of Subcutaneous Electrocardiogram Leads for Synchronous Timing During Chronic Counterpulsation Therapy. ASAIO J 2016; 63:134-138. [PMID: 27984317 DOI: 10.1097/mat.0000000000000498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Counterpulsation devices (CPDs) require an accurate, reliable electrocardiogram (ECG) waveform for triggering inflation and deflation. Surface electrodes are for short-term use, and transvenous/epicardial leads require invasive implant procedure. A subcutaneous ECG lead configuration was developed as an alternative approach for long-term use with timing mechanical circulatory support (MCS) devices. In this study, efficacy testing was completed by simultaneously recording ECG waveforms from clinical-grade epicardial (control) and subcutaneous (test) leads in chronic ischemic heart failure calves implanted with CPD for up to 30 days. Sensitivity and specificity of CPD triggering by R-wave detection was quantified for each lead configuration. The subcutaneous leads provided 98.9% positive predictive value and 98.9% sensitivity compared to the epicardial ECG leads. Lead migration (n = 1) and fracture (n = 1) were observed in only 2 of 40 implanted leads, without adversely impacting triggering efficacy due to lead redundancy. These findings demonstrate the efficacy of subcutaneous ECG leads for long-term CPD timing and potential use as an alternative method for MCS device timing.
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Argiriou M, Patris V, Lama N, Argiriou O, Charitos C. Off pump repair of left ventricular rupture following mitral valve replacement: The crucial assistance of the IntraAortic Balloon Pump. Int J Surg Case Rep 2012; 4:5-6. [PMID: 23088903 DOI: 10.1016/j.ijscr.2012.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/04/2012] [Accepted: 09/10/2012] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Left ventricular (LV) rupture is a not as frequent, but potentially lethal complication of mitral valve replacement or repair. PRESENTATION OF CASE We report a case of a 67-year-old man who underwent mitral valve replacement and Cox Maze IV procedure. A massive bleed from the LV rupture was noted postoperatively while the patient was extubated. The control of bleeding was impossible until an IntraAortic Balloon Pump (IABP) was inserted. A bovine pericardial patch was applied, overlapping an extensive epicardial area, perimetrically of the hematoma. Between the epicardium and the pericardial patch we applied an autologous fibrin sealant. DISCUSSION The off-pump technique used to repair the LV rupture after a MVR, is more feasible when the patient is supported by an IABP that subsequently decreases the tension of the myocardial suture site. CONCLUSION The IABP, is a necessary device, that decreases the tension along the suture site post a left ventricular rupture following a MVR.
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Affiliation(s)
- Mihalis Argiriou
- Cardiac Surgery Department, Evangelismos General Hospital, Athens, Greece.
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Toumanidis ST, Karapanos NT, Kottis G, Kaladaridou A, Bramos D, Trikka CO, Vasiladiotis N, Zakopoulos N, Moulopoulos SD. Effect of dobutamine combined with intra-aortic balloon counterpulsation on left ventricular function early after acute myocardial infarction: experimental study. Artif Organs 2011; 35:875-82. [PMID: 21906094 DOI: 10.1111/j.1525-1594.2011.01327.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Acute myocardial infarction (AMI) causes left ventricular (LV) remodeling, which forms the substrate for its early and late complications. The purpose of this study was to compare the acute effect of dobutamine or intra-aortic balloon pumping (IABP), alone or in combination, on LV function in the early phase of an experimental AMI. In 18 pigs, AMI was induced by ligation of the left anterior descending artery (LAD). IABP or dobutamine infusion at a rate of 5 µg/kg/min, or a combination of the two, was applied immediately after ligation of the LAD. Echocardiographic measurements of the long and short LV axes were obtained before (baseline) and post LAD ligation and at the end of each intervention for 5, 15, and 30 min. The fractional shortening (FS) of both axes, as well as the ejection fraction (EF), was calculated. The combination of dobutamine with IABP increased the EF significantly after the AMI in comparison to dobutamine or IABP alone, and improved the stroke volume, cardiac output, and long axis FS in comparison to IABP alone. Dobutamine alone produced a significantly higher increase of EF in comparison to IABP alone. These results indicate that the combination of dobutamine with IABP may be useful during AMI.
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Affiliation(s)
- Savvas Th Toumanidis
- Department of Clinical Therapeutics, Medical School, University of Athens, "Alexandra" Hospital, Athens, Greece.
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