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Vandenbriele C, M'Pembele R, Dannenberg L, Metzen D, Zako S, Helten C, Mourikis P, Ignatov D, Huhn R, Balthazar T, Adriaenssens T, Vanassche T, Meyns B, Panoulas V, Monteagudo-Vela M, Arachchillage D, Janssens S, Scherer C, Orban M, Petzold T, Horn P, Jung C, Zeus T, Price S, Westenfeld R, Kelm M, Polzin A. Heparin dosing in patients with Impella-supported cardiogenic shock. Int J Cardiol 2024; 399:131690. [PMID: 38160912 DOI: 10.1016/j.ijcard.2023.131690] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Impella™ is increasingly used in cardiogenic shock. However, thromboembolic and bleeding events are frequent during percutaneous mechanical circulatory support (pMCS). OBJECTIVE Therefore, we aimed to explore the optimal anticoagulation regime for pMCS to prevent thromboembolism and bleedings. METHODS This hypothesis-generating multi-center cohort study investigated 170 patients with left-Impella™ support. We (A) compared bleeding/thrombotic events in two centers with therapeutic range (TR-aPTT) activated partial thromboplastin time (60-80s) and (B) compared events of these centers with one center with intermediate range aPTT (40-60s). RESULTS After matching, there were no differences in patients' characteristics. In centers aiming at TR-aPTT, major bleeding was numerically lower with aPTT <60s within 48 h of left-Impella™ support, versus patients that achieved the aimed aPTT of ≥60s [aPTT ≥60s: 22 (37.3%) vs. aPTT<60s 14 (23.7%); Hazard ratio [HR], 0.62 (95%) CI, 0.28-1.38; p = 0.234]. Major cardiovascular and cerebrovascular adverse events (MACCE) did not differ between groups. In comparison of centers, TR-aPTT strategy showed higher major bleeding rates [TR: 8 (47.1%) vs. intermediate range: 1 (5.9%); HR, 0.06 (95%) CI, 0.01-0.45; p = 0.006]. MACCE were lower in the intermediate range aPTT group as well [TR 12 (70.6%) vs. intermediate range 5 (29.4%) HR, 0.32 (95%) CI, 0.11-0.92; p = 0.034]. CONCLUSION This pilot analysis showed that lowering UFH-targets in left-Impella™ supported CS patients seems to be a safe and promising strategy for reducing major bleedings without increasing MACCE. This needs to be validated in larger, randomized clinical trials.
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Affiliation(s)
| | - René M'Pembele
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Germany
| | - Lisa Dannenberg
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Daniel Metzen
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Saif Zako
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Carolin Helten
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Philipp Mourikis
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Denis Ignatov
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Ragnar Huhn
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Germany
| | - Tim Balthazar
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Tom Adriaenssens
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of cardiac surgery, University Hospitals Leuven, Belgium
| | - Vasileios Panoulas
- Department of Adult Intensive Care, Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Maria Monteagudo-Vela
- Department of Adult Intensive Care, Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Deepa Arachchillage
- Centre for haematology, Department of Immunology and Inflammation, Imperial College London, London, UK; Department of Haematology, Imperial College Healthcare NHS Trust, London, UK
| | - Stefan Janssens
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Clemens Scherer
- Intensive Care Unit and Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany
| | - Martin Orban
- Intensive Care Unit and Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany
| | - Tobias Petzold
- Intensive Care Unit and Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany
| | - Patrick Horn
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Christian Jung
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Tobias Zeus
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Susanna Price
- Department of Adult Intensive Care, Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Ralf Westenfeld
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Malte Kelm
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Amin Polzin
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany.
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2
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Gatta F, Haqzad Y, Gradinariu G, Malvindi PG, Khalid Z, Suelo-Calanao RL, Moawad N, Bashir A, Rogers LJ, Lloyd C, Nguyen B, Booth K, Wang L, Al-Attar N, McDowall N, Watkins S, Sayeed R, Baghdadi S, D'Alessio A, Monteagudo-Vela M, Djordjevic J, Goricar M, Hoppe S, Bocking C, Hussain A, Evans B, Arif S, Malkin C, Field M, Sandhu K, Harky A, Torky A, Uddin M, Abdulhakeem M, Kenawy A, Massey J, Cartwright N, Tyson N, Nicou N, Baig K, Jones M, Aljanadi F, Owens CG, Oyebanji T, Doyle J, Spence MS, Brennan PF, Manoharan G, Ramadan T, Ohri S, Loubani M. Redo aortic valve replacement versus valve-in-valve trans-catheter aortic valve implantation: a UK propensity-matched analysis. Monaldi Arch Chest Dis 2023; 94. [PMID: 37074089 DOI: 10.4081/monaldi.2023.2546] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/21/2023] [Indexed: 04/20/2023] Open
Abstract
This study sought to compare the morbidity and mortality of redo aortic valve replacement (redo-AVR) versus valve-in-valve trans-catheter aortic valve implantation (valve-in-valve TAVI) for patients with a failing bioprosthetic valve. A multicenter UK retrospective study of redo-AVR or valve-in-valve TAVI for patients referred for redo aortic valve intervention due to a degenerated aortic bioprosthesis. Propensity score matching was performed for confounding factors. From July 2005 to April 2021, 911 patients underwent redo-AVR and 411 patients underwent valve-in-valve TAVI. There were 125 pairs for analysis after propensity score matching. The mean age was 75.2±8.5 years. In-hospital mortality was 7.2% (n=9) for redo-AVR versus 0 for valve-in-valve TAVI, p=0.002. Surgical patients suffered more post-operative complications, including intra-aortic balloon pump support (p=0.02), early re-operation (p<0.001), arrhythmias (p<0.001), respiratory and neurological complications (p=0.02 and p=0.03) and multi-organ failure (p=0.01). The valve-in-valve TAVI group had a shorter intensive care unit and hospital stay (p<0.001 for both). However, moderate aortic regurgitation at discharge and higher post-procedural gradients were more common after valve-in-valve TAVI (p<0.001 for both). Survival probabilities in patients who were successfully discharged from the hospital were similar after valve-in-valve TAVI and redo-AVR over the 6-year follow-up (log-rank p=0.26). In elderly patients with a degenerated aortic bioprosthesis, valve-in-valve TAVI provides better early outcomes as opposed to redo-AVR, although there was no difference in mid-term survival in patients successfully discharged from the hospital.
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Affiliation(s)
- Francesca Gatta
- Department of Cardiology and Cardiothoracic Surgery, Castle Hill Hospital, Hull; Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Yama Haqzad
- Department of Cardiology and Cardiothoracic Surgery, Castle Hill Hospital, Hull.
| | - George Gradinariu
- Department of Cardiology and Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow.
| | | | - Zubair Khalid
- Department of Cardiology and Cardiothoracic Surgery, Castle Hill Hospital, Hull.
| | - Rona L Suelo-Calanao
- Department of Cardiology and Cardiothoracic Surgery, Castle Hill Hospital, Hull.
| | - Nader Moawad
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Aladdin Bashir
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Luke J Rogers
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Clinton Lloyd
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Bao Nguyen
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Karen Booth
- Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle.
| | - Lu Wang
- Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle.
| | - Nawwar Al-Attar
- Department of Cardiology and Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow.
| | - Neil McDowall
- Department of Cardiology and Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow.
| | - Stuart Watkins
- Department of Cardiology and Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow.
| | - Rana Sayeed
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Saleh Baghdadi
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Andrea D'Alessio
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Maria Monteagudo-Vela
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Jasmina Djordjevic
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Matej Goricar
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Solveig Hoppe
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Charlotte Bocking
- Department of Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford.
| | - Azar Hussain
- Department of Cardiology and Cardiothoracic Surgery, Leeds General Infirmary.
| | - Betsy Evans
- Department of Cardiology and Cardiothoracic Surgery, Leeds General Infirmary.
| | - Salman Arif
- Department of Cardiology and Cardiothoracic Surgery, Leeds General Infirmary.
| | - Christopher Malkin
- Department of Cardiology and Cardiothoracic Surgery, Leeds General Infirmary.
| | - Mark Field
- Department of Cardiology and Cardiothoracic Surgery, Derriford Hospital.
| | - Kully Sandhu
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Amer Harky
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Ahmed Torky
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Mauin Uddin
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Muhammad Abdulhakeem
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - Ayman Kenawy
- Department of Cardiology and Cardiothoracic Surgery, Liverpool Heart and Chest Hospital.
| | - John Massey
- Department of Cardiology and Cardiothoracic Surgery, Northern General Hospital, Sheffield.
| | - Neil Cartwright
- Department of Cardiology and Cardiothoracic Surgery, Northern General Hospital, Sheffield.
| | - Nathan Tyson
- Department of Cardiology and Cardiothoracic Surgery, Nottingham City Hospital.
| | - Niki Nicou
- Department of Cardiology and Cardiothoracic Surgery, Nottingham City Hospital.
| | - Kamran Baig
- Department of Cardiology and Cardiothoracic Surgery, Nottingham City Hospital.
| | - Mark Jones
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Firas Aljanadi
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Colum G Owens
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Tunde Oyebanji
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Joseph Doyle
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Mark S Spence
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Paul F Brennan
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Ganesh Manoharan
- Department of Cardiology and Cardiothoracic Surgery, Royal Victoria Hospital, Belfast.
| | - Taha Ramadan
- Department of Cardiology and Cardiothoracic Surgery, Southampton General Hospital.
| | - Sunil Ohri
- Department of Cardiology and Cardiothoracic Surgery, Southampton General Hospital.
| | - Mahmoud Loubani
- Department of Cardiology and Cardiothoracic Surgery, Castle Hill Hospital, Hull.
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3
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Mohite PN, Husain M, Monteagudo-Vela M, Umakumar K, Garcia Saez D, Jothidasan A, Simon AR. Sternal sparing bilateral symmetrical thoracotomy for implantation of left ventricular assist device. Multimed Man Cardiothorac Surg 2021; 2021. [PMID: 34662005 DOI: 10.1510/mmcts.2021.044] [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] [Indexed: 11/06/2022]
Abstract
Reopening the chest in patients with left ventricular assist devices at the time of a heart transplant is challenging due to adhesions and the possibility of injury to vital structures. The sternal sparing bilateral thoracotomy approach utilized to implant a left ventricular assist device minimizes the chances of such injuries and offers a cosmetically better outcome. We demonstrate a procedure for implanting a left ventricular assist device in a 54-year-old man diagnosed with dilated cardiomyopathy who suffered rapid decompensation despite maximum medical therapy.
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Affiliation(s)
- Prashant Nanasaheb Mohite
- Royal Brompton and Harefield NHS Foundation Trust Hill End Road, Harefield, Uxbridge, London, UB9 6JH
| | - Mubassher Husain
- Royal Brompton and Harefield NHS Foundation Trust Hill End Road, Harefield, Uxbridge, London, UB9 6JH
| | - Maria Monteagudo-Vela
- Royal Brompton and Harefield NHS Foundation Trust Hill End Road, Harefield, Uxbridge, London, UB9 6JH
| | - Kabeer Umakumar
- Royal Brompton and Harefield NHS Foundation Trust Hill End Road, Harefield, Uxbridge, London, UB9 6JH
| | - Diana Garcia Saez
- Royal Brompton and Harefield NHS Foundation Trust Hill End Road, Harefield, Uxbridge, London, UB9 6JH
| | - Anand Jothidasan
- Royal Brompton and Harefield NHS Foundation Trust Hill End Road, Harefield, Uxbridge, London, UB9 6JH
| | - Andre R Simon
- Royal Brompton and Harefield NHS Foundation Trust Hill End Road, Harefield, Uxbridge, London, UB9 6JH
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4
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Monteagudo-Vela M, Panoulas V, Kourliouros A, Krasopoulos G. Is the quality-of-life improvement after transcatheter aortic valve implantation equivalent to that achieved by surgical aortic valve replacement? Interact Cardiovasc Thorac Surg 2021; 33:866-870. [PMID: 34258620 DOI: 10.1093/icvts/ivab186] [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: 02/03/2021] [Revised: 05/20/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'is the quality-of-life (QoL) improvement after transcatheter aortic valve implantation (TAVI) equivalent to that achieved by surgical aortic valve replacement (sAVR)?' Literature search revealed 189 papers with reference to QoL after TAVI, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. QoL plays a crucial role in the decision-making process for procedures such as TAVI and sAVR. Current evidence included and analysed in this review have shown a clear improvement in QoL after both TAVI and sAVR. TAVI offers a rapid improvement of QoL, evident within the first 30 days. There is no difference in QoL at 2- and 5-year follow-up between TAVI and sAVR. There are currently paucity of data on long-term QoL and the potential impact of structural valve degeneration following TAVI.
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Affiliation(s)
- Maria Monteagudo-Vela
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Vasileios Panoulas
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Antonios Kourliouros
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford, Oxford, UK
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5
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Vandenbriele C, Dannenberg L, Monteagudo-Vela M, Balthazar T, Metzen D, Voss F, Horn P, Westenfeld R, Zeus T, Kelm M, Verhamme P, Janssens S, Panoulas V, Price S, Polzin A. Optimal antithrombotic regimen in patients with cardiogenic shock on ImpellaTM mechanical support: less might be more. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Bleeding and ischemic complications are the main cause of morbidity and mortality in critically ill cardiogenic shock patients, supported by short-term percutaneous mechanical circulatory support (pMCS) devices. Hence, finding the optimal antithrombotic regimen is challenging. Bleeding not only occurs because of heparin and antiplatelet therapy (both required in the prevention of pump and acute stent thrombosis) but also because of device- and disease related coagulopathy. To prevent clotting-related device failure, most centers target full therapeutic heparin anticoagulation levels in left ventricular (LV) Impella™ supported patients in analogy with Veno-Arterial Extracorporeal Membrane Oxygenation. We aimed to investigate the safety (related to bleeding and thrombotic complications) of targeting low-dose versus therapeutic heparin levels in left Impella™-supported cardiogenic shock patients on dual antiplatelet therapy (DAPT).
Methods
In this hypothesis generating pilot study, we investigated 114 patients supported for at least two days by LV Impella™ mechanical support due to cardiogenic shock at three tertiary ICUs, highly specialized in mechanical support. Low-dose heparin (aPTT 40–60s or anti-Xa 0.2–0.3) was compared to standard of care (aPTT 60–80s or anti-Xa 0.3–0.5). Major adverse cardio- and cerebrovascular events (MACCE; composite of death, myocardial infarction, stroke/transient ischemic attack) and BARC bleeding (bleeding academic research consortium classification) during 30 day follow-up were assessed. Inverse probability of treatment weighting (IPTW) analysis was calculated with age, gender, arterial hypertension, diabetes mellitus, smoking, chronic kidney disease, previous stroke, previous myocardial infarction, previous coronary arterial bypass grafting, hypercholesterolemia and DAPT as matching variables. COX regression analysis was conducted to test for robustness.
Results
IPTW revealed 52 patients in the low-dose heparin group and 62 patients in the therapeutic group. Mean age of patients after IPTW was 62±16 years in the intermediate and 62±13 years in the therapeutic group (p=0.99). 25% and 42.2% were male (p=0.92). Overall bleeding events and major (BARC3b) bleeding events were higher in the therapeutic heparin group (overall bleeding: Hazard ratio [HR]=2.58, 95% confidence interval [CI] 1.2–5.5; p=0.015; BARC 3b: HR=4.4, 95% CI 1.4–13.6, p=0.009). Minor bleeding (BARC3a) as well as MACCE and its single components (ischemic events) did not differ between both groups. These findings were robust in the COX regression analysis.
Conclusion
In this pilot analysis, low-dose heparin in 114 LV Impella™ cardiogenic shock patients was associated with less bleeding without increased ischemic events, adjusted for DAPT. Reducing the target heparin levels in critically ill patients supported by LV Impella™ might improve the outcome of this precarious group. These findings need to be validated in randomized clinical trials.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Vandenbriele
- University Hospitals (UZ) Leuven, Division of cardiovascular diseases, Leuven, Belgium
| | - L Dannenberg
- Heinrich Heine University, Division of cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - M Monteagudo-Vela
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - T Balthazar
- University Hospitals (UZ) Leuven, Division of cardiovascular diseases, Leuven, Belgium
| | - D Metzen
- Heinrich Heine University, Division of cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - F Voss
- Heinrich Heine University, Division of cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - P Horn
- Heinrich Heine University, Division of cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - R Westenfeld
- Heinrich Heine University, Division of cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - T Zeus
- Heinrich Heine University, Division of cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - M Kelm
- Heinrich Heine University, Division of cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - P Verhamme
- University Hospitals (UZ) Leuven, Division of cardiovascular diseases, Leuven, Belgium
| | - S Janssens
- University Hospitals (UZ) Leuven, Division of cardiovascular diseases, Leuven, Belgium
| | - V Panoulas
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Price
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Polzin
- Heinrich Heine University, Division of cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
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6
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Smail H, Monteagudo-Vela M, Stock U, Simon A. Total artificial heart implantation after right ventricular intimal spindle cell sarcoma. Eur J Cardiothorac Surg 2020; 56:1014-1015. [PMID: 31005997 DOI: 10.1093/ejcts/ezz117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/12/2019] [Accepted: 03/20/2019] [Indexed: 11/12/2022] Open
Abstract
This paper describes the case of a patient with a high-grade spindle sarcoma in the right ventricle. The patient underwent total cardiectomy followed by the implantation of a total artificial heart. The patient had an uneventful postoperative course and remained tumour-free for 12 months; after that time period she underwent a heart transplant.
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Affiliation(s)
- Hassiba Smail
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Maria Monteagudo-Vela
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ulrich Stock
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Andre Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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7
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Monteagudo-Vela M, Panoulas V, Riesgo-Gil F, Simon A. Surgical explant of a right ventricular assist device with sternum-sparing technique. Eur J Cardiothorac Surg 2019; 58:193-195. [DOI: 10.1093/ejcts/ezz352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
The use of long-term mechanical assist devices for isolated right ventricular failure is rare. Herein, we describe our protocol for successful recovery of the right ventricle and subsequent explantation of a right ventricular assist device using a sternum-sparing technique and insertion of a titanium plug to occlude the coring defect of the inflow cannula.
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Affiliation(s)
- Maria Monteagudo-Vela
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Vasileios Panoulas
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Fernando Riesgo-Gil
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Andre Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
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Monteagudo-Vela M, Panoulas V, Fernandez-Garda R, Garcia-Saez D, Simon A. Combined Use of Left Ventricular Assist Device, Extra Corporeal Life Support and Impella RP. Cardiovasc Revasc Med 2019; 20:67-69. [PMID: 31526659 DOI: 10.1016/j.carrev.2019.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/04/2019] [Accepted: 09/05/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Maria Monteagudo-Vela
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlessex, UK.
| | - Vasileios Panoulas
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlessex, UK
| | - Rita Fernandez-Garda
- Department of Intensive Care, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlessex, UK
| | - Diana Garcia-Saez
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlessex, UK
| | - Andre Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlessex, UK
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Benedetti G, Mohite P, Smail H, Garcia Saez D, Patil N, Husain M, Jothidasan A, Monteagudo-Vela M, Hassan H, Riesgo Gil F, Dar O, Mahesh B, Banner N, Simon A. Long-Term Follow up and Predicting Factors of de Novo Aortic Regurgitation after LVAD Implantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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