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Tietz F, Weidel A, Dashkevich A, Borger M, Thiele H, Rommel KP. Metastatic Penile Squamous Cell Carcinoma: Unmasked by an Acute Myocardial Infarction and Terminal Heart Failure. JACC Case Rep 2024; 29:102350. [PMID: 38680131 PMCID: PMC11046683 DOI: 10.1016/j.jaccas.2024.102350] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 05/01/2024]
Abstract
A young patient, recently treated for squamous cell penile carcinoma, presented with acute myocardial infarction and severe heart failure. Despite repeatedly ruling out metastatic disease on imaging, surgery for a mechanical assist device revealed unexpected squamous cell metastasis in the pericardium. Consequently, palliative care was initiated.
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Affiliation(s)
- Franziska Tietz
- Department of Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Alexey Dashkevich
- Department of Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Karl-Philipp Rommel
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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2
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Moreno PR, Fuster V. JACC Focus Seminar on Mechanical Complications of Acute Myocardial Infarction. J Am Coll Cardiol 2024; 83:1775-1778. [PMID: 38561163 DOI: 10.1016/j.jacc.2024.03.414] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Pedro R Moreno
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Valentin Fuster
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Meissner F, Szvetics S, Galbas MC, Russe M, Schibilsky D, Kaier K, Czerny M, Bothe W. Longitudinal cardiac dimensions in patients undergoing LVAD implantation. Artif Organs 2024; 48:550-558. [PMID: 38409825 DOI: 10.1111/aor.14728] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/17/2024] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND In conventional left ventricular assist devices (LVAD), a separate outflow graft is sutured to the ascending aorta. Novel device designs may include a transventricular outflow cannula crossing the aortic valve (AV). While transversal ventricular dimensions are well investigated in patients with severe heart failure, little is known about the longitudinal dimensions. These dimensions are, however, particularly critical for the design and development of mechanical circulatory support (MCS) devices with transaortic outflow cannula. METHODS In an explorative retrospective cohort study at the University Medical Center Freiburg, Germany, the longitudinal cardiac dimensions of patients undergoing computed tomography angiography (CTA) before and, if available, after LVAD implantation were analyzed. Among others, the following dimensions were assessed: (a) apex to AV, (b) apex to mitral valve, (c) AV to sinotubular junction (STJ), (d) apex to STJ, (e) apex to brachiocephalic artery (BCA), and (f) AV to BCA. RESULTS In total, 44 LVAD patients (36 male, age 55.8 years, height 1.75 m) were included. The longitudinal cardiac dimensions were (a) 114.5 ± 12.1 mm, (b) 108.0 ± 12.4 mm, (c) 20.9 ± 2.9, (d) 135.4 ± 13.4 mm, (e) 206.0 ± 18.3, and (f) 91.5 ± 9.8 mm. Postoperatively, (a) and (b) decreased by 31.5% and 39.5%, respectively (N = 14). CONCLUSIONS Longitudinal cardiac dimensions may be reduced by up to 40% after LVAD implantation. A better knowledge of these dimensions and their postoperative alterations in LVAD patients may improve surgical planning and help to design MCS devices with transventricular outflow cannula.
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Affiliation(s)
- Florian Meissner
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sophie Szvetics
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michelle Costa Galbas
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Russe
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David Schibilsky
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Bothe
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Silvestry S, Leacche M, Meyer DM, Shudo Y, Kawabori M, Mahesh B, Zuckermann A, D’Alessandro D, Schroder J. Outcomes in Heart Transplant Recipients by Bridge to Transplant Strategy When Using the SherpaPak Cardiac Transport System. ASAIO J 2024; 70:388-395. [PMID: 38300893 PMCID: PMC11057488 DOI: 10.1097/mat.0000000000002137] [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] [Indexed: 02/03/2024] Open
Abstract
The last several years have seen a rise in use of mechanical circulatory support (MCS) to bridge heart transplant recipients. A controlled hypothermic organ preservation system, the SherpaPak Cardiac Transport System (SCTS), was introduced in 2018 and has grown in utilization with reports of improved posttransplant outcomes. The Global Utilization And Registry Database for Improved heArt preservatioN (GUARDIAN)-Heart registry is an international, multicenter registry assessing outcomes after transplant using the SCTS. This analysis examines outcomes in recipients bridged with various MCS devices in the GUARDIAN-Heart Registry. A total of 422 recipients with donor hearts transported using SCTS were included and identified. Durable ventricular assist devices (VADs) were used exclusively in 179 recipients, temporary VADs or intra-aortic balloon pump (IABP) in 197, and extracorporeal membrane oxygenation (ECMO) in 14 recipients. Average ischemic times were over 3.5 hours in all cohorts. Severe primary graft dysfunction (PGD) posttransplant increased across groups (4.5% VAD, 5.1% temporary support, 21.4% ECMO), whereas intensive care unit (ICU) length of stay (18.2 days) and total hospital stay (39.4 days) was longer in the ECMO cohort than the VAD and IABP groups. A comparison of outcomes of MCS bridging in SCTS versus traditional ice revealed significantly lower rates of both moderate/severe right ventricular (RV) dysfunction and severe PGD in the SCTS cohort; however, upon propensity matching only the reductions in moderate/severe RV dysfunction were statistically significant. Use of SCTS in transplant recipients with various bridging strategies results in excellent outcomes.
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Affiliation(s)
- Scott Silvestry
- From the Department of Cardiothoracic Surgery, AdventHealth Transplant Institute, Orlando, Florida
| | - Marzia Leacche
- Division of Cardiothoracic Surgery, Corewell Health (Formerly Spectrum Health), Grand Rapids, Michigan
| | - Dan M. Meyer
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Masashi Kawabori
- Cardiovascular Center, Department of Surgery, Tufts Medical Center, Boston Massachusetts
| | - Balakrishnan Mahesh
- Division of Cardiac Surgery, Heart & Vascular Institute, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Andreas Zuckermann
- Department for Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - David D’Alessandro
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Jacob Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
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VanderPluym CJ. The power of "it will be okay". Pediatr Transplant 2024; 28:e14710. [PMID: 38553813 DOI: 10.1111/petr.14710] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 04/02/2024]
Abstract
As caregivers for critically ill children and their families, there are moments when we find ourselves unsure of how best to offer support. The magnitude of the medical experience can cloud our communication with patients and their families. With years of counseling families through some of their most challenging and darkest hours, I aim to emphasize the profound impact of thoughtful and well-informed reassurance; how we can provide hope in hopeless situations.
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Affiliation(s)
- Christina J VanderPluym
- Department of Cardiology, Boston Children's Hospital, Harvard School of Medicine, Boston, Massachusetts, USA
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Ashraf H, Patel M, Armas ISD, Jumean M. Ventriculo-arterial uncoupling with an impella assisted HVAD: The p-D LVAD. Catheter Cardiovasc Interv 2024. [PMID: 38648353 DOI: 10.1002/ccd.31043] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 03/06/2024] [Accepted: 03/31/2024] [Indexed: 04/25/2024]
Abstract
This paper presents the novel use of a temporary percutaneous ventricular assist device (pVAD) in a 51-year-old man with an implanted durable left ventricular assist device (d-LVAD). The pre-existing left ventricular assist device was unable to successfully unload the left ventricle, and the addition of the temporary pVAD achieved successful unloading as well as a decrease in pulmonary artery pressures without compromising the function of the right ventricle allowing safe UNOS listing for orthotopic heart transplantation.
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Affiliation(s)
- Hassan Ashraf
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Manish Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ismael Salas De Armas
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Marwan Jumean
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Nair RM, Kumar S, Saleem T, Lee R, Higgins A, Khot UN, Reed GW, Menon V. Impact of Age, Gender, and Body Mass Index on Short-Term Outcomes of Patients With Cardiogenic Shock on Mechanical Circulatory Support. Am J Cardiol 2024; 217:119-126. [PMID: 38382702 DOI: 10.1016/j.amjcard.2024.01.030] [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: 09/16/2023] [Revised: 01/08/2024] [Accepted: 01/19/2024] [Indexed: 02/23/2024]
Abstract
This single-center, observational study assessed the impact of age, gender, and body mass index (BMI) in patients with cardiogenic shock (CS) on temporary mechanical circulatory support. All adult patients admitted to the Cleveland Clinic main campus Cardiac Intensive Care Unit (CICU) between December 1, 2015, to December 31, 2019, CICU with CS necessitating mechanical circulatory support (MCS) with intra-aortic balloon pump, Impella, or venous arterial-extra corporeal membrane oxygenation were retrospectively analyzed for this study. Baseline characteristics and 30-day outcomes were collected through physician-directed chart review. The impact of age, gender, and BMI on 30-day mortality was assessed using multivariable logistic regression. Kaplan-Meier survival curves were used to analyze the survival difference in specific subsets. A total of 393 patients with CS on temporary MCS were admitted to our CICU during the study period. The median age of our cohort was 63 years (interquartile range 54 to 70 years), median BMI was 28.50 kg/m2 (interquartile range 24.62 to 29.72) and 70% (n = 276) were men. In total, 22 patients >80 years had received MCS compared with 372 patients <80 years. Patients >80 years on MCS had significantly higher 30-day mortality compared with those <80 years (81.8% vs 49.3%, p = 0.006). Upon stratifying patients by BMI, 161 (41%) patients were found to have BMI ≥30 kg/m2 whereas 232 (59%) patients had BMI <30 kg/m2. Comparison of 30-day mortality revealed that patients with BMI ≥30 did significantly worse than patients with BMI <30 (59.6% vs 45.3%, p = 0.007). There was no difference in 30-day mortality between men and women. On multivariable logistic regression, both age and BMI had a positive linear relation with adjusted 30-day mortality whereas gender did not have a major effect. Advanced age and higher BMI are independently associated with worse outcomes in patients with CS on MCS. Utilizing a strict selection criterion for patients in CS is pertinent to derive the maximum benefit from advanced mechanical support.
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Affiliation(s)
- Raunak M Nair
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sachin Kumar
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Talha Saleem
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ran Lee
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andrew Higgins
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Umesh N Khot
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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Hanuna M, Herz G, Stanzl AL, Li Y, Mueller CS, Kamla CE, Scherer C, Wassilowsky D, Juchem G, Orban M, Peterss S, Hagl C, Joskowiak D. Mid-Term Outcome after Extracorporeal Life Support in Postcardiotomy Cardiogenic Shock: Recovery and Quality of Life. J Clin Med 2024; 13:2254. [PMID: 38673527 PMCID: PMC11050874 DOI: 10.3390/jcm13082254] [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: 02/27/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Extracorporeal life support (ECLS) therapy for refractory postcardiotomy cardiogenic shock (rPCS) is associated with high early mortality rates. This study aimed to identify negative predictors of mid-term survival and to assess health-related quality of life (HRQoL) and recovery of the survivors. Methods: Between 2017 and 2020, 142 consecutive patients received ECLS therapy following cardiac surgery. The median age was 66.0 [57.0-73.0] years, 67.6% were male and the median EuroSCORE II was 10.5% [4.2-21.3]. In 48 patients, HRQoL was examined using the 36-Item Short Form Survey (SF-36) and the modified Rankin-Scale (mRS) at a median follow-up time of 2.2 [1.9-3.2] years. Results: Estimated survival rates at 3, 12, 24 and 36 months were 47%, 46%, 43% and 43% (SE: 4%). Multivariable Cox Proportional Hazard regression analysis revealed preoperative EuroSCORE II (p = 0.013), impaired renal function (p = 0.010), cardiopulmonary bypass duration (p = 0.015) and pre-ECLS lactate levels (p = 0.004) as independent predictors of mid-term mortality. At the time of follow-up, 83.3% of the survivors were free of moderate to severe disability (mRS < 3). SF-36 analysis showed a physical component summary of 45.5 ± 10.2 and a mental component summary of 50.6 ± 12.5. Conclusions: Considering the disease to be treated, ECLS for rPCS is associated with acceptable mid-term survival, health-related quality of life and functional status. Preoperative EuroSCORE II, impaired renal function, cardiopulmonary bypass duration and lactate levels prior to ECLS implantation were identified as negative predictors and should be included in the decision-making process.
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Affiliation(s)
- Maja Hanuna
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
| | - German Herz
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
| | - Andre L. Stanzl
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
| | - Yupeng Li
- Department of Political Science and Economics, Rowan University, Glassboro, NJ 08028, USA
| | - Christoph S. Mueller
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
| | - Christine E. Kamla
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
| | - Clemens Scherer
- Department of Cardiology, LMU University Hospital, 81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Dietmar Wassilowsky
- Department of Anaesthesiology, LMU University Hospital, 81377 Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
| | - Martin Orban
- Department of Cardiology, LMU University Hospital, 81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
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den Haan MC, Palmen M, Egorova AD, Hazekamp MG. Glenn shunt as a rescue strategy for acute right ventricular failure after right ventricular myocardial infarction. Eur J Cardiothorac Surg 2024:ezae157. [PMID: 38603625 DOI: 10.1093/ejcts/ezae157] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/31/2024] [Accepted: 04/10/2024] [Indexed: 04/13/2024] Open
Abstract
We present a case of a 52-year old woman with cardiogenic shock (CS) with refractory right ventricular (RV) failure due to spontaneous dissection of the right coronary artery (RCA). She remained dependent on mechanical support for several weeks and both RV assist device (RVAD) implantation and bidirectional cavopulmonary anastomosis (BCPA) were explored as long-term support options. History of malignancy and possible RV functional recovery resulted in a decision in favour of BCPA and concomitant tricuspid valve (TV) annuloplasty. Postoperatively her clinical condition improved significantly and she could be discharged home. Echocardiography showed normalization of RV dimensions and slight improvement of RV function.
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Affiliation(s)
- Melina C den Haan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Meindert Palmen
- Department of Cardiothoracic surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Anastasia D Egorova
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic surgery, Leiden University Medical Center, Leiden, Netherlands
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands
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Gupta K, Lemor A, Alkhatib A, McBride P, Cowger J, Grafton G, Alaswad K, O'Neill W, Villablanca P, Basir MB. Use of percutaneous mechanical circulatory support for right ventricular failure. Catheter Cardiovasc Interv 2024. [PMID: 38584525 DOI: 10.1002/ccd.31018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/24/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Utilization of right ventricular mechanical circulatory support (RV-MCS) devices has been limited by a lack of recognition of RV failure as well as a lack of availability and experience with RV-MCS. AIMS We report a single-center experience with the use of percutaneous RV-MCS and report predictors of adverse outcomes. METHODS This was a single-center retrospective cohort study. Data from consecutive patients who received RV-MCS for any indication between June 2015 and January 2022 were included. Data on baseline comorbidities, hemodynamics, and laboratory values were collected. The primary outcome was in-hospital mortality analyzed as a logistic outcome in a multivariable model. These variables were further ranked by their predictive value. RESULTS Among 58 consecutive patients enrolled, the median age was 66 years, 31% were female and 53% were white. The majority of the patients (48%) were hospitalized for acute on chronic heart failure. The majority of the patients were SCAI SHOCK Stage D (67%) and 34 (64%) patients had MCS placed within 24 h of the onset of shock. Before placement of RV-MCS, median central venous pressure (CVP) and RV stroke work index were 20 mmHg and 8.9 g m/m2, respectively. Median serum lactate was 3.5 (1.6, 6.2) mmol/L. Impella RP was implanted in 50% and ProtekDuo in the remaining 50%. Left ventricular MCS was concomitantly used in 66% of patients. Twenty-eight patients (48.3%) died. In these patients, median serum lactate was significantly higher (4.1 [2.3, 13.0] vs. 2.2 [1.4, 4.0] mmol/L, p = 0.007) and a trend toward higher median CVP (24 [18, 31] vs. 19 [14, 24] mmHg, p = 0.052). In the multivariable logistic model, both serum lactate and CVP before RV-MCS placement were independent predictors of in-hospital mortality. Serum lactate had the highest predictive value. CONCLUSION In our real-world cohort, 52% of patients treated with RV-MCS survived their index hospitalization. Serum lactate at presentation and CVP were the strongest predictors of in-hospital mortality.
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Affiliation(s)
- Kartik Gupta
- Division of Cardiovascular Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Alejandro Lemor
- Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ahmad Alkhatib
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Patrick McBride
- Division of General Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jennifer Cowger
- Division of Cardiovascular Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Gillian Grafton
- Division of Cardiovascular Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Khaldoon Alaswad
- Division of Cardiovascular Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - William O'Neill
- Division of Cardiovascular Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Pedro Villablanca
- Division of Cardiovascular Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mir B Basir
- Division of Cardiovascular Diseases, Henry Ford Hospital, Detroit, Michigan, USA
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Vaikunth SS, Ortega-Legaspi JM, Conrad DR, Chen S, Daugherty T, Haeffele CL, Teuteberg J, Mclean R, MacArthur JW, Woo YJ, Maeda K, Ma M, Nasirov T, Hoteit M, Hilscher MB, Wald J, Mandelbaum T, Olthoff KM, Abt PL, Atluri P, Cevasco M, Mavroudis CD, Fuller S, Lui GK, Kim YY. Mortality and morbidity after combined heart and liver transplantation in the failing Fontan: An updated dual center retrospective study. Clin Transplant 2024; 38:e15302. [PMID: 38567883 DOI: 10.1111/ctr.15302] [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: 10/25/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION As the adult Fontan population with Fontan associated liver disease continues to increase, more patients are being referred for transplantation, including combined heart and liver transplantation. METHODS We report updated mortality and morbidity outcomes after combined heart and liver transplant in a retrospective cohort series of 40 patients (age 14 to 49 years) with Fontan circulation across two centers from 2006-2022. RESULTS The 30-day, 1-year, 5-year and 10-year survival rate was 90%, 80%, 73% and 73% respectively. Sixty percent of patients met a composite comorbidity of needing either post-transplant mechanical circulatory support, renal replacement therapy or tracheostomy. Cardiopulmonary bypass time > 283 min (4.7 h) and meeting the composite comorbidity were associated with mortality by Kaplan Meier analysis. CONCLUSION Further study to mitigate early mortality and the above comorbidities as well as the high risk of bleeding and vasoplegia in this patient population is warranted.
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Affiliation(s)
- Sumeet S Vaikunth
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Juan M Ortega-Legaspi
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Desiree R Conrad
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sharon Chen
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Tami Daugherty
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Christiane L Haeffele
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jeffrey Teuteberg
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Rhondalynn Mclean
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John W MacArthur
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Katsuhide Maeda
- Division of Cardiac Surgery, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael Ma
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Teimour Nasirov
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Marrouf Hoteit
- Division of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Moira B Hilscher
- Division of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joyce Wald
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tal Mandelbaum
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kim M Olthoff
- Division of Transplant Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter L Abt
- Division of Transplant Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marisa Cevasco
- Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Constantine D Mavroudis
- Division of Cardiac Surgery, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Stephanie Fuller
- Division of Cardiac Surgery, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - George K Lui
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Yuli Y Kim
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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12
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Wang W, Feng Y, Lin X, Wu X, Chen G, Ma R, Guan X. Massive post-infarction ventricular septal rupture complicaing cardiogenic shock with long term veno-arterial extracorporeal membrane oxygenation support. Perfusion 2024; 39:603-606. [PMID: 36541675 DOI: 10.1177/02676591221147426] [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] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is a rare but serious complication often causing cardiogenic shock (CS). The timing of surgery is a difficult problem for surgeons because of high mortality and surgical complexity. We present a case of successful use of extracorporeal membrane oxygenation (ECMO) for maintaining haemodynamic stability preoperative and delaying surgical repair of VSR patient in severe CS. CASE REPORT A 57-year-old man with AMI complicated by severe CS due to an massive VSR. Emergency surgery was considered a too high mortality risk. The patient was implanted with a percutaneous veno-arterial ECMO (VA-ECMO) system as a bridge to surgery for stabilizing general condition. On the 31th day after ECMO implantation, the ventricular septal defect was successfully repaired and weaning from the ECMO. DISCUSSION This case study illustrates that it may be considered to use long term ECMO preoperative to delayed surgery which leads to higher survival in cases of massive VSR patient after AMI in hemodynamically compromised patients. Still the optimal duration of mechanical circulatory support and the optimal timing for surgery need more research to define. CONCLUSION This case indicates the feasibility of preoperative using of a long term VA-ECMO as a bridge to surgical repair of VSR patient after AMI in severe CS. The optimal duration of mechanical circulatory support and the optimal timing for surgery still require further investigation.
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Affiliation(s)
- Wei Wang
- Department of Cardiopulmonary Bypass, Lanzhou University Second Hospital, Lanzhou, China
| | - Ying Feng
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Xin Lin
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Xiangyang Wu
- Department of Cardiovascular Surgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Gang Chen
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Ruchao Ma
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Xinqiang Guan
- Department of Cardiovascular Surgery, Lanzhou University Second Hospital, Lanzhou, China
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13
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Grewal J, Tripathi N, Bortner B, Gregoski MJ, Cook D, Britt A, Hajj J, Rofael M, Sheidu M, Montovano MJ, Mehta M, Hajduczok AG, Rajapreyar IN, Brailovsky Y, Genuardi MV, Kanwar MK, Atluri P, Lander M, Shah P, Hsu S, Kilic A, Houston BA, Mehra MR, Sheikh FH, Tedford RJ. A multicenter evaluation of the HeartMate 3 risk score. J Heart Lung Transplant 2024; 43:626-632. [PMID: 38061468 DOI: 10.1016/j.healun.2023.11.018] [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: 07/16/2023] [Revised: 11/16/2023] [Accepted: 11/30/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND The Heartmate 3 (HM3) risk score (HM3RS) was derived and validated internally from within the Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 (MOMENTUM 3) trial population and provides 1- and 2-year mortality risk prediction for patients in those before HM3 left ventricular assist device (LVAD) implantation. We aimed to evaluate the HM3RS in nontrial unselected patients, including those not meeting inclusion criteria for MOMENTUM 3 trial enrollment. METHODS Patients who underwent HM3 LVAD implant at 1 of 7 US centers between 2017 and 2021, with at least 1-year follow-up, were included in this analysis. Patients were retrospectively assessed for their eligibility for the MOMENTUM 3 trial based on study inclusion and exclusion criteria. HM3RS risk discrimination was evaluated using time-dependent receiver operating characteristic curve analysis for 1-year mortality for all patients and further stratified by MOMENTUM 3 trial eligibility. Kaplan-Meier curves were constructed using the HM3RS-based risk categories. RESULTS Of 521 patients included in the analysis, 266 (51.1%) would have met enrollment criteria for MOMENTUM 3. The 1- and 2-year survival for the total cohort was 85% and 81%, respectively. There was no statistically significant difference in survival between those who met and did not meet enrollment criteria at 1 (87% vs 83%; p = 0.21) and 2 years postimplant (80% vs 78%; p = 0.39). For the total cohort, HM3RS predicted 1-year survival with an area under the curve (AUC) of 0.63 (95% confidence interval [CI]: 0.57-0.69, p < 0.001). HM3RS performed better in the subset of patients meeting enrollment criteria: AUC 0.69 (95% CI:0.61-0.77, p < 0.001) compared to the subset that did not: AUC 0.58 (95% CI: 0.49-0.66, p = 0.078). CONCLUSIONS In this real-world evidence, multicenter cohort, 1- and 2-year survival after commercial HM3 LVAD implant was excellent, regardless of trial eligibility. The HM3RS provided adequate risk discrimination in "trial-like" patients, but predictive value was reduced in patients who did not meet trial criteria.
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Affiliation(s)
- Jagpreet Grewal
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Neeta Tripathi
- MedStar Heart and Vascular Institute/Georgetown University School of Medicine, Washington, DC
| | - Ben Bortner
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Mathew J Gregoski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel Cook
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Annie Britt
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer Hajj
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Michael Rofael
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Mariyam Sheidu
- Advanced Heart Failure, MCS and Transplant, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Margaret J Montovano
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mili Mehta
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander G Hajduczok
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Indranee N Rajapreyar
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yevgeniy Brailovsky
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael V Genuardi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Manreet K Kanwar
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Pavan Atluri
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Lander
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Palak Shah
- Advanced Heart Failure, MCS and Transplant, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Arman Kilic
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Brian A Houston
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Mandeep R Mehra
- Center for Advanced Heart Disease, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Farooq H Sheikh
- MedStar Heart and Vascular Institute/Georgetown University School of Medicine, Washington, DC
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
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14
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Petty K, Daubenspeck D. Rescue ECMO for Isolated Right Ventricular Dysfunction in a Trauma Patient. J Cardiothorac Vasc Anesth 2024; 38:1031-1036. [PMID: 38105124 DOI: 10.1053/j.jvca.2023.10.040] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Kyle Petty
- University of Chicago, Department of Anesthesia and Critical Care, 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637.
| | - Danisa Daubenspeck
- Assistant Professor of Anesthesia and Critical Care, University of Chicago, Department of Anesthesia and Critical Care, 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637.
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15
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Ivanov Y, Buratto E, Konstantinov IE, Clifford M, Brizard CP, Horton S. Clinical assessment can be lifesaving: Salvage of catastrophic cerebral ischemia by conversion to central extracorporeal membrane oxygenation. Perfusion 2024; 39:612-614. [PMID: 36751733 DOI: 10.1177/02676591221148045] [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] [Indexed: 02/09/2023]
Abstract
Peripheral veno-artertial extracorporeal membrane oxygenation (VA-ECMO) is commonly used in the paediatric population for intractable respiratory and cardiac failure. One of the devastating complications of VA-ECMO is severe brain damage due to ischemia or haemorrhage. We describe a case of peripheral cervical VA-ECMO complicated by evolving right cerebral ischemia which was rescued with rapid conversion from peripheral to central VA-ECMO support. Notably, the patient had a complete circle of Willis. Following conversion, we observed complete resolution of neurological symptoms with full functional recovery.
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Affiliation(s)
- Yaroslav Ivanov
- Department of Cardiac Surgery, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Heart Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Heart Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, VIC, Australia
| | - Michel Clifford
- Department of Intensive Care Medicine, Royal Children's Hospital, Parkville, VIC, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Heart Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Stephen Horton
- Department of Cardiac Surgery, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Heart Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Perfusion, Royal Children's Hospital, Melbourne, VIC, Australia
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16
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Cho J, Tunuguntla HP, Tume SC, Spinner JA, Bocchini CE, Teruya J, Heinle JS, Hickey EJ, Adachi I. Long-term implantable ventricular assist device support in children. J Thorac Cardiovasc Surg 2024; 167:1417-1426.e1. [PMID: 37913838 DOI: 10.1016/j.jtcvs.2023.10.048] [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: 06/28/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND In pediatrics, implantable continuous-flow ventricular assist devices (IC-VAD) are often used as a "temporary" support, bridging children to cardiac transplantation during the same hospital admission. METHODS We conducted a retrospective review of our consecutive patients undergoing IC-VAD support at a tertiary pediatric heart center between 2008 and 2022. RESULTS We identified 100 IC-VAD implant encounters: HeartWare HVAD (67; 67%), HeartMate II (17; 17%), and HeartMate 3 (16; 16%). The median (range) age, weight, and body surface area at implantation were 14.1 (3.0-56.5) years, 54.8 (13.3-140) kg, and 1.6 (0.6-2.6) m2, respectively. Cardiomyopathy (58; 58%) was the most common etiology, followed by congenital heart disease (37; 37%, including 13 single ventricle). At 6 months of IC-VAD support, 94 (94%) encounters achieved positive outcomes: ongoing support (59; 59%), transplant (33; 33%), and cardiac recovery (2; 2%). Eighty-two encounters (82%) resulted in home discharge with ongoing VAD support, including 38 (46%, out of 82) requiring readmission and 7 (9%, out of 82) resulting in death. There was a clinically significant decrease in morbidity rates before versus after home discharge: bleeding (1.55 vs 0.06), infection (0.84 vs 0.37), and stroke (0.84 vs 0.15 event per patient-year). Overall, 86 encounters (86%) reached positive end points at the latest follow-up (64 transplant, 15 ongoing support, and 7 recovery). Infection (29%; 4 of 14) was the most common cause of negative outcomes, followed by cerebrovascular accident (21%; 3), and unresolved frailty (21%; 3). The estimated overall survival at 1, 2, and 5 years was 90%, 86%, and 77%, respectively. CONCLUSIONS This study suggests the feasibility of outpatient management of pediatric IC-VAD support. The ability to offer true long-term support maximizes the potential of IC-VAD support, not limited to a temporary bridging tool for heart transplantation.
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Affiliation(s)
- Junsang Cho
- Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Hari P Tunuguntla
- Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Sebastian C Tume
- Pediatric Critical Care, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Joseph A Spinner
- Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Claire E Bocchini
- Pediatric Infectious Disease, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Jun Teruya
- Pathology & Immunology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Jeffrey S Heinle
- Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Edward J Hickey
- Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Iki Adachi
- Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
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17
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Garmany A, Inglis SS, Behfar A, Rosenbaum AN. Biventricular catheterization combined with pressure-volume loop monitoring provides insight into the dynamic effects of left ventricular assist devices ramp on right ventricular function. Catheter Cardiovasc Interv 2024; 103:799-802. [PMID: 38461378 PMCID: PMC11037112 DOI: 10.1002/ccd.30993] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/11/2024]
Abstract
Ramp studies are utilized for speed optimization of continuous flow left ventricular assist devices (CF-LVADs). We here report the utility of combined left and right heart catheterization during a ramp study to ensure a comprehensive understanding of the hemodynamic implications on both ventricles. Pressure-volume loop (PV loop) monitoring uncovered compromised systolic and mildly compromised right ventricular function with increasing LVAD speeds, despite improvement in left ventricular unloading. These findings informed patient management and highlight the potential utility of PV loop monitoring as an adjunct to left and right heart catheterization during ramp studies of next-generation LVADs.
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Affiliation(s)
- Armin Garmany
- Graduate School of Biomedical Sciences, Alix School of Medicine, Medical Scientist Training Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Sara S. Inglis
- Department of Cardiovascular Medicine, Division of Circulatory Failure, Mayo Clinic, Rochester, Minnesota
- VanCleve Cardiac Regenerative Medicine Program and Fong Chao Foundation, Center for Regenerative Medicine, Mayo Clinic Rochester MN
| | - Atta Behfar
- Department of Cardiovascular Medicine, Division of Circulatory Failure, Mayo Clinic, Rochester, Minnesota
- William J von Liebig Center for Transplantation and Clinical Regeneration. Mayo Clinic, Rochester, Minnesota
- VanCleve Cardiac Regenerative Medicine Program and Fong Chao Foundation, Center for Regenerative Medicine, Mayo Clinic Rochester MN
| | - Andrew N. Rosenbaum
- Department of Cardiovascular Medicine, Division of Circulatory Failure, Mayo Clinic, Rochester, Minnesota
- VanCleve Cardiac Regenerative Medicine Program and Fong Chao Foundation, Center for Regenerative Medicine, Mayo Clinic Rochester MN
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18
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Bilchenko AO, Gritsenko OV, Kolisnyk VO, Rafalyuk OI, Pyzhevskii AV, Myzak YV, Besh DI, Salo VM, Chaichuk SO, Lehoida MO, Danylchuk IV, Polivenok IV. Acute myocardial infarction complicated by cardiogenic shock in Ukraine: multicentre registry analysis 2021-2022. Front Cardiovasc Med 2024; 11:1377969. [PMID: 38606380 PMCID: PMC11007039 DOI: 10.3389/fcvm.2024.1377969] [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: 01/28/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Background Data on the results and management strategies in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) in the Low and Lower-Middle Income Countries (LLMICs) are limited. This lack of understanding of the situation partially hinders the development of effective cardiogenic shock treatment programs in this part of the world. Materials and methods The Ukrainian Multicentre Cardiogenic Shock Registry was analyzed, covering patient data from 2021 to 2022 in 6 major Ukrainian reperfusion centres from different parts of the country. Analysis was focusing on outcomes, therapeutic modalities and mortality predictors in AMI-CS patients. Results We analyzed data from 221 consecutive patients with CS from 6 hospitals across Ukraine. The causes of CS were ST-elevated myocardial infarction (85.1%), non-ST-elevated myocardial infarction (5.9%), decompensated chronic heart failure (7.7%) and arrhythmia (1.3%), with a total in-hospital mortality rate for CS of 57.1%. The prevalence of CS was 6.3% of all AMI with reperfusion rate of 90.5% for AMI-CS. In 23.5% of cases, CS developed in the hospital after admission. Mechanical circulatory support (MCS) utilization was 19.9% using intra-aortic balloon pump alone. Left main stem occlusion, reperfusion deterioration, Charlson Comorbidity Index >4, and cardiac arrest were found to be independent predictors for hospital mortality in AMI-СS. Conclusions Despite the wide adoption of primary percutaneous coronary intervention as the main reperfusion strategy for AMI, СS remains a significant problem in LLMICs, associated with high in-hospital mortality. There is an unmet need for the development and implementation of a nationwide protocol for CS management and the creation of reference CS centers based on the country-wide reperfusion network, equipped with modern technologies for MCS.
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Affiliation(s)
- Anton O. Bilchenko
- Department of Prevention and Treatment of Emergency Conditions, L.T. Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
| | - Olga V. Gritsenko
- Department of Interventional Cardiology, V.T. Zaitcev Institute of General and Urgent Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
| | | | - Oleg I. Rafalyuk
- Department of Interventional Radiology, Lviv Regional Clinical Treatment and Diagnostic Cardiology Center, Lviv, Ukraine
| | - Andrii V. Pyzhevskii
- Department of Interventional Radiology, Lviv Regional Clinical Treatment and Diagnostic Cardiology Center, Lviv, Ukraine
| | - Yaroslav V. Myzak
- Department of Interventional Radiology, 1st Territorial Medical Union, Lviv, Ukraine
| | - Dmytro I. Besh
- Department of Interventional Radiology, 1st Territorial Medical Union, Lviv, Ukraine
- Department of Family Medicine, Danylo Halytsky National Medical University, Lviv, Ukraine
| | - Victor M. Salo
- Department of Interventional Radiology, 1st Territorial Medical Union, Lviv, Ukraine
| | - Sergii O. Chaichuk
- Department of Interventional Cardiology, Oleksandrivska Clinical Hospital, Kyiv, Ukraine
| | - Mykhailo O. Lehoida
- Department of Cardiology, Vinnytsia Regional Clinical Treatment and Diagnostic Center of Cardiovascular Pathology, Vinnytsia, Ukraine
| | - Ihor V. Danylchuk
- Department of Cardiology, Vinnytsia Regional Clinical Treatment and Diagnostic Center of Cardiovascular Pathology, Vinnytsia, Ukraine
| | - Ihor V. Polivenok
- Department of Interventional Cardiology, V.T. Zaitcev Institute of General and Urgent Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
- Department of Therapy No 1, Kharkiv National Medical University, Kharkiv, Ukraine
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19
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Van Edom CJ, Swol J, Castelein T, Gramegna M, Huber K, Leonardi S, Mueller T, Pappalardo F, Price S, Schaubroeck H, Schrage B, Tavazzi G, Vercaemst L, Vranckx P, Vandenbriele C. European practices on antithrombotic management during percutaneous mechanical circulatory support in adults: A survey of the Association for Acute CardioVascular Care (ACVC) of the ESC and the European branch of the Extracorporeal Life Support Organization (EuroELSO). Eur Heart J Acute Cardiovasc Care 2024:zuae040. [PMID: 38529950 DOI: 10.1093/ehjacc/zuae040] [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] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Bleeding and thrombotic complications compromise outcomes in patients undergoing percutaneous mechanical circulatory support (pMCS) with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and/or microaxial flow pumps like the Impella™. Antithrombotic practices are an important determinant of the coagulopathic risk, but standardization in the antithrombotic management during pMCS is lacking. This survey outlines European practices in antithrombotic management in adults on pMCS, making an initial effort to standardize practices, inform future trials, and enhance outcomes. METHODS This online cross-sectional survey was distributed through digital newsletters and social media platforms by the Association of Acute Cardiovascular Care and the European branch of the Extracorporeal Life Support Organization. The survey was available from April 17th to May 23rd, 2023. The target population were European clinicians involved in care for adults on pMCS. RESULTS We included 105 responses from 26 European countries. Notably, 72.4% of the respondents adhered to locally established anticoagulation protocols, with unfractionated heparin (UFH) being the predominant anticoagulant (Impella™: 97.0% and V-A ECMO: 96.1%). A minority, 10.8% and 14.5%, respectively, utilized anti-factor-Xa assay with activated partial thromboplastin time in parallel for UFH monitoring during Impella™ and V-A ECMO support. Anticoagulant targets varied across institutions. Following acute coronary syndrome without percutaneous coronary intervention (PCI), 54.0% and 42.7% administered dual antiplatelet therapy during Impella™ and V-A ECMO support, increasing to 93.7% and 84.0% after PCI. CONCLUSIONS Substantial heterogeneity in antithrombotic practices emerged from participants' responses, potentially contributing to variable device-associated bleeding and thrombotic complications.
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Affiliation(s)
- Charlotte J Van Edom
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Justyna Swol
- Department of Respiratory Medicine, Paracelsus Medical University Nuremberg, Germany
| | - Thomas Castelein
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Mario Gramegna
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital and Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Sergio Leonardi
- Department of Medical Sciences and Infective Disease, University of Pavia and Fondazione, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Thomas Mueller
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Federico Pappalardo
- Department of Anesthesia & Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Susanna Price
- Department of Critical Care, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Hannah Schaubroeck
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- Intensive Care Unit, Fondazione Policlinico San Matteo IRCCS, Pavia, Italy
| | - Leen Vercaemst
- Department of Perfusion, University Hospital Gasthuisberg, Leuven, Belgium
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, and the Faculty of Medicine and Life Sciences, Hasselt University, Hasselt
| | - Christophe Vandenbriele
- Department of Critical Care, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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20
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Zapletal B, Zimpfer D, Schlöglhofer T, Fritzer-Szekeres M, Szekeres T, Bernardi MH, Geilen J, Schultz MJ, Tschernko EM. Hemolysis Index Correlations with Plasma-Free Hemoglobin and Plasma Lactate Dehydrogenase in Critically Ill Patients under Extracorporeal Membrane Oxygenation or Mechanical Circulatory Support-A Single-Center Study. Diagnostics (Basel) 2024; 14:680. [PMID: 38611592 PMCID: PMC11011733 DOI: 10.3390/diagnostics14070680] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
Monitoring for thrombosis and hemolysis is crucial for patients under extracorporeal or mechanical circulatory support, but it can be costly. We investigated correlations between hemolysis index (HI) and plasma-free hemoglobin (PFH) levels on one hand, and between the HI and plasma lactate dehydrogenase (LDH) levels on the other, in critically ill patients with and without extracorporeal or mechanical circulatory support. Additionally, we calculated the cost reductions if monitoring through HI were to replace monitoring through PFH or plasma LDH. In a single-center study, HI was compared with PFH and plasma LDH levels in blood samples taken for routine purposes in critically ill patients with and without extracorporeal or mechanical circulatory support. A cost analysis, restricted to direct costs associated with each measurement, was made for an average 10-bed ICU. This study included 147 patients: 56 patients with extracorporeal or mechanical circulatory support (450 measurements) and 91 patients without extracorporeal or mechanical circulatory support (562 measurements). The HI correlated well with PFH levels (r = 0.96; p < 0.01) and poorly with plasma LDH levels (r = 0.07; p < 0.01) in patients with extracorporeal or mechanical circulatory support. Similarly, HI correlated well with PFH levels (r = 0.97; p < 0.01) and poorly with plasma LDH levels (r = -0.04; p = 0.39) in patients without extracorporeal or mechanical circulatory support. ROC analyses demonstrated a strong performance of HI, with the curve indicating excellent discrimination in the whole cohort (area under the ROC of 0.969) as well as in patients under ECMO or mechanical circulatory support (area under the ROC of 0.988). Although the negative predictive value of HI for predicting PFH levels > 10 mg/dL was high, its positive predictive value was found to be poor at various cutoffs. A simple cost analysis showed substantial cost reduction if HI were to replace PFH or plasma LDH for hemolysis monitoring. In conclusion, in this cohort of critically ill patients with and without extracorporeal or mechanical circulatory support, HI correlated well with PFH levels, but poorly with plasma LDH levels. Given the high correlation and substantial cost reductions, a strategy utilizing HI may be preferable for monitoring for hemolysis compared to monitoring strategies based on PFH or plasma LDH. The PPV of HI, however, is unacceptably low to be used as a diagnostic test.
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Affiliation(s)
- Bernhard Zapletal
- Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria; (B.Z.); (M.H.B.); (J.G.); (E.M.T.)
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (D.Z.); (T.S.)
| | - Thomas Schlöglhofer
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (D.Z.); (T.S.)
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, 1090 Vienna, Austria
| | - Monika Fritzer-Szekeres
- Department of Laboratory Medicine, Medical University Vienna, 1090 Vienna, Austria; (M.F.-S.); (T.S.)
| | - Thomas Szekeres
- Department of Laboratory Medicine, Medical University Vienna, 1090 Vienna, Austria; (M.F.-S.); (T.S.)
| | - Martin H. Bernardi
- Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria; (B.Z.); (M.H.B.); (J.G.); (E.M.T.)
| | - Johannes Geilen
- Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria; (B.Z.); (M.H.B.); (J.G.); (E.M.T.)
| | - Marcus J. Schultz
- Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria; (B.Z.); (M.H.B.); (J.G.); (E.M.T.)
- Department of Intensive Care, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Edda M. Tschernko
- Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria; (B.Z.); (M.H.B.); (J.G.); (E.M.T.)
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21
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Lim HS, González-Costello J, Belohlavek J, Zweck E, Blumer V, Schrage B, Hanff TC. Hemodynamic management of cardiogenic shock in the intensive care unit. J Heart Lung Transplant 2024:S1053-2498(24)01528-6. [PMID: 38518863 DOI: 10.1016/j.healun.2024.03.009] [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: 12/15/2023] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 03/24/2024] Open
Abstract
Hemodynamic derangements are defining features of cardiogenic shock. Randomized clinical trials have examined the efficacy of various therapeutic interventions, from percutaneous coronary intervention to inotropes and mechanical circulatory support (MCS). However, hemodynamic management in cardiogenic shock has not been well-studied. This State-of-the-Art review will provide a framework for hemodynamic management in cardiogenic shock, including a description of the 4 therapeutic phases from initial 'Rescue' to 'Optimization', 'Stabilization' and 'de-Escalation or Exit therapy' (R-O-S-E), phenotyping and phenotype-guided tailoring of pharmacological and MCS support, to achieve hemodynamic and therapeutic goals. Finally, the premises that form the basis for clinical management and the hypotheses for randomized controlled trials will be discussed, with a view to the future direction of cardiogenic shock.
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Affiliation(s)
- Hoong Sern Lim
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - José González-Costello
- Advanced Heart Failure and Heart Transplant Unit, Department of Cardiology, Hospital Universitari de Bellvitge, BIOHEART-Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain; Ciber Cardiovascular (CIBERCV), Instituto Salud Carlos III, Madrid, Spain
| | - Jan Belohlavek
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Elric Zweck
- Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Vanessa Blumer
- Inova Schar Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Benedikt Schrage
- University Heart and Vascular Centre Hamburg, German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Thomas C Hanff
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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22
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Buda KG, Hryniewicz K, Eckman PM, Basir MB, Cowger JA, Alaswad K, Mukundan S, Sandoval Y, Elliott A, Brilakis ES, Megaly MS. Early vs. Delayed Mechanical Circulatory Support in Patients with Acute Myocardial Infarction and Cardiogenic Shock. Eur Heart J Acute Cardiovasc Care 2024:zuae034. [PMID: 38502888 DOI: 10.1093/ehjacc/zuae034] [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] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/12/2024] [Accepted: 03/06/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Despite increased temporary mechanical circulatory support (tMCS) utilization for acute myocardial infarction complicated by cardiogenic shock (AMI-CS), data regarding efficacy and optimal timing for tMCS support are limited. This study aimed to describe outcomes based on tMCS timing in AMI-CS and to identify predictors of 30-day mortality and readmission. METHODS Patients with AMI-CS identified in the National Readmissions Database were grouped according to the use of tMCS and early (<24 hours) vs. delayed (≥24 hours) tMCS. The correlation between tMCS timing and inpatient outcomes was evaluated using linear regression. Multivariate logistic regression was used to identify variables associated with 30-day mortality and readmission. RESULTS Of 294,839 patients with AMI-CS, 109,148 patients were supported with tMCS (8,067 veno-arterial extracorporeal membrane oxygenation, 33,577 Impella, and 79,161 intra-aortic balloon pump). Of patients requiring tMCS, patients who received early tMCS (n = 79,906) had shorter lengths of stay (7 days vs. 15 days, p < 0.001) and lower rates of ischemic and bleeding complications than those with delayed tMCS (n = 32,241). Patients requiring tMCS had higher in-hospital mortality (OR [95% CI]) (1.7 [1.7-1.8], p < 0.001). Among patients requiring tMCS, early support was associated with fewer complications, lower mortality (0.90 [0.85-0.94], p < 0.001), and fewer 30-day readmissions (0.91 [0.85-0.97], p = 0.005) compared to patients with delayed tMCS. CONCLUSION Among patients receiving tMCS for AMI-CS, early tMCS was associated with fewer complications, shorter lengths of stay, lower hospital costs, and fewer deaths and readmissions at 30 days.
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Affiliation(s)
- Kevin G Buda
- Allina Health - Minneapolis Heart Institute, Minneapolis, MN
- Cardiology Division, Department of Internal Medicine, Hennepin Healthcare, Minneapolis, MN
| | | | - Peter M Eckman
- Allina Health - Minneapolis Heart Institute, Minneapolis, MN
| | - Mir B Basir
- Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI
| | | | | | - Srini Mukundan
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Yader Sandoval
- Allina Health - Minneapolis Heart Institute, Minneapolis, MN
- Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, MN
| | - Andrea Elliott
- Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Emmanouil S Brilakis
- Allina Health - Minneapolis Heart Institute, Minneapolis, MN
- Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, MN
| | - Michael S Megaly
- Division of Cardiology, Willis Knighton Heart Institute, Shreveport, LA
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23
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Yagi-Nakajima S, Miura M, Sawada S, Funaki T, Uchimura K, Susukita K, Hatakeyama T, Kagaya Y, Saito H, Sato K, Kanazawa M, Kondo M, Endo H, Yaegashi H, Nakamura A. An Autopsy Case of Fulminant Myocarditis with Massive Left Ventricular Calcification. Intern Med 2024; 63:821-827. [PMID: 38494729 PMCID: PMC11008995 DOI: 10.2169/internalmedicine.2200-23] [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: 04/26/2023] [Accepted: 06/04/2023] [Indexed: 03/19/2024] Open
Abstract
Myocardial calcification in myocarditis is rare and may be linked to poor outcomes. We herein report a case of fulminant myocarditis with massive myocardial calcification and its pathological outcomes at autopsy. A 49-year-old man experienced chest pain and was diagnosed with acute myocarditis. His cardiac function did not recover despite mechanical circulatory support in combination with V-A extracorporeal membrane oxygenation and IMPELLA CP®. He eventually developed sepsis and gastrointestinal bleeding and died on day 27. Diffuse myocardial calcification was observed on computed tomography at autopsy. The pathological autopsy depicted that calcification filled every myocardial cell in the left ventricle.
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Affiliation(s)
| | - Masanobu Miura
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | - Shun Sawada
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | - Takahiro Funaki
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | - Kumi Uchimura
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | - Kai Susukita
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | | | - Yuta Kagaya
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | - Hiroki Saito
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | - Kenjiro Sato
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | | | - Masateru Kondo
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | - Hideaki Endo
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | - Hiroshi Yaegashi
- Department of Pathology, Iwate Prefectural Central Hospital, Japan
| | - Akihiro Nakamura
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
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24
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Schurr JW, Ambrosi L, Fitzgerald J, Bermudez C, Genuardi MV, Brahier M, Elliot T, McGowan K, Zaaqoq A, Laskar S, Pope SM, Givertz MM, Mallidi H, Sylvester KW, Seifert FC, McLarty AJ. Multicenter evaluation of left ventricular assist device implantation with or without ECMO bridge in cardiogenic shock. Artif Organs 2024. [PMID: 38459758 DOI: 10.1111/aor.14740] [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: 09/05/2023] [Revised: 01/26/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND The efficacy of extracorporeal membrane oxygenation (ECMO) as a bridge to left ventricular assist device (LVAD) remains unclear, and recipients of the more contemporary HeartMate 3 (HM3) LVAD are not well represented in previous studies. We therefore undertook a multicenter, retrospective study of this population. METHODS AND RESULTS INTERMACS 1 LVAD recipients from five U.S. centers were included. In-hospital and one-year outcomes were recorded. The primary outcome was the overall mortality hazard comparing ECMO versus non-ECMO patients by propensity-weighted survival analysis. Secondary outcomes included survival by LVAD type, as well as postoperative and one-year outcomes. One hundred and twenty-seven patients were included; 24 received ECMO as a bridge to LVAD. Mortality was higher in patients bridged with ECMO in the primary analysis (HR 3.22 [95%CI 1.06-9.77], p = 0.039). Right ventricular assist device was more common in the ECMO group (ECMO: 54.2% vs non-ECMO: 11.7%, p < 0.001). Ischemic stroke was higher at one year in the ECMO group (ECMO: 25.0% vs non-ECMO: 4.9%, p = 0.006). Among the study cohort, one-year mortality was lower in HM3 than in HeartMate II (HMII) or HeartWare HVAD (10.5% vs 46.9% vs 31.6%, respectively; p < 0.001) recipients. Pump thrombosis at one year was lower in HM3 than in HMII or HVAD (1.8% vs 16.1% vs 16.2%, respectively; p = 0.026) recipients. CONCLUSIONS Higher mortality was observed with ECMO as a bridge to LVAD, likely due to higher acuity illness, yet acceptable one-year survival was seen compared with historical rates. The receipt of the HM3 was associated with improved survival compared with older generation devices.
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Affiliation(s)
- James W Schurr
- Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lara Ambrosi
- Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jillian Fitzgerald
- Stony Brook University Hospital, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Christian Bermudez
- Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael V Genuardi
- Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mark Brahier
- Medstar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC, USA
| | - Tonya Elliot
- Medstar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC, USA
| | - Kevin McGowan
- Medstar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC, USA
| | - Akram Zaaqoq
- UVA Health, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Sonjoy Laskar
- Emory University Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stuart M Pope
- Emory University Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael M Givertz
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hari Mallidi
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Katelyn W Sylvester
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank C Seifert
- Stony Brook University Hospital, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Allison J McLarty
- Stony Brook University Hospital, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
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25
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Javorski MJ, Bauza K, Xiang F, Soltesz E, Chen L, Bakaeen FG, Svensson L, Thuita L, Blackstone EH, Tong MZ. Identifying and mitigating risk of postcardiotomy cardiogenic shock in patients with ischemic and nonischemic cardiomyopathy. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00191-0. [PMID: 38452888 DOI: 10.1016/j.jtcvs.2024.02.025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES To identify preoperative predictors of postcardiotomy cardiogenic shock in patients with ischemic and nonischemic cardiomyopathy and evaluate trajectory of postoperative ventricular function. METHODS From January 2017 to January 2020, 238 patients with ejection fraction <30% (206/238) or 30% to 34% with at least moderately severe mitral regurgitation (32/238) underwent conventional cardiac surgery at Cleveland Clinic, 125 with ischemic and 113 with nonischemic cardiomyopathy. Preoperative ejection fraction was 25 ± 4.5%. The primary outcome was postcardiotomy cardiogenic shock, defined as need for microaxial temporary left ventricular assist device, extracorporeal membrane oxygenation, or vasoactive-inotropic score >25. RandomForestSRC was used to identify its predictors. RESULTS Postcardiotomy cardiogenic shock occurred in 27% (65/238). Pulmonary artery pulsatility index <3.5 and pulmonary capillary wedge pressure >19 mm Hg were the most important factors predictive of postcardiotomy cardiogenic shock in ischemic cardiomyopathy. Cardiac index <2.2 L·min-1 m-2 and pulmonary capillary wedge pressure >21 mm Hg were the most important predictive factors in nonischemic cardiomyopathy. Operative mortality was 1.7%. Ejection fraction at 12 months after surgery increased to 39% (confidence interval, 35-40%) in the ischemic group and 37% (confidence interval, 35-38%) in the nonischemic cardiomyopathy group. CONCLUSIONS Predictors of postcardiotomy cardiogenic shock were different in ischemic and nonischemic cardiomyopathy. Right heart dysfunction, indicated by low pulmonary artery pulsatility index, was the most important predictor in ischemic cardiomyopathy, whereas greater degree of cardiac decompensation was the most important in nonischemic cardiomyopathy. Therefore, preoperative right heart catheterization will help identify patients with low ejection fraction who are at greater risk of postcardiotomy cardiogenic shock.
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Affiliation(s)
- Michael J Javorski
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Karolis Bauza
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Fei Xiang
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward Soltesz
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lin Chen
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Faisal G Bakaeen
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars Svensson
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lucy Thuita
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio
| | - Michael Z Tong
- Department of Thoracic & Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic Foundation, Cleveland, Ohio.
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26
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Zhang A, Kurlansky P, Ning Y, Wang A, Kaku Y, Fried J, Takeda K. Outcomes following successful decannulation from extracorporeal life support for cardiogenic shock. J Thorac Cardiovasc Surg 2024; 167:1033-1046.e8. [PMID: 36180251 DOI: 10.1016/j.jtcvs.2022.08.007] [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: 02/03/2022] [Revised: 07/09/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although extracorporeal life support (ECLS) has increasingly been used for the treatment of patients with cardiogenic shock (CS), the outcomes of those successfully weaned from support remain poorly defined. METHODS Of 510 venoarterial ECLS CS patients at our institution between January 2015 and December 2020, 249 were decannulated and survived for 30 days or until discharge (ie, successfully weaned). Factors associated with survival to discharge were assessed and 1-year survival was described. RESULTS Of 510 eligible CS ECLS patients, 249 (48.8%) were successfully decannulated, 227 (44.5%) died during/following ECLS, and 34 (6.7%) were bridged to heart transplantation or a ventricular assist device. Patients with a primary graft dysfunction etiology of CS had a greater chance of successful decannulation (odds ratio [OR], 3.088; 95% CI, 1.1-8.671; P = .0323), whereas patients with ECLS during cardiopulmonary resuscitation had a reduced chance of successful decannulation (OR, 0.354; 95% CI, 0.17-0.735; P = .0054). Of successfully decannulated patients, 218 (87.6%) survived to hospital discharge and 31 (12.4%) died in the hospital. Acute myocardial infarction etiology (OR, 4.751; 95% CI, 1.623-13.902; P = .0044), preexisting chronic kidney disease (OR, 3.422; 95% CI, 1.374-8.52; P = .0082), and initiation of continuous renal replacement therapies (OR, 3.188; 95% CI, 1.291-7.871; P = .012) were significantly associated with in-hospital mortality despite successful decannulation. One-year survival in successfully decannulated patients surviving to hospital discharge was 95.0% and comparable to 1-year survival in patients who received a heart transplant or ventricular assist device. CONCLUSIONS Successful decannulation can be achieved in a significant proportion of patients treated with ECLS for CS but does not guarantee survival to hospital discharge. However, 1-year survival of hospital survivors remains high and is comparable to patients bridged to transplant or a ventricular assist device.
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Affiliation(s)
- Ashley Zhang
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Paul Kurlansky
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY; Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, NY
| | - Yuming Ning
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, NY
| | - Amy Wang
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Yuji Kaku
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Justin Fried
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Koji Takeda
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY.
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27
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Kwon JH, Skidmore SH, Bhandari K, Carnicelli AP, Yourshaw JP, Shorbaji K, Kilic A. Waitlist and transplant outcomes in heart transplant candidates bridged with temporary endovascular right ventricular assist devices. J Heart Lung Transplant 2024; 43:369-378. [PMID: 37951321 DOI: 10.1016/j.healun.2023.11.001] [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: 03/20/2023] [Revised: 10/20/2023] [Accepted: 11/06/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Advances in mechanical circulatory support and changes in allocation policy have shifted waitlisting practices for heart transplantation (HT) in the United States. This analysis reports waitlist and transplant outcomes among HT candidates bridged with temporary endovascular right ventricular assist devices (tRVADs). METHODS Patients awaiting HT from 2008 to 2022 in the United Network of Organ Sharing registry were grouped by the presence of tRVAD while waitlisted and propensity matched. Waitlist outcomes were HT and a competing outcome of death/deterioration requiring waitlist inactivation. Competing-risks regression was used to model waitlist outcomes. Subanalyses were performed to compare waitlist outcomes among patients with durable and temporary left ventricular assist devices (LVADs) with and without concomitant tRVADs. One-year posttransplant mortality was estimated using Kaplan-Meier analysis. RESULTS Of 41,507 HT candidates, 133 (0.3%) had tRVADs. After propensity matching, patients with tRVAD had a similar likelihood of HT and an elevated hazard for death/deterioration (hazard ratio 2.2, 95% confidence interval 1.4-3.2, p < 0.001) compared to those without tRVAD. Most patients with tRVAD (84%) had concomitant LVADs. tRVAD was associated with an elevated risk for deterioration/death among those with temporary LVADs but not durable LVADs. For patients undergoing HT, tRVAD was associated with an increased risk for 1-year mortality compared to propensity-matched recipients. CONCLUSIONS Bridging with tRVAD is uncommon and primarily used in patients requiring biventricular support. tRVADs are associated with waitlist inactivation or death, particularly with concomitant temporary LVAD support. As temporary devices are increasingly used as a bridge to HT, outcomes of patients with tRVADs should inform future allocation policy, particularly for candidates with biventricular failure.
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Affiliation(s)
- Jennie H Kwon
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Savannah H Skidmore
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Krishna Bhandari
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Anthony P Carnicelli
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Jeffrey P Yourshaw
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Khaled Shorbaji
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Arman Kilic
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina.
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28
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Miller T, Lang FM, Rahbari A, Theodoropoulos K, Topkara VK. Right heart failure after durable left ventricular assist device implantation. Expert Rev Med Devices 2024; 21:197-206. [PMID: 38214584 DOI: 10.1080/17434440.2024.2305362] [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: 07/28/2023] [Accepted: 01/10/2024] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Right heart failure (RHF) is a well-known complication after left ventricular assist device (LVAD) implantation and portends increased morbidity and mortality. Understanding the mechanisms and predictors of RHF in this clinical setting may offer ideas for early identification and aggressive management to minimize poor outcomes. A variety of medical therapies and mechanical circulatory support options are currently available for the management of post-LVAD RHF. AREAS COVERED We reviewed the existing definitions of RHF including its potential mechanisms in the context of durable LVAD implantation and currently available medical and device therapies. We performed a literature search using PubMed (from 2010 to 2023). EXPERT OPINION RHF remains a common complication after LVAD implantation. However, existing knowledge gaps limit clinicians' ability to adequately address its consequences. Early identification and management are crucial to reducing the risk of poor outcomes, but existing risk stratification tools perform poorly and have limited clinical applicability. This is an area ripe for investigation with the potential for major improvements in identification and targeted therapy in an effort to improve outcomes.
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Affiliation(s)
- Tamari Miller
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Frederick M Lang
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ashkon Rahbari
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Kleanthis Theodoropoulos
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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Woehrle A, Sachs A, Doss M, Popov AF. Acute right atrial thrombus formation after extracorporeal life support removal during LVAD-implantation. Asian Cardiovasc Thorac Ann 2024; 32:143-144. [PMID: 38087496 DOI: 10.1177/02184923231219822] [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: 03/14/2024]
Abstract
A 58-year-old male underwent LVAD-Implantation after ECLS explantation. After removal of ECLS (A) transesophageal echocardiography revealed thrombus in the inferior vena cava (B) and right atrium (C). The thrombus was removed with a second pump run including RVAD-Implantation. (D) The diameter of thrombus formations was 6 × 1 cm and 5 × 1.5 cm.
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Affiliation(s)
- Anne Woehrle
- Department of Cardiovascular Surgery, Helios Klinikum Siegburg, Siegburg, Germany
| | - Alexander Sachs
- Department of Anesthesiology, Helios Klinikum Siegburg, Siegburg, Germany
| | - Mirko Doss
- Department of Cardiovascular Surgery, Helios Klinikum Siegburg, Siegburg, Germany
| | - Aron Frederik Popov
- Department of Cardiovascular Surgery, Helios Klinikum Siegburg, Siegburg, Germany
- Department of Cardiac-, Thoracic-, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
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L'Hoyes W, Rosseel T, Jacobs B, Van Edom C, Tavazzi G, Voigt JU, Price S, Dauwe DF, Vandenbriele C. Blood Speckle Imaging in Critical Care: A New Tool in Mechanical Circulatory Support Management. Circ Heart Fail 2024; 17:e010697. [PMID: 38328968 DOI: 10.1161/circheartfailure.123.010697] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- Wouter L'Hoyes
- Department of Cardiovascular Diseases (W.L., T.R., C.V.E., J.-U.V., C.V.), University Hospitals Leuven, Belgium
- Department of Cardiology, Hartcentrum, Jessa Hospital, Hasselt, Belgium (W.L.)
| | - Thomas Rosseel
- Department of Cardiovascular Diseases (W.L., T.R., C.V.E., J.-U.V., C.V.), University Hospitals Leuven, Belgium
| | - Bart Jacobs
- Department of Intensive Care Medicine (B.J., D.D.), University Hospitals Leuven, Belgium
| | - Charlotte Van Edom
- Department of Cardiovascular Diseases (W.L., T.R., C.V.E., J.-U.V., C.V.), University Hospitals Leuven, Belgium
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy (G.T.)
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases (W.L., T.R., C.V.E., J.-U.V., C.V.), University Hospitals Leuven, Belgium
| | - Susanna Price
- Adult Intensive Care, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (S.P., C.V.)
| | - Dieter Frans Dauwe
- Department of Intensive Care Medicine (B.J., D.D.), University Hospitals Leuven, Belgium
| | - Christophe Vandenbriele
- Department of Cardiovascular Diseases (W.L., T.R., C.V.E., J.-U.V., C.V.), University Hospitals Leuven, Belgium
- Adult Intensive Care, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (S.P., C.V.)
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Memon S, Drosou ME, Caroline M, Casanova E, Gnall EM. Feasibility and outcomes with subclavian vein access for crescent jugular dual lumen catheter for venovenous extracorporeal membrane oxygenation in COVID-19 related acute respiratory distress syndrome. Perfusion 2024; 39:304-309. [PMID: 36373765 PMCID: PMC9659699 DOI: 10.1177/02676591221137760] [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] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Femoral-femoral Veno-Venous ExtraCorporeal Life Support (V-V ECLS) has been associated with higher infections rates, vascular site bleeding complications, and restricted patient mobility. Jugular or bicaval dual lumen V-V ECLS conceptually overcomes some of these adverse factors, but experience has shown that jugular vein cannulation still limits mobility and has increased bleeding complications. Technique and outcomes of subclavian vein single-cannulation with Crescent jugular dual-lumen V-V ECLS is described. METHOD five patients with COVID-19 related acute respiratory distress syndrome (ARDS) underwent right subclavian vein V-V ECLS placement with the Crescent 32 French jugular dual-lumen V-V ECLS catheter. A standardized percutaneous technique was developed that allowed efficient insertion without need for any specialized imaging (i.e. transesophageal echocardiogram) and outcomes assessed. RESULTS Mean age of the five patients was 41.2 years, all obese with an average basal mass index of 45.2 kg/m2 and mean days to decannulation of 24.2 days. Outcomes discovered included; improved patient mobility allowing physical rehabilitation, no vascular access site related complications requiring surgery or endovascular intervention, and none had evidence of superior vena cava syndrome. One patient had subclavian/axillary vein thrombosis with resolution after 3 months of direct-acting oral anticoagulants, and one patient had blood cultures positive at day 37, nearing decannulation. CONCLUSION Subclavian vein access for crescent jugular dual lumen V-V ECLS catheter appears to be safe and feasible with added benefits of decreased bleeding and increased mobility over jugular or femoral-femoral access site for long term V-V ECLS support in COVID-19 related ARDS patients.
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Affiliation(s)
- Sehrish Memon
- Division of Cardiovascular Diseases
and Mechanical Circulatory Support, Lankenau Medical Center
and Lankenau Institute of Medical
Research, Wynnewood, PA, USA
| | - Maria Eleni Drosou
- Division of Cardiovascular Diseases
and Mechanical Circulatory Support, Lankenau Medical Center
and Lankenau Institute of Medical
Research, Wynnewood, PA, USA
| | - Mara Caroline
- Division of Cardiovascular Diseases
and Mechanical Circulatory Support, Lankenau Medical Center
and Lankenau Institute of Medical
Research, Wynnewood, PA, USA
| | - Elena Casanova
- Division of Cardiovascular Diseases
and Mechanical Circulatory Support, Lankenau Medical Center
and Lankenau Institute of Medical
Research, Wynnewood, PA, USA
| | - Eric M Gnall
- Division of Cardiovascular Diseases
and Mechanical Circulatory Support, Lankenau Medical Center
and Lankenau Institute of Medical
Research, Wynnewood, PA, USA
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von Dossow V, Hulde N, Starke H, Schramm R. How Would We Treat Our Own Cystic Fibrosis With Lung Transplantation? J Cardiothorac Vasc Anesth 2024; 38:626-634. [PMID: 38030425 DOI: 10.1053/j.jvca.2023.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/03/2023] [Revised: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
Lung transplantation is the only therapy for patients with end-stage lung disease. In advanced lung diseases such as cystic fibrosis (CF), life expectancy increases, and it is important to recognize extrapulmonary comorbidities. Cardiovascular involvement, including pulmonary hypertension, right-heart failure, and myocardial dysfunction, are manifest in the late stages of CF disease. Besides right-heart failure, left-heart dysfunction seems to be underestimated. Therefore, an optimal anesthesia and surgical management risk evaluation in this high-risk patient population is mandatory, especially concerning the perioperative use of mechanical circulatory support. The use of an index case of an older patient with the diagnosis of cystic fibrosis demonstrates the importance of early risk stratification and strategy planning in a multidisciplinary team approach to guarantee successful lung transplantation.
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Affiliation(s)
- Vera von Dossow
- Institute of Anesthesiology and Pain Therapy, Heart and Diabetes Center Bad Oeynhausen, University Clinic of Ruhr-University Bochum, Bochum, Germany
| | - Nikolai Hulde
- Institute of Anesthesiology and Pain Therapy, Heart and Diabetes Center Bad Oeynhausen, University Clinic of Ruhr-University Bochum, Bochum, Germany.
| | - Henning Starke
- Institute of Anesthesiology and Pain Therapy, Heart and Diabetes Center Bad Oeynhausen, University Clinic of Ruhr-University Bochum, Bochum, Germany
| | - Rene Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Clinic of Ruhr-University Bochum, Bochum, Germany
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Nasir BS, Weatherald J, Ramsay T, Cypel M, Donahoe L, Durkin C, Schisler T, Nagendran J, Liberman M, Landry C, Overbeek C, Moore A, Ferraro P. Randomized trial of routine versus on-demand intraoperative extracorporeal membrane oxygenation in lung transplantation: A feasibility study. J Heart Lung Transplant 2024:S1053-2498(24)01496-7. [PMID: 38423414 DOI: 10.1016/j.healun.2024.02.1454] [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: 08/08/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
In most centers, extracorporeal membrane oxygenation (ECMO) is the preferred means to provide cardiopulmonary support during lung transplantation. However, there is controversy about whether intraoperative venoarterial (VA) ECMO should be used routinely or selectively. A randomized controlled trial is the best way to address this controversy. In this publication, we describe a feasibility study to assess the practicality of a protocol comparing routine versus selective VA-ECMO during lung transplantation. This prospective, single-center, randomized controlled trial screened all patients undergoing lung transplantation. Exclusion criteria include retransplantation, multiorgan transplantation, and cases where ECMO is mandatory. We determined that the trial would be feasible if we could recruit 19 participants over 6 months with less than 10% protocol violations. Based on the completed feasibility study, we conclude that the protocol is feasible and safe, giving us the impetus to pursue a multicenter trial with little risk of failure due to low recruitment.
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Affiliation(s)
- Basil S Nasir
- Division of Thoracic Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, Quebec, Canada
| | - Jason Weatherald
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Mazankowski Heart Institute, Edmonton, Alberta, Canada
| | - Tim Ramsay
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marcelo Cypel
- Division of Thoracic Surgery, University Health Networks/Toronto General Hospital (UHN-TGH), Toronto, Ontario, Canada
| | - Laura Donahoe
- Division of Thoracic Surgery, University Health Networks/Toronto General Hospital (UHN-TGH), Toronto, Ontario, Canada
| | - Chris Durkin
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia-Vancouver General Hospital (UBC-VGH), Vancouver, British Columbia, Canada
| | - Travis Schisler
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia-Vancouver General Hospital (UBC-VGH), Vancouver, British Columbia, Canada
| | - Jayan Nagendran
- Division of Cardiac Surgery, University of Alberta and Mazankowski Heart Institute, Edmonton, Alberta, Canada
| | - Moishe Liberman
- Division of Thoracic Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, Quebec, Canada
| | - Caroline Landry
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec, Canada
| | - Charles Overbeek
- Department of Anesthesiology, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, Quebec, Canada
| | - Alex Moore
- Department of Anesthesiology, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, Quebec, Canada
| | - Pasquale Ferraro
- Division of Thoracic Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, Quebec, Canada
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Hong Y, Agrawal N, Hess NR, Ziegler LA, Sicke MM, Hickey GW, Ramanan R, Fowler JA, Chu D, Yoon PD, Bonatti JO, Kaczorowski DJ. Outcomes of Impella 5.0 and 5.5 for cardiogenic shock: A single-center 137 patient experience. Artif Organs 2024. [PMID: 38400638 DOI: 10.1111/aor.14735] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/25/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND This study evaluated the outcomes of patients with cardiogenic shock (CS) supported with Impella 5.0 or 5.5 and identified risk factors for in-hospital mortality. METHODS Adults with CS who were supported with Impella 5.0 or 5.5 at a single institution were included. Patients were stratified into three groups according to their CS etiology: (1) acute myocardial infarction (AMI), (2) acute decompensated heart failure (ADHF), and (3) postcardiotomy (PC). The primary outcome was survival, and secondary outcomes included adverse events during Impella support and length of stay. Multivariable logistic regression was performed to identify risk factors for in-hospital mortality. RESULTS One hundred and thirty-seven patients with CS secondary to AMI (n = 47), ADHF (n = 86), and PC (n = 4) were included. The ADHF group had the highest survival rates at all time points. Acute kidney injury (AKI) was the most common complication during Impella support in all 3 groups. Increased rates of AKI and de novo renal replacement therapy were observed in the PC group, and the AMI group experienced a higher incidence of bleeding requiring transfusion. Multivariable analysis demonstrated diabetes mellitus, elevated pre-insertion serum lactate, and elevated pre-insertion serum creatinine were independent predictors of in-hospital mortality, but the etiology of CS did not impact mortality. CONCLUSIONS This study demonstrates that Impella 5.0 and 5.5 provide effective mechanical support for patients with CS with favorable outcomes, with nearly two-thirds of patients alive at 180 days. Diabetes, elevated pre-insertion serum lactate, and elevated pre-insertion serum creatinine are strong risk factors for in-hospital mortality.
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Affiliation(s)
- Yeahwa Hong
- Department of Surgery, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nishant Agrawal
- School of Medicine, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nicholas R Hess
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Luke A Ziegler
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - McKenzie M Sicke
- School of Medicine, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gavin W Hickey
- Division of Cardiology, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Raj Ramanan
- Department of Critical Care Medicine, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeffrey A Fowler
- Division of Cardiology, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Danny Chu
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Pyongsoo D Yoon
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Johannes O Bonatti
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David J Kaczorowski
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ortoleva J, Dalia AA, Pisano DV, Shapeton A. Diagnosis and Management of Vasoplegia in Temporary Mechanical Circulatory Support: A Narrative Review. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00123-X. [PMID: 38490900 DOI: 10.1053/j.jvca.2024.02.028] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/10/2024] [Accepted: 02/18/2024] [Indexed: 03/17/2024]
Abstract
Refractory vasodilatory shock, or vasoplegia, is a pathophysiologic state observed in the intensive care unit and operating room in patients with a variety of primary diagnoses. Definitions of vasoplegia vary by source but are qualitatively defined clinically as a normal or high cardiac index and low systemic vascular resistance causing hypotension despite high-dose vasopressors in the setting of euvolemia. This definition can be difficult to apply to patients undergoing mechanical circulatory support (MCS). A large body of mostly retrospective literature exists on vasoplegia in the non-MCS population, but the increased use of temporary MCS justifies an examination of vasoplegia in this population. MCS, particularly extracorporeal membrane oxygenation, adds complexity to the diagnosis and management of vasoplegia due to challenges in determining cardiac output (or total blood flow), lack of clarity on appropriate dosing of noncatecholamine interventions, increased thrombosis risk, the difficulty in determining the endpoints of adequate volume resuscitation, and the unclear effects of rescue agents (methylene blue, hydroxocobalamin, and angiotensin II) on MCS device monitoring and function. Care teams must combine data from invasive and noninvasive sources to diagnose vasoplegia in this population. In this narrative review, the available literature is surveyed to provide guidance on the diagnosis and management of vasoplegia in the temporary MCS population, with a focus on noncatecholamine treatments and special considerations for patients supported by extracorporeal membrane oxygenation, transvalvular heart pumps, and other ventricular assist devices.
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Affiliation(s)
- Jamel Ortoleva
- Department of Anesthesiology, Boston Medical Center, Boston, MA.
| | - Adam A Dalia
- Division of Cardiac Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Alexander Shapeton
- Veterans Affairs Boston Healthcare System, Department of Anesthesia, Critical Care and Pain Medicine, and Tufts University School of Medicine, Boston, MA
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Berg DD, Singal S, Palazzolo M, Baird-Zars VM, Bofarrag F, Bohula EA, Chaudhry SP, Dodson MW, Hillerson D, Lawler PR, Liu S, O'Brien CG, Pisani BA, Racharla L, Roswell RO, Shah KS, Solomon MA, Sridharan L, Thompson AD, Diepen SVAN, Katz JN, Morrow DA. Modes of Death in Patients with Cardiogenic Shock in the Cardiac Intensive Care Unit: A Report from the Critical Care Cardiology Trials Network. J Card Fail 2024:S1071-9164(24)00042-3. [PMID: 38387758 DOI: 10.1016/j.cardfail.2024.01.012] [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: 01/05/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND There are limited data on how patients with cardiogenic shock (CS) die. METHODS The Critical Care Cardiology Trials Network is a research network of cardiac intensive care units coordinated by the Thrombolysis In Myocardial Infarction (TIMI) Study Group (Boston, MA). Using standardized definitions, site investigators classified direct modes of in-hospital death for CS admissions (October 2021 to September 2022). Mutually exclusive categories included 4 modes of cardiovascular death and 4 modes of noncardiovascular death. Subgroups defined by CS type, preceding cardiac arrest (CA), use of temporary mechanical circulatory support (tMCS), and transition to comfort measures were evaluated. RESULTS Among 1068 CS cases, 337 (31.6%) died during the index hospitalization. Overall, the mode of death was cardiovascular in 82.2%. Persistent CS was the dominant specific mode of death (66.5%), followed by arrhythmia (12.8%), anoxic brain injury (6.2%), and respiratory failure (4.5%). Patients with preceding CA were more likely to die from anoxic brain injury (17.1% vs 0.9%; P < .001) or arrhythmia (21.6% vs 8.4%; P < .001). Patients managed with tMCS were more likely to die from persistent shock (P < .01), both cardiogenic (73.5% vs 62.0%) and noncardiogenic (6.1% vs 2.9%). CONCLUSIONS Most deaths in CS are related to direct cardiovascular causes, particularly persistent CS. However, there is important heterogeneity across subgroups defined by preceding CA and the use of tMCS.
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Affiliation(s)
- David D Berg
- Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Sachit Singal
- Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Palazzolo
- Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vivian M Baird-Zars
- Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Fadel Bofarrag
- Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erin A Bohula
- Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Mark W Dodson
- Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah
| | - Dustin Hillerson
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Shuangbo Liu
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Connor G O'Brien
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Barbara A Pisani
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | | | - Robert O Roswell
- Northwell, Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell. New Hyde Park, NY
| | - Kevin S Shah
- Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Michael A Solomon
- Critical Care Medicine Department, National Institutes of Health Clinical Center and Cardiovascular Branch, National Heart, Lung, Blood Institute of the National Institutes of Health, Bethesda, Maryland
| | - Lakshmi Sridharan
- Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Andrea D Thompson
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sean VAN Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jason N Katz
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - David A Morrow
- Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Sigala MI, Harris JE, Morton C, Donahue KR, Kim JH. A case series analysis of bicarbonate-based purge solution administration via Impella ventricular assist device. Am J Health Syst Pharm 2024; 81:e115-e121. [PMID: 37952169 DOI: 10.1093/ajhp/zxad278] [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: 11/06/2023] [Indexed: 11/14/2023] Open
Abstract
PURPOSE The Impella device historically required a heparin-based purge solution to reduce the risk of biomaterial deposition to maintain pump function. In April 2022, the Food and Drug Administration approved utilization of bicarbonate-based purge solutions (BBPS) as an alternative to heparin for patients who are intolerant to heparin or in whom heparin is contraindicated. The purpose of this case series is to report patient outcomes of Impella support with BBPS use at our institution. SUMMARY Eighteen patients who received BBPS via the Impella CP or Impella 5.5 device were included in our review. Patients were included if they had BBPS administration for greater than 24 hours. All patients were followed for 72 hours after cessation of BBPS. Indications for BBPS were coagulopathy (n = 5, 28%), suspected HIT (n = 2, 11%), confirmed HIT (n = 1, 6%), and major bleeding (n = 10, 56%). Three patients (17%) experienced an Impella complication while on BBPS. One patient required pump exchange, one required removal of the Impella device, and one received alteplase for suspected purge block. Of these, two patients experienced complications greater than 21 days into BBPS therapy. CONCLUSION This case series adds to the literature describing clinical outcomes for patients on Impella support with BBPS. While BBPS offers a viable option for the management of patients on Impella devices who are unable to tolerate heparin-based purge solutions, further data is needed to determine the longevity of the Impella device with BBPS to minimize risk of Impella complications.
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Affiliation(s)
| | | | | | | | - Ju H Kim
- Advanced Heart Failure and Transplant, Houston Methodist Hospital, Methodist DeBakey Cardiology Associates, Houston, TX, USA
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38
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Lenz M, Krychtiuk KA, Zilberszac R, Heinz G, Riebandt J, Speidl WS. Mechanical Circulatory Support Systems in Fulminant Myocarditis: Recent Advances and Outlook. J Clin Med 2024; 13:1197. [PMID: 38592041 PMCID: PMC10932153 DOI: 10.3390/jcm13051197] [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: 02/10/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Fulminant myocarditis (FM) constitutes a severe and life-threatening form of acute cardiac injury associated with cardiogenic shock. The condition is characterised by rapidly progressing myocardial inflammation, leading to significant impairment of cardiac function. Due to the acute and severe nature of the disease, affected patients require urgent medical attention to mitigate adverse outcomes. Besides symptom-oriented treatment in specialised intensive care units (ICUs), the necessity for temporary mechanical cardiac support (MCS) may arise. Numerous patients depend on these treatment methods as a bridge to recovery or heart transplantation, while, in certain situations, permanent MCS systems can also be utilised as a long-term treatment option. Methods: This review consolidates the existing evidence concerning the currently available MCS options. Notably, data on venoarterial extracorporeal membrane oxygenation (VA-ECMO), microaxial flow pump, and ventricular assist device (VAD) implantation are highlighted within the landscape of FM. Results: Indications for the use of MCS, strategies for ventricular unloading, and suggested weaning approaches are assessed and systematically reviewed. Conclusions: Besides general recommendations, emphasis is put on the differences in underlying pathomechanisms in FM. Focusing on specific aetiologies, such as lymphocytic-, giant cell-, eosinophilic-, and COVID-19-associated myocarditis, this review delineates the indications and efficacy of MCS strategies in this context.
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Affiliation(s)
- Max Lenz
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria (W.S.S.)
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Konstantin A. Krychtiuk
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria (W.S.S.)
| | - Robert Zilberszac
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria (W.S.S.)
| | - Gottfried Heinz
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria (W.S.S.)
| | - Julia Riebandt
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Walter S. Speidl
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria (W.S.S.)
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Padberg JS, Feld J, Padberg L, Köppe J, Makowski L, Gerß J, Dröge P, Ruhnke T, Günster C, Lange SA, Reinecke H. Complications and Outcomes in 39,864 Patients Receiving Standard Care Plus Mechanical Circulatory Support or Standard Care Alone for Infarct-Associated Cardiogenic Shock. J Clin Med 2024; 13:1167. [PMID: 38398478 PMCID: PMC10889198 DOI: 10.3390/jcm13041167] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Temporary mechanical circulatory support devices (tMCS) are increasingly being used in patients with infarct-associated cardiogenic shock (AMICS). Evidence on patient selection, complications and long-term outcomes is lacking. We aim to investigate differences in clinical characteristics, complications and outcomes between patients receiving no tMCS or either intra-aortic balloon pump (IABP), veno-arterial extracorporeal membrane oxygenation (V-A ECMO) or Impella® for AMICS, with a particular focus on long-term outcomes. METHODS Using health claim data from AOK-Die Gesundheitskasse (local health care funds), we retrospectively analysed complications and outcomes of all insured patients with AMICS between 1 January 2010 and 31 December 2017. RESULTS A total of 39,864 patients were included (IABP 5451; Impella 776; V-A ECMO 833; no tMCS 32,804). In-hospital complications, including renal failure requiring dialysis (50.3% V-A ECMO vs. 30.5% Impella vs. 29.2 IABP vs. 12.1% no tMCS), major bleeding (38.1% vs. 20.9% vs. 18.0% vs. 9.3%) and sepsis (22.5% vs. 15.9% vs. 13.9% vs. 9.3%) were more common in V-A ECMO patients. In a multivariate analysis, the use of both V-A ECMO (HR 1.57, p < 0.001) and Impella (HR 1.25, p < 0.001) were independently associated with long-term mortality, whereas use of IABP was not (HR 0.89, p < 0.001). Kaplan-Meier estimates showed better survival for patients on IABP compared with Impella, V-A ECMO and no-tMCS. Short- and long-term mortality was high across all groups. CONCLUSIONS Our data show noticeably more in-hospital complications in patients on tMCS and higher mortality with V-A ECMO and Impella. The use of both devices is an independent risk factor for mortality, whereas the use of IABP is associated with a survival benefit.
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Affiliation(s)
- Jan-Sören Padberg
- Department for Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany
| | - Jannik Feld
- Institute of Biostatistics and Clinical Research, University of Münster, D-48149 Münster, Germany
| | - Leonie Padberg
- Department for Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Münster, D-48149 Münster, Germany
| | - Lena Makowski
- Department for Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany
| | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Münster, D-48149 Münster, Germany
| | - Patrik Dröge
- AOK Research Institute (WIdO), AOK-Bundesverband, D-10178 Berlin, Germany
| | - Thomas Ruhnke
- AOK Research Institute (WIdO), AOK-Bundesverband, D-10178 Berlin, Germany
| | - Christian Günster
- AOK Research Institute (WIdO), AOK-Bundesverband, D-10178 Berlin, Germany
| | - Stefan Andreas Lange
- Department for Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany
| | - Holger Reinecke
- Department for Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany
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Antonopoulos M, Bonios MJ, Dimopoulos S, Leontiadis E, Gouziouta A, Kogerakis N, Koliopoulou A, Elaiopoulos D, Vlahodimitris I, Chronaki M, Chamogeorgakis T, Drakos SG, Adamopoulos S. Advanced Heart Failure: Therapeutic Options and Challenges in the Evolving Field of Left Ventricular Assist Devices. J Cardiovasc Dev Dis 2024; 11:61. [PMID: 38392275 PMCID: PMC10888700 DOI: 10.3390/jcdd11020061] [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: 01/05/2024] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
Heart Failure is a chronic and progressively deteriorating syndrome that has reached epidemic proportions worldwide. Improved outcomes have been achieved with novel drugs and devices. However, the number of patients refractory to conventional medical therapy is growing. These advanced heart failure patients suffer from severe symptoms and frequent hospitalizations and have a dismal prognosis, with a significant socioeconomic burden in health care systems. Patients in this group may be eligible for advanced heart failure therapies, including heart transplantation and chronic mechanical circulatory support with left ventricular assist devices (LVADs). Heart transplantation remains the treatment of choice for eligible candidates, but the number of transplants worldwide has reached a plateau and is limited by the shortage of donor organs and prolonged wait times. Therefore, LVADs have emerged as an effective and durable form of therapy, and they are currently being used as a bridge to heart transplant, destination lifetime therapy, and cardiac recovery in selected patients. Although this field is evolving rapidly, LVADs are not free of complications, making appropriate patient selection and management by experienced centers imperative for successful therapy. Here, we review current LVAD technology, indications for durable MCS therapy, and strategies for timely referral to advanced heart failure centers before irreversible end-organ abnormalities.
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Affiliation(s)
- Michael Antonopoulos
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Michael J Bonios
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Stavros Dimopoulos
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Evangelos Leontiadis
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Aggeliki Gouziouta
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Nektarios Kogerakis
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Antigone Koliopoulou
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Dimitris Elaiopoulos
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Ioannis Vlahodimitris
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Maria Chronaki
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Themistocles Chamogeorgakis
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Stavros G Drakos
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Stamatis Adamopoulos
- Heart Failure, Transplant and Mechanical Circulatory Support Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece
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Ughetto A, Eliet J, Nagot N, David H, Bazalgette F, Marin G, Kollen S, Mourad M, Zeroual N, Muller L, Gaudard P, Colson P. Early temporary mechanical circulatory support for cardiogenic shock: Real-life data from a regional cardiac assistance network. J Heart Lung Transplant 2024:S1053-2498(24)00052-4. [PMID: 38367739 DOI: 10.1016/j.healun.2024.02.009] [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: 05/15/2023] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Temporary mechanical circulatory support as well as multidisciplinary team approach in a regional care organization might improve survival of cardiogenic shock. No study has evaluated the relative effect of each temporary mechanical circulatory support on mortality in the context of a regional network. METHODS Prospective observational data were retrieved from patients consecutively admitted with cardiogenic shock to the intensive care units in 3 centers organized into a regional cardiac assistance network. Temporary mechanical circulatory support indication was decided by a heart team, based on the initial shock severity or if shock was refractory to medical treatment within 24 hours of admission. A propensity score for circulatory support use was used as an adjustment co-variable to emulate a target trial. The primary endpoint was in-hospital mortality. RESULTS Two hundred and forty-six patients were included in the study (median age: 59.5 years, 71.9% male): 121 received early mechanical assistance. The main etiologies were acute myocardial infraction (46.8%) and decompensated heart failure (27.2%). Patients who received early mechanical assistance had more severe conditions than other patients. Their crude in-hospital mortality was 38% and 22.4% in other patients but adjusted in-hospital mortality was not different (hazard ratio 0.91, 95% CI:0.65-1.26). Patients with mechanical assistance had a higher rate of complications than others with longer Intensive Care Unit and hospital stays. CONCLUSIONS In the conditions of a cardiac assistance regional network, in-hospital mortality was not improved by early mechanical assistance implantation. A high incidence of complications of temporary mechanical circulatory support may have jeopardized its potential benefit.
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Affiliation(s)
- Aurore Ughetto
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Jacob Eliet
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Nicolas Nagot
- Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Hélène David
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, University of Montpellier, Montpellier, France; University of Montpellier, CNRS, INSERM, PhyMedExp, Montpellier, France
| | - Florian Bazalgette
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Grégory Marin
- Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Sébastien Kollen
- Department of Critical Care Medicine, CH Perpignan, Perpignan, France
| | - Marc Mourad
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Norddine Zeroual
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Laurent Muller
- Department of Critical Care Medicine, CHU Nîmes, University of Montpellier-Nîmes, Nîmes, France
| | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, University of Montpellier, Montpellier, France; University of Montpellier, CNRS, INSERM, PhyMedExp, Montpellier, France
| | - Pascal Colson
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, University of Montpellier, Montpellier, France; University of Montpellier, CNRS, INSERM, Institut de Génomique Fonctionnelle, Montpellier, France.
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Hanson ID, Rusia A, Palomo A, Tawney A, Pow T, Dixon SR, Meraj P, Sievers E, Johnson M, Wohns D, Ali O, Kapur NK, Grines C, Burkhoff D, Anderson M, Lansky A, Naidu SS, Basir MB, O'Neill W. Treatment of Acute Myocardial Infarction and Cardiogenic Shock: Outcomes of the RECOVER III Postapproval Study by Society of Cardiovascular Angiography and Interventions Shock Stage. J Am Heart Assoc 2024; 13:e031803. [PMID: 38293995 PMCID: PMC11056148 DOI: 10.1161/jaha.123.031803] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND The Society for Cardiovascular Angiography and Interventions proposed a staging system (A-E) to predict prognosis in cardiogenic shock. Herein, we report clinical outcomes of the RECOVER III study for the first time, according to Society for Cardiovascular Angiography and Interventions shock classification. METHODS AND RESULTS The RECOVER III study is an observational, prospective, multicenter, single-arm, postapproval study of patients with acute myocardial infarction with cardiogenic shock undergoing percutaneous coronary intervention with Impella support. Patients enrolled in the RECOVER III study were assigned a baseline Society for Cardiovascular Angiography and Interventions shock stage. Staging was then repeated within 24 hours after initiation of Impella. Kaplan-Meier survival curve analyses were conducted to assess survival across Society for Cardiovascular Angiography and Interventions shock stages at both time points. At baseline assessment, 16.5%, 11.4%, and 72.2% were classified as stage C, D, and E, respectively. At ≤24-hour assessment, 26.4%, 33.2%, and 40.0% were classified as stage C, D, and E, respectively. Thirty-day survival among patients with stage C, D, and E shock at baseline was 59.7%, 56.5%, and 42.9%, respectively (P=0.003). Survival among patients with stage C, D, and E shock at ≤24 hours was 65.7%, 52.1%, and 29.5%, respectively (P<0.001). After multivariable analysis of impact of shock stage classifications at baseline and ≤24 hours, only stage E classification at ≤24 hours was a significant predictor of mortality (odds ratio, 4.8; P<0.001). CONCLUSIONS In a real-world cohort of patients with acute myocardial infarction with cardiogenic shock undergoing percutaneous coronary intervention with Impella support, only stage E classification at ≤24 hours was significantly predictive of mortality, suggesting that response to therapy may be more important than clinical severity of shock at presentation.
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Affiliation(s)
- Ivan D. Hanson
- Department of Cardiovascular MedicineWilliam Beaumont University HospitalRoyal OakMI
| | - Akash Rusia
- Department of Advanced Heart Failure, Baylor Scott & White Health–The Heart HospitalPlanoTX
| | - Andres Palomo
- Department of Cardiovascular MedicineWilliam Beaumont University HospitalRoyal OakMI
| | - Adam Tawney
- Department of Cardiovascular MedicineWilliam Beaumont University HospitalRoyal OakMI
| | - Timothy Pow
- Department of Cardiovascular MedicineWilliam Beaumont University HospitalRoyal OakMI
| | - Simon R. Dixon
- Department of Cardiovascular MedicineWilliam Beaumont University HospitalRoyal OakMI
| | | | - Eric Sievers
- Department of Cardiovascular SurgeryJackson‐Madison County HospitalJacksonTN
| | | | - David Wohns
- Division of CardiologySpectrum HealthGrand RapidsMI
| | - Omar Ali
- Department of CardiologyDetroit Medical CenterDetroitMI
| | - Navin K. Kapur
- Department of CardiologyTufts University School of MedicineBostonMA
| | - Cindy Grines
- Northside Hospital Cardiovascular InstituteAtlantaGA
| | | | - Mark Anderson
- Department of Cardiac SurgeryHackensack University Medical CenterHackensackNJ
| | | | - Srihari S. Naidu
- Department of CardiologyWestchester Medical Center and New York Medical CollegeValhallaNY
| | - Mir B. Basir
- Division of CardiologyHenry Ford HospitalDetroitMI
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Seadler BD, Melamed J, Sow M, Rogers AL, Syed A, Linsky PL, Ubert HA, Schena S, Durham LA, Almassi GH. A model for delivery of extracorporeal life support in a stand-alone veterans affairs medical center. Artif Organs 2024. [PMID: 38321771 DOI: 10.1111/aor.14722] [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: 07/28/2023] [Revised: 01/09/2024] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION For the Veterans Health Administration (VHA) to continue to perform complex cardiothoracic surgery, there must be an established pathway for providing urgent/emergent extracorporeal life support (ECLS). Partnership with a nearby tertiary care center with such expertise may be the most resource-efficient way to provide ECLS services to patients in post-cardiotomy cardiogenic shock or respiratory failure. The goal of this project was to assess the efficiency, safety, and outcomes of surgical patients who required transfer for perioperative ECLS from a single stand-alone Veterans Affairs Medical Center (VAMC) to a separate ECLS center. METHODS Cohort consisted of all cardiothoracic surgery patients who experienced cardiogenic shock or refractory respiratory failure at the local VAMC requiring urgent or emergent institution of ECLS between 2019 and 2022. The primary outcomes are the safety and timeliness of transport. RESULTS Mean time from the initial shock call to arrival at the ECLS center was 2.8 h. There were no complications during transfer. Six patients (86%) survived to decannulation. CONCLUSION These results suggest that complex cardiothoracic surgery can be performed within the VHA system and when there is an indication for ECLS, those services can be safely and effectively provided at an affiliated, properly equipped center.
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Affiliation(s)
- Benjamin D Seadler
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Joshua Melamed
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Mami Sow
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Austin L Rogers
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Ali Syed
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Paul L Linsky
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - H Adam Ubert
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stefano Schena
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Lucian A Durham
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - G Hossein Almassi
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
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Khiabani AJ, Pawale A. Extracorporeal Membrane Oxygenation in Cardiogenic Shock: Execution Is Something; Timing Is Everything? J Am Heart Assoc 2024; 13:e033348. [PMID: 38240242 PMCID: PMC11056149 DOI: 10.1161/jaha.123.033348] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 02/07/2024]
Affiliation(s)
- Ali J. Khiabani
- Division of Cardiothoracic Surgery, Department of SurgeryWashington University School of Medicine, Barnes‐Jewish HospitalSt LouisMOUSA
| | - Amit Pawale
- Division of Cardiothoracic Surgery, Department of SurgeryWashington University School of Medicine, Barnes‐Jewish HospitalSt LouisMOUSA
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Jentzer JC, Drakos SG, Selzman CH, Owyang C, Teran F, Tonna JE. Timing of Initiation of Extracorporeal Membrane Oxygenation Support and Outcomes Among Patients With Cardiogenic Shock. J Am Heart Assoc 2024; 13:e032288. [PMID: 38240232 PMCID: PMC11056129 DOI: 10.1161/jaha.123.032288] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/27/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Venoarterial extracorporeal membrane oxygenation (ECMO) provides full hemodynamic support for patients with cardiogenic shock, but optimal timing of ECMO initiation remains uncertain. We sought to determine whether earlier initiation of ECMO is associated with improved survival in cardiogenic shock. METHODS AND RESULTS We analyzed adult patients with cardiogenic shock who received venoarterial ECMO from the international Extracorporeal Life Support Organization (ELSO) registry from 2009 to 2019, excluding those cannulated following an operation. Multivariable logistic regression evaluated the association between time from admission to ECMO initiation and in-hospital death. Among 8619 patients (median, 56.7 [range, 44.8-65.6] years; 33.5% women), the median duration from admission to ECMO initiation was 14 (5-32) hours. Patients who had ECMO initiated within 24 hours (n=5882 [68.2%]) differed from those who had ECMO initiated after 24 hours, with younger age, more preceding cardiac arrest, and worse acidosis. After multivariable adjustment, patients with ECMO initiated >24 hours after admission had higher risk of in-hospital death (adjusted odds ratio, 1.20 [95% CI, 1.06-1.36]; P=0.004). Each 12-hour increase in the time from admission to ECMO initiation was incrementally associated with higher adjusted in-hospital mortality rate (adjusted odds ratio, 1.06 [95% CI, 1.03-1.10]; P<0.001). The association between longer time to ECMO and worse outcomes appeared stronger in patients with lower shock severity. CONCLUSIONS Longer delays from admission to ECMO initiation were associated with higher a mortality rate in a large-scale, international registry. Our analysis supports optimization of door-to-support time and the avoidance of inappropriately delayed ECMO initiation.
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Affiliation(s)
| | - Stavros G. Drakos
- Division of Cardiovascular Medicine and Nora Eccles Harrison Cardiovascular Research Training InstituteUniversity of UtahSalt Lake CityUTUSA
| | - Craig H. Selzman
- Division of Cardiothoracic Surgery, Department of SurgeryUniversity of UtahSalt Lake CityUTUSA
| | - Clark Owyang
- Department of Emergency MedicineNew York Presbyterian Hospital‐Weill Cornell Medical CenterNew YorkNYUSA
| | - Felipe Teran
- Department of Emergency MedicineNew York Presbyterian Hospital‐Weill Cornell Medical CenterNew YorkNYUSA
| | - Joseph E. Tonna
- Division of Cardiothoracic Surgery, Department of SurgeryUniversity of UtahSalt Lake CityUTUSA
- Department of Emergency MedicineUniversity of UtahSalt Lake CityUTUSA
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Kunioka S, Suzuki F, Nagata M, Tsutsui M, Kamiya H. A Rare Case of Leukemoid Reaction During Mechanical Circulatory Support in a Patient With Severe Heart Failure: An Autopsy Study. Cureus 2024; 16:e54603. [PMID: 38524048 PMCID: PMC10958757 DOI: 10.7759/cureus.54603] [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] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
The leukemoid reaction (LR) is reported to be caused by severe stress conditions such as infection, malignancies, intoxication, severe hemorrhage, or acute hemolysis; this condition is attributed to a very severe prognosis. Some reports have suggested that the LR was associated with a systemic stress response. A 36-year-old man who required mechanical circulatory support (MCS), including veno-arterial extracorporeal membrane oxygenation and Impella 5.5 due to severe heart failure, was transferred to our hospital. He showed a markedly elevated WBC count and died of multiple organ failure. The autopsy revealed the possibility that leukocytosis might have been due to an LR; however, the cause of the cardiac failure was unknown. To the best of our knowledge, this study is the first to report a rare case of LR in a patient with severe heart failure requiring MCS.
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Affiliation(s)
- Shingo Kunioka
- Intensive Care Unit/Cardiac Surgery, Asahikawa Medical University, Asahikawa, JPN
| | - Fumitaka Suzuki
- Cardiac Surgery, Asahikawa Medical University, Asahikawa, JPN
| | | | | | - Hiroyuki Kamiya
- Cardiac Surgery, Asahikawa Medical University, Asahikawa, JPN
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Kanwar MK, Billia F, Randhawa V, Cowger JA, Barnett CM, Chih S, Ensminger S, Hernandez-Montfort J, Sinha SS, Vorovich E, Proudfoot A, Lim HS, Blumer V, Jennings DL, Reshad Garan A, Renedo MF, Hanff TC, Baran DA. Heart failure related cardiogenic shock: An ISHLT consensus conference content summary. J Heart Lung Transplant 2024; 43:189-203. [PMID: 38069920 DOI: 10.1016/j.healun.2023.09.014] [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: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 12/22/2023] Open
Abstract
In recent years, there have been significant advancements in the understanding, risk-stratification, and treatment of cardiogenic shock (CS). Despite improved pharmacologic and device-based therapies for CS, short-term mortality remains as high as 50%. Most recent efforts in research have focused on CS related to acute myocardial infarction, even though heart failure related CS (HF-CS) accounts for >50% of CS cases. There is a paucity of high-quality evidence to support standardized clinical practices in approach to HF-CS. In addition, there is an unmet need to identify disease-specific diagnostic and risk-stratification strategies upon admission, which might ultimately guide the choice of therapies, and thereby improve outcomes and optimize resource allocation. The heterogeneity in defining CS, patient phenotypes, treatment goals and therapies has resulted in difficulty comparing published reports and standardized treatment algorithms. An International Society for Heart and Lung Transplantation (ISHLT) consensus conference was organized to better define, diagnose, and manage HF-CS. There were 54 participants (advanced heart failure and interventional cardiologists, cardiothoracic surgeons, critical care cardiologists, intensivists, pharmacists, and allied health professionals), with vast clinical and published experience in CS, representing 42 centers worldwide. State-of-the-art HF-CS presentations occurred with subsequent breakout sessions planned in an attempt to reach consensus on various issues, including but not limited to models of CS care delivery, patient presentations in HF-CS, and strategies in HF-CS management. This consensus report summarizes the contemporary literature review on HF-CS presented in the first half of the conference (part 1), while the accompanying document (part 2) covers the breakout sessions where the previously agreed upon clinical issues were discussed with an aim to get to a consensus.
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Affiliation(s)
- Manreet K Kanwar
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania.
| | - Filio Billia
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Varinder Randhawa
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer A Cowger
- Department of Cardiology, Henry Ford Health Heart and Vascular Institute, Detroit, Michigan
| | - Christopher M Barnett
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Sharon Chih
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Jaime Hernandez-Montfort
- Advanced Heart Disease, Recovery and Replacement Program, Baylor Scott and White Health, Temple, Texas
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Esther Vorovich
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alastair Proudfoot
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Hoong S Lim
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Vanessa Blumer
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Douglas L Jennings
- Department of Pharmacy, Columbia University Irving Medical Center, New York, New York
| | - A Reshad Garan
- Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiology, Harvard Medical School, Boston, Massachusetts
| | - Maria F Renedo
- Department of Heart Failure and Thoracic Transplantation, Fundacion Favaloro, Buenos Aires, Argentina
| | - Thomas C Hanff
- Division of Cardiovascular Medicine, University of Utah Hospital, Salt Lake City, Utah
| | - David A Baran
- Heart, Vascular Thoracic Institute, Cleveland Clinic Florida, Weston, Florida.
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Peng DM, Kwiatkowski DM, Lasa JJ, Zhang W, Banerjee M, Mikesell K, Joong A, Dykes JC, Tume SC, Niebler RA, Teele SA, Klugman D, Gaies MG, Schumacher KR. Contemporary Care and Outcomes of Critically-ill Children With Clinically Diagnosed Myocarditis. J Card Fail 2024; 30:350-358. [PMID: 37150502 DOI: 10.1016/j.cardfail.2023.04.010] [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: 12/09/2022] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To describe contemporary management and outcomes in children with myocarditis who are admitted to a cardiac intensive care unit (CICU) and to identify the characteristics associated with mortality. METHODS All patients in the Pediatric Cardiac Critical Care Consortium (PC4) registry between August 2014 and June 2021 who were diagnosed with myocarditis were included. Univariable analyses and multivariable logistic regression evaluated the factors associated with in-hospital mortality. RESULTS There were 847 CICU admissions for myocarditis in 51 centers. The median age was 12 years (IQR 2.7-16). In-hospital mortality occurred in 53 patients (6.3%), and 60 (7.1%) had cardiac arrest during admission. Mechanical ventilation was required in 339 patients (40%), and mechanical circulatory support (MCS) in 177 (21%); extracorporeal membrane oxygenation (ECMO)-only in 142 (16.7%), ECMO-to-ventricular assist device (VAD) in 20 (2.4%), extracorporeal cardiac resuscitation in 43 (5%), and VAD-only in 15 (1.8%) patients. MCS was associated with in-hospital mortality; 20.3% receiving MCS died compared to 2.5% without MCS (P < 0.001). Mortality rates were similar in ECMO-only, ECMO-to-VAD and VAD-only groups. The median time from CICU admission to ECMO was 2.0 hours (IQR 0-9.4) and to VAD, it was 9.9 days (IQR 6.3-16.8). Time to MCS was not associated with mortality. In multivariable modeling of patients' characteristics, smaller body surface area (BSA) and low eGFR were independently associated with mortality, and after including critical therapies, mechanical ventilation and ECMO were independent predictors of mortality. CONCLUSION This contemporary cohort of children admitted to CICUs with myocarditis commonly received high-resource therapies; however, most patients survived to hospital discharge and rarely received VAD. Smaller patient size, acute kidney injury and receipt of mechanical ventilation or ECMO were independently associated with mortality.
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Affiliation(s)
- David M Peng
- University of Michigan, CS Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI.
| | | | - Javier J Lasa
- Texas Children's Hospital, 6621 Fannin Street, Houston, TX
| | - Wendy Zhang
- University of Michigan, CS Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI
| | - Mousumi Banerjee
- University of Michigan, CS Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI
| | - Katherine Mikesell
- University of Michigan, CS Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI
| | - Anna Joong
- Lurie Children's Hospital, 225 East Chicago Avenue, Chicago, IL
| | - John C Dykes
- Lucile Packard Children's Hospital Stanford, 725 Welch Road, Palo Alto, CA
| | | | - Robert A Niebler
- Children's Hospital Wisconsin, 8915 West Connell Court, Milwaukee, WI
| | - Sarah A Teele
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA
| | - Darren Klugman
- The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD
| | - Michael G Gaies
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH
| | - Kurt R Schumacher
- University of Michigan, CS Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI
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Colvin MM, Smith JM, Ahn YS, Handarova DK, Martinez AC, Lindblad KA, Israni AK, Snyder JJ. OPTN/SRTR 2022 Annual Data Report: Heart. Am J Transplant 2024; 24:S305-S393. [PMID: 38431362 DOI: 10.1016/j.ajt.2024.01.016] [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] [Indexed: 03/05/2024]
Abstract
The number of heart transplants in the United States has continued to increase. Since 2011, pediatric heart transplants have increased 31.7% to 494 and adult heart transplants have increased 85.8% to 3,668 in 2022. The numbers of new candidates for pediatric and adult heart transplants have also increased, with 703 new pediatric candidates and 4,446 new adult candidates in 2022. Adult heart transplant rates continue to rise, peaking at 122.5 transplants per 100 patient-years in 2022; however, the pediatric heart transplant rate decreased to its lowest rate in the past decade, 104.2 transplants per 100 patient-years, a decrease of 13.9% from 121 transplants per 100 patient-years in 2011. Despite this, pretransplant mortality among pediatric candidates has decreased by 52.2%, from 20.8 deaths per 100 patient-years in 2011 to 10.0 deaths per 100 patient-years in 2022, but remains excessive for candidates younger than 1 year at 25.7 deaths per 100 patient-years. Among adult candidates, pretransplant mortality declined from 15 deaths per 100 patient-years in 2011 to 8.7 deaths per 100 patient-years in 2022. Since 2011, posttransplant mortality has been stable to slightly better; among recipients who underwent transplant in 2015-2017, the 1-, 3-, and 5-year pediatric survival rates were 93.7%, 89.2%, and 85.0%, respectively, and the adult survival rates were 91.3%, 85.7%, and 80.4%. Donor trends have been favorable, with an increase in the numbers of hearts recovered and growing numbers of hearts procured after circulatory death.
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Affiliation(s)
- Monica M Colvin
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN; Department of Cardiology, University of Michigan, Ann Arbor, MI
| | - Jodi M Smith
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN; Department of Pediatrics, University of Washington, Seattle, WA
| | - Yoon Son Ahn
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN
| | - Dzhuliyana K Handarova
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - Alina C Martinez
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - Kelsi A Lindblad
- Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA
| | - Ajay K Israni
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN; Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN; Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN
| | - Jon J Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN; Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN; Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN
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Ergui I, Salama J, Hooda U, Ebner B, Dangl M, Vincent L, Sancassani R, Colombo R. In-hospital outcomes in unhoused patients with cardiogenic shock in the United States: Insights from The National Inpatient Sample 2011-2019. Clin Cardiol 2024; 47:e24235. [PMID: 38366788 PMCID: PMC10873680 DOI: 10.1002/clc.24235] [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: 10/27/2023] [Revised: 01/22/2024] [Accepted: 01/30/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Unhoused patients face significant barriers to receiving health care in both the inpatient and outpatient settings. For unhoused patients with heart failure who are in extremis, there is a lack of data regarding in-hospital outcomes and resource utilization in the setting of cardiogenic shock (CS). HYPOTHESIS Unhoused patients hospitalized with CS have increased mortality and decreased use of invasive therapies as compared to housed patients. METHODS The National Inpatient Sample (NIS) database was queried from 2011 to 2019 for relevant ICD-9 and ICD-10 codes to identify unhoused patients with an admission diagnosis of CS. Baseline characteristics and in-hospital outcomes between patients were compared. Binary logistic regression was used to adjust outcomes for prespecified and significantly different baseline characteristics (p < .05). RESULTS We identified a weighted sample of 1 202 583 adult CS hospitalizations, of whom 4510 were unhoused (0.38%). There was no significant difference in the comorbidity adjusted odds of mortality between groups. Unhoused patients had lower odds of receiving mechanical circulatory support, left heart catheterization, percutaneous coronary intervention, or pulmonary artery catheterization. Unhoused patients had higher adjusted odds of infectious complications, undergoing intubation, or requiring restraints. CONCLUSIONS These data suggest that, despite having fewer traditional comorbidities, unhoused patients have similar mortality and less access to more aggressive care than housed patients. Unhoused patients may experience under-diuresis, or more conservative care strategies, as evidenced by the higher intubation rate in this population. Further studies are needed to elucidate long-term outcomes and investigate systemic methods to ameliorate barriers to care in unhoused populations.
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Affiliation(s)
- Ian Ergui
- Division of Internal Medicine, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Joshua Salama
- Division of Internal Medicine, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Urvashi Hooda
- Division of Cardiology, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Bertrand Ebner
- Division of Cardiology, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Michael Dangl
- Division of Internal Medicine, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Louis Vincent
- Division of Cardiology, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Rhea Sancassani
- Department of CardiologyJackson Memorial HospitalMiamiFloridaUSA
| | - Rosario Colombo
- Division of Cardiology, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
- Department of CardiologyJackson Memorial HospitalMiamiFloridaUSA
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