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Matsushita S, Tada T, Sasaki W, Osakada K, Kawase Y, Kadota K. COVID-19 fulminant myocarditis recovered with veno-arterial extracorporeal membrane oxygenation and Impella CP. J Cardiol Cases 2023:S1878-5409(23)00062-2. [PMID: 37361643 PMCID: PMC10169577 DOI: 10.1016/j.jccase.2023.05.003] [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: 01/22/2023] [Revised: 03/30/2023] [Accepted: 04/26/2023] [Indexed: 06/28/2023] Open
Abstract
A 38-year-old man without a history of coronavirus disease 2019 (COVID-19) vaccination presented with dyspnea and fever. Polymerase chain reaction nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 was positive. Electrocardiogram showed diffuse ST-segment elevation, and chest radiography showed mild pulmonary congestion. The left ventricular (LV) function was markedly impaired. Vital signs were unstable, and serum lactate level was elevated. The patient was diagnosed with cardiogenic shock due to COVID-19 fulminant myocarditis and received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and Impella CP (Abiomed, Inc., Danvers, MA, USA). Remdesivir and intravenous immunoglobulin were also administered. Corticosteroids were not administered because of the absence of pneumonia. On admission, endomyocardial biopsy showed a small direct inflammatory infiltrate of the myocardium. During mechanical support, the cardiac function improved, the patient was weaned off VA-ECMO on day 6, and Impella CP on day 7. Cardiac magnetic resonance imaging implied recent myocardial damage. The patient was discharged on day 30, and the LV function fully recovered. Since the treatment and prognosis of COVID-19 fulminant myocarditis remain unclear, we report the course of COVID-19 fulminant myocarditis with favorable outcomes. Mechanical circulatory support might be an important factor in determining the prognosis of COVID-19 fulminant myocarditis. Learning objective Coronavirus disease 2019 fulminant myocarditis sometimes requires mechanical circulatory support. The prognosis and treatment have not yet been adequately established. The prognosis is favorable if adequate hemodynamic support is provided.
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Affiliation(s)
| | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Wataru Sasaki
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kohei Osakada
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yuichi Kawase
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
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Vandenbriele C, Nijs S, Rega F, Balthazar T. A femoral Impella TM CP plus REBOA for combined cardiogenic and haemorrhagic shock. Acta Cardiol 2023; 78:267-268. [PMID: 36729027 DOI: 10.1080/00015385.2023.2169436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Christophe Vandenbriele
- Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium.,Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Stefaan Nijs
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tim Balthazar
- Department of Cardiology, University Hospitals Brussel, Jette, Belgium
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van den Buijs DMF, van den Brink FS, Wilgenhof A, Zivelonghi C, Verouden N, Knaapen P, Sjauw KD, Vermeersch P, Nap A. Complex High-Risk Indicated Percutaneous Coronary Intervention With Prophylactic Use of the Impella CP Ventricular Assist Device. J Invasive Cardiol 2022; 34:E665-E671. [PMID: 36001456] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Patients with complex coronary artery disease, concomitant cardiac disease, and multiple comorbidities are addressed as complex higher-risk indicated patients (CHIPs). Selecting a revascularization strategy in this population remains challenging. If coronary artery bypass grafting is deemed high risk or patients are considered inoperable, high-risk percutaneous coronary intervention (PCI) with the support of the Impella CP ventricular assist device (Abiomed) may be an attractive alternative. METHODS In this retrospective, multicenter study, we included consecutive patients undergoing Impella CP-facilitated complex high-risk PCI. All patients were discussed by the heart team and were declined for surgery. Additionally, periprocedural mechanical circulatory support was deemed necessary. We collected demographic, clinical, and procedural characteristics. Major adverse cardiac event (MACE) and mortality rates up to 30 days were evaluated. RESULTS A total of 27 patients (median age, 73 ± 9.7 years; 74.1% men) were included in our study. The median SYNTAX score was 32 (range, 8-57) and EuroSCORE was 7.25% (range, 1.33-49.66; ± 12.76%). Periprocedural hemodynamic instability was observed in 1 patient (3.7%). In-hospital combined with 30-day mortality was 7.4% (2/27). No repeat revascularization was necessary. MACE was observed in 10 patients (37.0%). Six patients (22.2%) had a major bleeding complication, of which 2 were related to Impella access site. Median Impella run time was 1.22 hours and there was no significant decrease in kidney function. Median admission time after PCI was 3 days (range, 1-23; ± 4.76). CONCLUSIONS The Impella CP system showed good feasibility and provided adequate hemodynamic support during high-risk PCI in this CHIP population.
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Hirst CS, Thayer KL, Harwani N, Kapur NK. Post-Closure Technique to Reduce Vascular Complications Related to Impella CP. Cardiovasc Revasc Med 2022; 39:38-42. [PMID: 34810113 DOI: 10.1016/j.carrev.2021.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 07/22/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Use of percutaneous mechanical circulatory support has grown exponentially. Vascular complications remain a growing concern and best practices for device removal do not exist. We describe a novel post-closure technique for the next generation Impella CP removal and immediate hemostasis. METHODS This study is a single center, retrospective, exploratory analysis of 11 consecutive patients receiving an Impella CP for either high-risk PCI or cardiogenic shock and then referred for post-closure compared to 20 patients receiving manual compression for Impella CP removal between 2017 and 2019. RESULTS Mean age range was 62.7-65.4 years and 50-65% male between groups. Average duration of Impella CP treatment ranged from 3.4 to 5.2 days. Patients referred for post-closure had significantly lower rates of all-cause adverse vascular events (0% versus 40%; n = 0/11 versus n = 8/20; p = 0.01). There was no significant difference in BARC 3 or greater bleeding, transfusion requirement, hospitalization duration or intensive care duration between removal strategies. CONCLUSION The novel post-closure technique may significantly reduce vascular complications associated with device removal and may improve clinical outcomes for these critically ill patients.
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Affiliation(s)
- Colin S Hirst
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA, United States of America; Ascension Saint John Heart and Vascular Institute, Ascension Saint John Hospital, Detroit, MI, United States of America
| | - Katherine L Thayer
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA, United States of America
| | - Neil Harwani
- Tufts University School of Medicine, Boston, MA, United States of America
| | - Navin K Kapur
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA, United States of America.
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Saito R, Koyama K, Kongoji K, Soejima K. Acute myocardial infarction with simultaneous total occlusion of the left anterior descending artery and right coronary artery successfully treated with percutaneous coronary intervention. BMC Cardiovasc Disord 2022; 22:206. [PMID: 35538416 PMCID: PMC9088105 DOI: 10.1186/s12872-022-02652-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Simultaneous thrombosis in more than one coronary artery is an uncommon angiographic finding in patients with acute ST-segment elevation myocardial infarction. It is difficult to identify using 12-lead electrocardiography and usually leads to cardiogenic shock and fatal outcomes, including sudden cardiac death. Therefore, immediate revascularization and adequate mechanical circulatory support are required. CASE PRESENTATION We report the case of a 58-year-old man who presented with vomiting and chest pain complicated by cardiogenic shock and complete atrioventricular block. Electrocardiography revealed ST-segment elevation in leads II, III, aVF, and V1-V6. Emergency coronary angiography revealed total occlusion of the proximal left anterior descending artery and right coronary artery. The patient successfully underwent primary percutaneous coronary intervention with ballooning and stenting for both arteries. An Impella CP was inserted during the procedure. Fifty-seven days after admission, he had New York Heart Association class II heart failure and was transferred to a rehabilitation hospital. CONCLUSIONS Acute double-vessel coronary thrombosis, a serious event with a high mortality rate, requires prompt diagnosis and management to prevent complications such as cardiogenic shock and ventricular arrhythmias. A combination of judicious medical treatment, efficient primary percutaneous coronary intervention, and early mechanical support device insertion is crucial to improve the survival rate of patients with this disease.
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Affiliation(s)
- Ryuhei Saito
- Department of Cardiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Kohei Koyama
- Department of Cardiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan.
| | - Ken Kongoji
- Department of Cardiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
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Caminiti R, Colarusso L, Vizzari G, Crea P. Tolerance of sustained ventricular fibrillation during left ventricular assist device support with IMPELLA CP®. Cardiovasc Revasc Med 2021; 40S:305-307. [PMID: 34887202 DOI: 10.1016/j.carrev.2021.11.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022]
Abstract
A 64-year-old man was admitted with subacute anterior ST-segment elevation myocardial infarction treated with implantation of four drug-eluting stents in proximal left anterior descending artery. Despite successful percutaneous coronary intervention, the patient developed a significant worsening of left ventricular ejection fraction because of late diagnosis. A percutaneous mechanical circulatory support device (Impella CP; Abiomed) was then required in order to preserve adequate systemic perfusion. Twelve hours later, the patient developed rapid ventricular tachycardia degenerated in ventricular fibrillation, without loss of consciousness. During the arrhythmia, lasting for 10 min, the patient was alert, with preserved mental status. After adequate sedation, a single unsynchronized 200 J DC shock converted the patient to sinus rhythm.
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Affiliation(s)
- Rodolfo Caminiti
- Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy
| | - Luigi Colarusso
- Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy
| | - Giampiero Vizzari
- Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy
| | - Pasquale Crea
- Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy.
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Araco M, Quagliana A, Pedrazzini G, Valgimigli M. A new iteration for the single-access large-bore technique during Impella supported complex and high-risk coronary intervention: a case report. Eur Heart J Case Rep 2021; 5:ytab428. [PMID: 34917876 PMCID: PMC8669554 DOI: 10.1093/ehjcr/ytab428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/26/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Complex and high-risk coronary intervention (CHIP-PCI) and PCI in cardiogenic shock complicating acute coronary syndrome (ACS) are increasingly performed under mechanical circulatory support-so-called protected PCI. Among the available options, Impella Cardiac Power (CP) heart pump (Abiomed) is percutaneously inserted over the femoral artery and typically requires a second arterial access to perform PCI, which further enhances the risk of vascular and bleeding complications. The single-access technique allows Impella CP placement and PCI performance through the same vascular access. When a 7 Fr system is desirable, only a long and entirely hydrophilic coated sheath has been previously used, which is not available in Europe. CASE SUMMARY A 85-year-old patient admitted with non ST-elevation - acute coronary syndrome (NSTE-ACS), severely reduced left ventricular function and three-vessel coronary artery disease underwent single-access CHIP-PCI under Impella CP support. After a failed attempt to insert a standard 7 Fr long femoral sheath alongside the Impella catheter, we successfully introduced a 7.5 Fr sheathless guiding catheter and delivered the planned percutaneous treatment with the benefits conferred by a 7 Fr-rather than 6-lumen catheter, without the need for an additional arterial access. DISCUSSION This is, to the best of our knowledge, the first case of CHIP-PCI performed under Impella support utilizing the single-access technique with a 7.5 Fr sheathless guiding catheter. Beyond advantages of the single-access technique in sparing time and avoiding vascular complications associated with gaining a second arterial access, the lower outer diameter of the sheathless catheter compared with standard 7 Fr sheaths may allow improved limb perfusion and lower chance of interference with the Impella CP catheter.
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Affiliation(s)
- Marco Araco
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Interventional Cardiology Department, via Tesserete 48, 6900 Lugano, Switzerland
| | - Angelo Quagliana
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Interventional Cardiology Department, via Tesserete 48, 6900 Lugano, Switzerland
| | - Giovanni Pedrazzini
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Interventional Cardiology Department, via Tesserete 48, 6900 Lugano, Switzerland
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Interventional Cardiology Department, via Tesserete 48, 6900 Lugano, Switzerland
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Iida Y, Tamai K, Oka H, Inaba Y, Miki T, Takahashi H, Hachiya T, Shimizu H. Insertion of Impella CP following postcardiotomy cardiogenic shock concomitant with veno-arterial extracorporeal membrane oxygenation. Gen Thorac Cardiovasc Surg 2021; 69:1144-6. [PMID: 33788168 DOI: 10.1007/s11748-021-01623-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
Postcardiotomy cardiogenic shock (PCCS) is associated with considerably high rates of mortality. In PCCS, veno-arterial extracorporeal membrane oxygenation has been used despite the high rates of complications and poor outcome. Since the introduction of Impella CP (Abiomed, Danvers, MA, USA), effective left-ventricular unloading and systemic perfusion could be maintained even in patients with severe PCCS. Herein, we describe the successful treatment of PCCS following combined heart surgery in a patient by Impella CP insertion.
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Iannaccone M, Albani S, Giannini F, Colangelo S, Boccuzzi GG, Garbo R, Brilakis ES, D'ascenzo F, de Ferrari GM, Colombo A. Short term outcomes of Impella in cardiogenic shock: A review and meta-analysis of observational studies. Int J Cardiol 2020; 324:44-51. [PMID: 32971148 DOI: 10.1016/j.ijcard.2020.09.044] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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: 06/12/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The clinical impact of invasive hemodynamic support with Impella in patients with cardiogenic shock (CS) remains to be defined. METHOD Only studies including patients treated with Impella in CS were selected. The primary endpoint was short term mortality, while secondary endpoints were major vascular complications and major bleeding. RESULTS 17 studies and 3933 patients were included in the analysis. Median age was 61.9 (IQR 59.2-63.5) years, CS was mainly related to acute coronary syndrome (ACS): 79.6% (IQR 75.1-79.6). Thirty-day mortality was 47.8% (CI 43.7-52%). Based on metaregression analysis, the Impella 5.0 (point estimate -0.006, 95% CI -0.01 - - 0.02, p < 0.01) and the Impella CP (point estimate -0.007, 95% CI -0.01 - - 0.03, p < 0.01) devices were related to a higher survival rate, whereas the Impella 2.5 was not. Furthermore, a correlation with reduced mortality was found when Impella was initiated in CS not complicated by cardiac arrest (CA), and before revascularization, (point estimate 0.01, 95% CI 0.002-0.02, p < 0.01 and point estimate -0.02, 95% CI 0.023-0.01, p < 0.001 respectively). The vascular complication and major bleeding rate were 7.4% (95% CI 5.6-9.6%) and 15.2% (95% CI 10.7-21%) respectively, and were associated with older age and comorbidities, while the implantation of an Impella CP/2.5 L was associated with fewer complications. CONCLUSIONS Despite the use of Impella the 30 day mortality of CS still remains high. Our data suggest that the use of an Impella CP, initiation of Impella prior to PCI and in patients without cardiac arrest was correlated with outcome improvements.
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Affiliation(s)
- Mario Iannaccone
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy.
| | - Stefano Albani
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Salvatore Colangelo
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Giacomo G Boccuzzi
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Roberto Garbo
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute at Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, MN, United States of America
| | - Fabrizio D'ascenzo
- Department of Cardiology, Città della scienza e della Salute, University of Turin, Turin, Italy
| | | | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
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Pivato CA, Ferrante G, Briani M, Sanz Sanchez J, Reimers B, Pagnotta P. MitraClip Treatment for Severe Mitral Regurgitation Due to Chordae Rupture Following Impella CP Support in a Patient With Severe Aortic Stenosis. Cardiovasc Revasc Med 2020; 28S:118-120. [PMID: 32855084 DOI: 10.1016/j.carrev.2020.08.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
We report the case of an 85-year-old man with severe aortic stenosis who underwent high-risk percutaneous coronary intervention with Impella CP support. Unfortunately, the device caused mitral chordae tendineae rupture leading to severe mitral regurgitation. The patient underwent a staged fully percutaneous treatment with transcatheter aortic valve replacement followed by elective Mitraclip therapy. Echocardiographic monitoring is of paramount importance during Impella insertion and removal in order to avoid and deal with mitral damage. Mitraclip therapy is a feasible rescue therapy for severe mitral regurgitation due to chordae rupture in patients at high risk for surgery.
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Affiliation(s)
- Carlo Andrea Pivato
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Mi, Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
| | - Giuseppe Ferrante
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Mi, Italy
| | - Martina Briani
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Mi, Italy
| | - Jorge Sanz Sanchez
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Mi, Italy
| | - Bernhard Reimers
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Mi, Italy
| | - Paolo Pagnotta
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Mi, Italy
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Roberts N, Chandrasekaran U, Das S, Qi Z, Corbett S. Hemolysis associated with Impella heart pump positioning: In vitro hemolysis testing and computational fluid dynamics modeling. Int J Artif Organs 2020; 43:391398820909843. [PMID: 32126866 DOI: 10.1177/0391398820909843] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 01/25/2023]
Abstract
INTRODUCTION Short-term mechanical circulatory support devices provide temporary hemodynamic support in heart failure and are increasingly used to enable recovery or as a bridge to decision. Blood damage with mechanical circulatory support devices is influenced by many factors, including the magnitude and duration of shear stress and obstruction to blood flow. This study aimed to evaluate the effects of the Impella CP® heart pump positioning on hemolysis using in vitro hemolysis testing and computational fluid dynamics modeling. METHODS The in vitro hemolysis testing was conducted per the recommended Food and Drug Administration and American Society for Testing and Materials guidelines. The bench hemolysis testing and computational fluid dynamics simulation analysis were performed for both normal operating (outlet unobstructed) and outlet-obstructed condition of Impella CP (mimicking outlet on the aortic valve due to improper positioning). RESULTS The modified index of hemolysis was 2.78 ± 0.69 at normal operating conditions compared to 18.7 ± 7.8 when the Impella CP outlet was obstructed (p = 0.002). Computational fluid dynamics modeling showed about three times increase in exposure time to regions of high shear stress when the Impella CP outlet was obstructed compared to unobstructed condition, thus supporting the experimental observations. CONCLUSION Based on these results, it is recommended to ensure proper placement of Impella CP via regular monitoring using echocardiographic guidance or other methods to minimize the risk of hemolysis associated with an obstructed outflow.
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Alraies MC, Soud M, Pacha HM, Waksman R, Ben-Dor I. Cardiogenic Shock Complicating Transcatheter Aortic Valve Replacement Due to Severe Para-Valvular Regurgitation. Cardiovasc Revasc Med 2017; 19:393-395. [PMID: 29146552 DOI: 10.1016/j.carrev.2017.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/28/2017] [Revised: 11/01/2017] [Accepted: 11/03/2017] [Indexed: 10/18/2022]
Abstract
We describe a challenging case of successful use of Impella CP™ to provide emergent left ventricular support following a circulatory collapse during transcatheter valve-in-valve implantation with a CoreValve Evolut R prosthesis.
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Affiliation(s)
- M Chadi Alraies
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC.
| | - Mohamad Soud
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Homam Moussa Pacha
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - Itsik Ben-Dor
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC
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Cena M, Karam F, Ramineni R, Khalife W, Barbagelata A. New Impella Cardiac Power Device Used in Patient with Cardiogenic Shock due to Nonischemic Cardiomyopathy. Int J Angiol 2014; 25:258-262. [PMID: 27867292 DOI: 10.1055/s-0034-1384822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The new percutaneous Impella CP (Cardiac Power; Abiomed, Inc., Danvers, MA) was designed to provide a higher level of support than Impella 2.5 (Abiomed, Inc.). We present the first documented case of a patient that was transitioned from the Impella 2.5 to Impella CP. A 48-year-old male patient with no medical history was transferred to our institution with a one day history of worsening shortness of breath. The patient was unstable and found to have monomorphic ventricular tachycardia at 220 beats/min that was cardioverted to normal sinus rhythm. An emergent right and left heart catheterization was performed showing nonobstructive coronary artery disease, biventricular failure with a left ventricular ejection fraction (LVEF) of 5 to 10%, high pulmonary capillary wedge pressure (PCWP) 22 mm Hg, right atrial (RA) pressure 22 mm Hg, and a very low cardiac index of 1.0 L/min/m2. Because of severe cardiogenic shock, Impella 2.5 was inserted providing flow up to 2.1 L/min; however, the patient remained unstable and critically ill with severe multiorgan failure. To provide better mechanical support, the device was upgraded to the new Impella CP that can provide up to 3.5 L/min of cardiac output. Over the course of the next 72 hours, the patient showed significant improvement in hemodynamics and cardiac function (LVEF 45%), with recovery of liver function. The Impella CP was removed with no complications. The new Impella CP was shown to be safe and effective for prolonged use in critically ill patients and may significantly improve their prognosis.
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Affiliation(s)
- Marek Cena
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX
| | - Frances Karam
- Division of Anesthesiology, Baylor College of Medicine, Houston, TX
| | - Rajesh Ramineni
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX
| | - Wissam Khalife
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX
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Chan W, Seidelin PH. Trans-aortic percutaneous heart valve deployment of Impella CP(TM) to assist in high-risk percutaneous coronary intervention. Heart Lung Circ 2014; 23:e142-4. [PMID: 24525146 DOI: 10.1016/j.hlc.2013.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 12/16/2013] [Accepted: 12/24/2013] [Indexed: 11/21/2022]
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