Impella as Bridge to Durable Left Ventricular Assist Device in Acute Myocardial Infarction Cardiogenic Shock Patients.

IF 3.1 3区 医学 Q2 ENGINEERING, BIOMEDICAL
ASAIO Journal Pub Date : 2024-11-01 Epub Date: 2024-03-27 DOI:10.1097/MAT.0000000000002201
Silvia Ajello, Marina Pieri, Sara Dormio, Luca Baldetti, Savino Altizio, Filippo Consolo, Pasquale Nardelli, Alessandro Ortalda, Anna Mara Scandroglio
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Abstract

Implantation of durable left ventricular assist device (LVAD) in cardiogenic shock (CS) patients after acute myocardial infarction (AMI) poses specific challenges (small left ventricular size, acute infarct area, need for antithrombotic therapy, status Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 1 with impaired organ function and derangements in coagulation and inflammatory parameters) which may affect outcomes. We reviewed data of all AMI-CS patients who were implanted LVAD after Impella support at a referral center with the aim to analyze feasibility, timing, and outcomes of durable LVAD implantation after tMCS with Impella due to AMI-CS. Twenty-one patients were treated between 2013 and 2023: all were in Society for Cardiovascular Angiography & Interventions (SCAI) class D-E and INTERMACS 1-2 at presentation, median LV ejection fraction (EF) and LV end-diastolic diameter (EDD) were 15 (10-20)% and 57 (54-60) mm, respectively. Eleven patients (52%) were supported with Impella CP, seven with Impella 5.0 (33%), and three (14%) with Impella 2.5. Axillary cannulation was performed in nine patients (43%). Five patients (24%) had concomitant venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. Median duration of Impella support was 12 (8-14) days. Overall, the use of Impella was characterized by low rate of complications and allowed successful bridge to durable LVAD in all patients, with 100% 30 day survival rate.

在急性心肌梗死心源性休克患者中,Impella 是连接耐用左心室辅助装置的桥梁。
为急性心肌梗死(AMI)后的心源性休克(CS)患者植入耐久性左心室辅助装置(LVAD)具有特殊的挑战性(左心室体积小、急性梗死面积大、需要抗血栓治疗、处于机械辅助循环支持机构间注册(INTERMACS)1状态、器官功能受损以及凝血和炎症参数紊乱),可能会影响治疗效果。我们回顾了在一家转诊中心接受 Impella 支持后植入 LVAD 的所有 AMI-CS 患者的数据,旨在分析因 AMI-CS 而接受 Impella tMCS 后植入耐用 LVAD 的可行性、时机和疗效。21 名患者在 2013 年至 2023 年期间接受了治疗:所有患者在发病时均属于心血管造影和介入学会(SCAI)D-E 级和 INTERMACS 1-2 级,左心室射血分数(EF)和左心室舒张末期直径(EDD)的中位数分别为 15 (10-20)% 和 57 (54-60) mm。11 名患者(52%)使用 Impella CP,7 名患者(33%)使用 Impella 5.0,3 名患者(14%)使用 Impella 2.5。九名患者(43%)进行了腋窝插管。五名患者(24%)同时接受了静脉动脉体外膜肺氧合(VA-ECMO)支持。Impella支持的中位持续时间为12(8-14)天。总体而言,使用 Impella 的特点是并发症发生率低,所有患者都能成功过渡到耐用的 LVAD,30 天存活率为 100%。
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来源期刊
ASAIO Journal
ASAIO Journal 医学-工程:生物医学
CiteScore
6.60
自引率
7.10%
发文量
651
审稿时长
4-8 weeks
期刊介绍: ASAIO Journal is in the forefront of artificial organ research and development. On the cutting edge of innovative technology, it features peer-reviewed articles of the highest quality that describe research, development, the most recent advances in the design of artificial organ devices and findings from initial testing. Bimonthly, the ASAIO Journal features state-of-the-art investigations, laboratory and clinical trials, and discussions and opinions from experts around the world. The official publication of the American Society for Artificial Internal Organs.
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