微轴血流泵治疗心源性休克:对血液动力学、溶血和末端器官恢复的影响

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Lauren E. Parker, Lillian Kang, Carmelo A. Milano, Alejandro A. Lobo, Julie W. Doberne, Muath Bishawi, Christopher. W. Jensen, Chetan B. Patel, Adam D. DeVore, Stuart D. Russell, Jason N. Katz, Jacob N. Schroder
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引用次数: 0

摘要

背景。Impella 5.5 为左心室机械支持提供了一种创伤较小的经瓣方法。对耐用左心室辅助装置的内脏恢复和溶血情况进行了深入研究,但 Impella 5.5 对这些参数的影响还没有得到很好的描述。方法。对一家机构 2020 年 8 月至 2023 年 6 月期间所有 Impella 5.5 的接受者进行了审查。比较了植入前和设备移除前的血液动力学和实验室值。溶血定义为术后乳酸脱氢酶 1000 IU/L,同时无血浆血红蛋白 50 mg/dL。配对 Wilcoxon 检验比较了植入前和植入前数值差异的中位数。结果。我们对 127 例连续植入 Impella 5.5 的患者进行了研究。有 31 例患者同时进行了 VA-ECMO,1 例患者在 LVAD 持久置换后接受了 Impella 5.5;这些病例被排除在外。我们的最终队列包括 95 名患者,平均年龄为 55.29 ± 14.5 岁。中位植入时间为 11 天(IQR:6-16 天)。为了避免血流动力学因素的干扰,我们将血流动力学分析限制在 37 名接受了单独 Impella 5.5 的患者,排除了之前接受过 IABP、Impella CP、急性心肌梗死或之前接受过心脏手术的患者。这些患者的肺血管阻力(-77.03 达因/秒/厘米-5,p < 0.01)和楔压(-6.5 毫米汞柱,p < 0.01)比基线有所改善。此外,心脏指数也比基线有所改善(+1.3,p <0.01)。在所有患者(95 人)中,植入前肌酐(-0.2 mg/dL,p <0.01)和谷丙转氨酶(-9.0 mg/dL,p <0.01)与植入前相比均有所下降。23名患者(24%)达到了溶血标准,但没有人因临床上明显的溶血而拆除装置。25 名患者需要取回装置,其中 22 人是因为腋窝血肿。结论。Impella 5.5 支持可在短期内改善内脏器官功能和血液动力学指标,包括 PVR。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Microaxial Flow Pumps for Cardiogenic Shock: Effects on Hemodynamics, Hemolysis, and End-Organ Recovery

Microaxial Flow Pumps for Cardiogenic Shock: Effects on Hemodynamics, Hemolysis, and End-Organ Recovery

Background. The Impella 5.5 offers a less invasive transvalvular approach to left ventricular mechanical support. End-organ recovery and hemolysis have been well-studied with durable left ventricular assist devices but effects of Impella 5.5 on these parameters are less well described. Methods. All Impella 5.5 recipients between August 2020 and June 2023 were reviewed from a single institution. Hemodynamics and laboratory values were compared between preimplant and prior to device removal. Hemolysis was defined as postoperative lactate dehydrogenase >1000 IU/L with concurrent plasma-free hemoglobin >50 mg/dL. Paired Wilcoxon tests compared the median of differences between preimplant and pre-explant values. Results. We studied 127 consecutive implants of the Impella 5.5. Thirty-one patients had concomitant VA-ECMO, and one received Impella 5.5 after durable LVAD explant; these cases were excluded. Our final cohort included 95 patients, with an average age of 55.29 ± 14.5 years. Median implant duration was 11 days (IQR:6–16 days). To avoid confounding hemodynamic factors, we restricted hemodynamic analysis to the 37 patients who received isolated Impella 5.5, excluding those with prior IABP, Impella CP, acute MI, or prior cardiac surgery. These patients experienced improvements from baseline in pulmonary vascular resistance (−77.03 dynes/sec/cm−5, p < 0.01) and wedge pressure (−6.5 mmHg, p < 0.01). Furthermore, cardiac index improved from baseline (+1.3, p < 0.01). In the total cohort (n = 95), pre-explant creatinine (−0.2 mg/dL, p < 0.01) and ALT (−9.0 mg/dL, p < 0.01) decreased relative to values before the implant. Twenty-three (24%) met criteria for hemolysis; however, none underwent device removal for clinically significant hemolysis. Takeback was required in 25 patients, 22 of which were for axillary hematoma. Conclusions. Impella 5.5 support acutely improved markers of end-organ function and hemodynamics, including PVR.

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来源期刊
CiteScore
2.90
自引率
12.50%
发文量
976
审稿时长
3-8 weeks
期刊介绍: Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.
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