Marta L. Medina, Daniel Lewin, Hendrik Treede, Sebastian V. Rojas, Alexander Bernhardt, Michael Billion, Anna L. Meyer, Ivan Netuka, Janajade Kooij, Marina Pieri, Antonio Loforte, Mauro Rinaldi, Mariusz K. Szymanski, Adriaan O. Kraajieveld, Christian J.H. Moeller, Payam Akhyari, Khalil Jawad, Bastian Schmack, Gloria Färber, Assad Haneya, Daniel Zimpfer, Gaik Nersesian, Ilija Djordjevic, Diyar Saeed, Finn Gustafsson, Anna M. Scandroglio, Bart Meyns, Steffen Hofmann, Jan Belohlavek, Jan Gummert, Pia Lanmueller, Evgenij V. Potapov, Mehmet Oezkur
{"title":"多中心比较各种微轴泵装置作为持久辅助装置植入的桥梁。","authors":"Marta L. Medina, Daniel Lewin, Hendrik Treede, Sebastian V. Rojas, Alexander Bernhardt, Michael Billion, Anna L. Meyer, Ivan Netuka, Janajade Kooij, Marina Pieri, Antonio Loforte, Mauro Rinaldi, Mariusz K. Szymanski, Adriaan O. Kraajieveld, Christian J.H. Moeller, Payam Akhyari, Khalil Jawad, Bastian Schmack, Gloria Färber, Assad Haneya, Daniel Zimpfer, Gaik Nersesian, Ilija Djordjevic, Diyar Saeed, Finn Gustafsson, Anna M. Scandroglio, Bart Meyns, Steffen Hofmann, Jan Belohlavek, Jan Gummert, Pia Lanmueller, Evgenij V. Potapov, Mehmet Oezkur","doi":"10.1002/ehf2.15282","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aims</h3>\n \n <p>Patients with acute decompensated advanced heart failure requiring left ventricular assist device (LVAD) implantation often experience progressive cardiac function deterioration, negatively impacting surgical outcomes. This study aimed to assess the efficacy of different microaxial flow pump (mAFP) support devices (Impella®) in achieving optimal left ventricular unloading for preconditioning and facilitating definitive treatment in this high-risk patient cohort.</p>\n </section>\n \n <section>\n \n <h3> Methods and results</h3>\n \n <p>A retrospective analysis was conducted across 19 high-volume European centres. The study population included patients transitioning from temporary to durable circulatory support over a 7.5-year period, with a median follow-up of 1 year. Patients were categorized based on mAFP support capacity: those receiving high-flow support (>5 L/min, ‘5+’) and those with lower-flow support (3.5 L/min, ‘CP’). Patients who were initially treated with CP but subsequently upgraded to 5+ support were classified in the 5+ group. Demographic and clinical characteristics, mobilization, right heart function, and organ dysfunction outcomes were analysed. A total of 339 patients received preoperative mAFP support prior to LVAD implantation. The 5+ group comprised 247 patients (73%), including 38 patients who were upgraded from CP, while the CP group included 92 patients (27%). Baseline demographic and clinical characteristics were comparable between groups, except for mobilization status, which showed significant differences (<i>P</i> < 0.001). Patients in the 5+ group achieved higher rates of full and partial mobilization compared to the CP group. Extracorporeal life support (ECLS) was more frequently required in the CP group than in the 5+ group (40.5% vs. 33.8%; <i>P</i> < 0.001). Additionally, right ventricular assist device (RVAD) implantation was significantly more common in the CP group (29.2% vs. 18.2%; <i>P</i> = 0.026). Patients in the 5+ group demonstrated greater reductions in both vasoactive inotropic scores (<i>P</i> = 0.006) and inotropic scores (<i>P</i> = 0.008). Furthermore, liver dysfunction (<i>P</i> = 0.016), renal failure (<i>P</i> = 0.041), and the need for dialysis (<i>P</i> = 0.013) were significantly more prevalent in the CP group. There were no significant differences between the two groups in terms of LVAD operative duration (<i>P</i> = 0.637) or cardiopulmonary bypass time (<i>P</i> = 0.408).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>High-flow mAFP devices (+5) provided superior haemodynamic support, enhanced left ventricular unloading, and reduced dependence on catecholamines compared to lower-flow CP devices. These improvements were associated with lower rates of right ventricular failure, renal dysfunction, and liver injury. However, no statistically significant difference was observed between mAFP groups regarding 30-day mortality rates.</p>\n </section>\n </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"2552-2564"},"PeriodicalIF":3.7000,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15282","citationCount":"0","resultStr":"{\"title\":\"Multicentre comparison of various microaxial pump devices as a bridge to durable assist device implantation\",\"authors\":\"Marta L. Medina, Daniel Lewin, Hendrik Treede, Sebastian V. Rojas, Alexander Bernhardt, Michael Billion, Anna L. Meyer, Ivan Netuka, Janajade Kooij, Marina Pieri, Antonio Loforte, Mauro Rinaldi, Mariusz K. Szymanski, Adriaan O. Kraajieveld, Christian J.H. Moeller, Payam Akhyari, Khalil Jawad, Bastian Schmack, Gloria Färber, Assad Haneya, Daniel Zimpfer, Gaik Nersesian, Ilija Djordjevic, Diyar Saeed, Finn Gustafsson, Anna M. Scandroglio, Bart Meyns, Steffen Hofmann, Jan Belohlavek, Jan Gummert, Pia Lanmueller, Evgenij V. Potapov, Mehmet Oezkur\",\"doi\":\"10.1002/ehf2.15282\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Aims</h3>\\n \\n <p>Patients with acute decompensated advanced heart failure requiring left ventricular assist device (LVAD) implantation often experience progressive cardiac function deterioration, negatively impacting surgical outcomes. This study aimed to assess the efficacy of different microaxial flow pump (mAFP) support devices (Impella®) in achieving optimal left ventricular unloading for preconditioning and facilitating definitive treatment in this high-risk patient cohort.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods and results</h3>\\n \\n <p>A retrospective analysis was conducted across 19 high-volume European centres. The study population included patients transitioning from temporary to durable circulatory support over a 7.5-year period, with a median follow-up of 1 year. Patients were categorized based on mAFP support capacity: those receiving high-flow support (>5 L/min, ‘5+’) and those with lower-flow support (3.5 L/min, ‘CP’). Patients who were initially treated with CP but subsequently upgraded to 5+ support were classified in the 5+ group. Demographic and clinical characteristics, mobilization, right heart function, and organ dysfunction outcomes were analysed. A total of 339 patients received preoperative mAFP support prior to LVAD implantation. The 5+ group comprised 247 patients (73%), including 38 patients who were upgraded from CP, while the CP group included 92 patients (27%). Baseline demographic and clinical characteristics were comparable between groups, except for mobilization status, which showed significant differences (<i>P</i> < 0.001). Patients in the 5+ group achieved higher rates of full and partial mobilization compared to the CP group. Extracorporeal life support (ECLS) was more frequently required in the CP group than in the 5+ group (40.5% vs. 33.8%; <i>P</i> < 0.001). Additionally, right ventricular assist device (RVAD) implantation was significantly more common in the CP group (29.2% vs. 18.2%; <i>P</i> = 0.026). Patients in the 5+ group demonstrated greater reductions in both vasoactive inotropic scores (<i>P</i> = 0.006) and inotropic scores (<i>P</i> = 0.008). Furthermore, liver dysfunction (<i>P</i> = 0.016), renal failure (<i>P</i> = 0.041), and the need for dialysis (<i>P</i> = 0.013) were significantly more prevalent in the CP group. There were no significant differences between the two groups in terms of LVAD operative duration (<i>P</i> = 0.637) or cardiopulmonary bypass time (<i>P</i> = 0.408).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>High-flow mAFP devices (+5) provided superior haemodynamic support, enhanced left ventricular unloading, and reduced dependence on catecholamines compared to lower-flow CP devices. These improvements were associated with lower rates of right ventricular failure, renal dysfunction, and liver injury. However, no statistically significant difference was observed between mAFP groups regarding 30-day mortality rates.</p>\\n </section>\\n </div>\",\"PeriodicalId\":11864,\"journal\":{\"name\":\"ESC Heart Failure\",\"volume\":\"12 4\",\"pages\":\"2552-2564\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2025-04-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15282\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ESC Heart Failure\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/ehf2.15282\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ESC Heart Failure","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ehf2.15282","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Multicentre comparison of various microaxial pump devices as a bridge to durable assist device implantation
Aims
Patients with acute decompensated advanced heart failure requiring left ventricular assist device (LVAD) implantation often experience progressive cardiac function deterioration, negatively impacting surgical outcomes. This study aimed to assess the efficacy of different microaxial flow pump (mAFP) support devices (Impella®) in achieving optimal left ventricular unloading for preconditioning and facilitating definitive treatment in this high-risk patient cohort.
Methods and results
A retrospective analysis was conducted across 19 high-volume European centres. The study population included patients transitioning from temporary to durable circulatory support over a 7.5-year period, with a median follow-up of 1 year. Patients were categorized based on mAFP support capacity: those receiving high-flow support (>5 L/min, ‘5+’) and those with lower-flow support (3.5 L/min, ‘CP’). Patients who were initially treated with CP but subsequently upgraded to 5+ support were classified in the 5+ group. Demographic and clinical characteristics, mobilization, right heart function, and organ dysfunction outcomes were analysed. A total of 339 patients received preoperative mAFP support prior to LVAD implantation. The 5+ group comprised 247 patients (73%), including 38 patients who were upgraded from CP, while the CP group included 92 patients (27%). Baseline demographic and clinical characteristics were comparable between groups, except for mobilization status, which showed significant differences (P < 0.001). Patients in the 5+ group achieved higher rates of full and partial mobilization compared to the CP group. Extracorporeal life support (ECLS) was more frequently required in the CP group than in the 5+ group (40.5% vs. 33.8%; P < 0.001). Additionally, right ventricular assist device (RVAD) implantation was significantly more common in the CP group (29.2% vs. 18.2%; P = 0.026). Patients in the 5+ group demonstrated greater reductions in both vasoactive inotropic scores (P = 0.006) and inotropic scores (P = 0.008). Furthermore, liver dysfunction (P = 0.016), renal failure (P = 0.041), and the need for dialysis (P = 0.013) were significantly more prevalent in the CP group. There were no significant differences between the two groups in terms of LVAD operative duration (P = 0.637) or cardiopulmonary bypass time (P = 0.408).
Conclusions
High-flow mAFP devices (+5) provided superior haemodynamic support, enhanced left ventricular unloading, and reduced dependence on catecholamines compared to lower-flow CP devices. These improvements were associated with lower rates of right ventricular failure, renal dysfunction, and liver injury. However, no statistically significant difference was observed between mAFP groups regarding 30-day mortality rates.
期刊介绍:
ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.