A New Paradigm in Mechanical Circulatory Support: 100-Patient Experience
| Autor: | Akbarshakh Akhmerov, Alfredo Trento, J. Chung, Jon A. Kobashigawa, Danny Ramzy, R. Cole, Fardad Esmailian, D. Megna, Jaime Moriguchi, Dominic Emerson |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Acute decompensated heart failure medicine.medical_treatment 030204 cardiovascular system & hematology Single Center Ventricular Function Left 03 medical and health sciences 0302 clinical medicine Internal medicine Humans Medicine Registries Impella Retrospective Studies Heart Failure Heart transplantation Ejection fraction business.industry Stroke Volume Middle Aged medicine.disease Right Ventricular Assist Device Treatment Outcome 030228 respiratory system Ventricular assist device Heart failure Acute Disease Cardiology Female Surgery Heart-Assist Devices Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 109:1370-1377 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2019.08.041 |
| Popis: | Acutely decompensated heart failure presents a complicated challenge. Established temporary support measures have significant adverse effects. A minimally invasive temporary left ventricular assist device (LVAD), the Impella 5.0 (Abiomed, Danvers, MA), has been developed to support these patients.Patients with acutely decompensated heart failure in whom medical management had failed and who required additional support using an Impella 5.0 device were evaluated from January 2014 to September 2018 at a single center in a retrospective manner using a prospectively maintained database. Patients were treated with the device as a bridge to recovery (BTR; n = 30), bridge to durable device (BTDD; n = 23), or bridge to transplantation (BTT; n = 47). All devices were placed using an axillary artery approach. Demographic features and outcomes were evaluated for each group and compared.A total of 100 patients underwent insertion of an axillary Impella 5.0 LVAD. Patients had an average age of 56.7 ± 13.2 years, were predominantly male (84%), and had a severely depressed left ventricular ejection fraction (average 16%), and most had an Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 (57%) or 2 (33%) score. When divided into groups, there was no difference in age or INTERMACS score, but a statistical difference was noted in baseline left ventricular ejection fraction (20%, 14%, 15%) and creatinine level (1.0, 2.0, 1.6), in the BTR, BTDD, or BTT group, respectively (all P.05). Survival was 64% overall, and it was 50%, 48%, and 81% for BTR, BTDD, and BTT, respectively (P = .007). Survival improved during this experience and was 90% overall in the most recent 30 patients.Use of this minimally invasive LVAD system is an attractive strategy to support patients with acute decompensated heart failure to recovery, durable LVAD, or heart transplantation. |
| Databáze: | OpenAIRE |
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