Midterm Outcomes of Bridge-to-Recovery Patients After Short-Term Mechanical Circulatory Support

Publication date: August 2019Source: The Annals of Thoracic Surgery, Volume 108, Issue 2Author(s): Yi-Tso Cheng, Arthur R. Garan, Joseph Sanchez, Paul Kurlansky, Masahiko Ando, Marisa Cevasco, Melana Yuzefpolskaya, Paolo C. Colombo, Yoshifumi Naka, Hiroo Takayama, Koji TakedaBackgroundThe use of short-term mechanical circulatory support (ST-MCS) has increased for refractory cardiogenic shock. However, there are scant data about bridge-to-recovery patients.MethodsWe retrospectively reviewed 502 patients with cardiogenic shock who received venoarterial extracorporeal membrane oxygenation or a temporary surgical ventricular assist device as ST-MCS between 2010 and 2016. There were 178 patients (35.5%) who survived through device explantation. Of these, 149 patients (29.7%) survived to discharge and were included for analysis. The primary outcome was midterm survival without undergoing heart replacement therapy.ResultsIn our bridge-to-recovery cohort, 101 patients (67.8%) were men, and the median age was 59 years (interquartile range, 51 to 67 years). Etiology of cardiogenic shock included postcardiotomy shock in 35.6% of patients (n = 53), allograft failure in 26.8% (n = 40), acute myocardial infarction (AMI) in 24.2% (n = 36), and other acute decompensated heart failure in 14.4% (n = 20). There were 24 major events (16.1%) recorded, including 21 patients who died and 3 patients who received heart replacement therapy during median follow-up of 306 days (inter...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research

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CARDIOGENIC SHOCK is a state of inadequate end-organ perfusion resulting from myriad causes, including ischemia, myocarditis, acute and chronic heart failure, postcardiotomy, and post-transplantation. It is the leading cause of death among patients experiencing acute myocardial infarction, with a mortality of 40% to 50%.1 Treatment generally includes revascularization for ischemia and supportive care with inotropes, vasopressors, and fluids as needed. Refractory cardiogenic shock is defined as ongoing hypoperfusion despite the administration of multiple vasoactive medications and treatment of the underlying cause.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Pro and Con Source Type: research
AbstractAimWe sought to describe the contemporary annual incidence of cardiogenic shock (CS) following acute myocardial infarction (AMICS), the proportion of patients developing CS following ST ‐elevation myocardial infarction (STEMI), and other temporal changes in AMICS in Denmark between 2010 and 2017.Methods and resultsMedical records of patients suspected of having AMICS during 2010 –2017 were reviewed to identify consecutive patients with AMICS in a cohort corresponding to two‐thirds of the Danish population. Due to changes in recruitment area over the study period, population‐based incidence could only be...
Source: European Journal of Heart Failure - Category: Cardiology Authors: Tags: Research Article Source Type: research
Authors: Alsadat N, Hyun K, D'Souza M, Chew D, Weaver J, Juergens C, Kritharides L, Hammett C, Brieger D Abstract BACKGROUND: Approximately 50% of patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) have multivessel coronary disease (MVD). Evidence on the best PCI approach for these patients is conflicting. The aim of this study is to examine Australian data from the CONCORDANCE registry to describe the practice and outcomes of patients receiving multivessel vs culprit-only PCI. METHODS: Two cohorts were constructed from MVD-STEMI patients undergoi...
Source: The Journal of Invasive Cardiology - Category: Cardiology Tags: J Invasive Cardiol Source Type: research
ConclusionsThe incidence of arrhythmia and shock in patients with TTC does not correlate with the extent of myocardium involvement. The presence of LBBB in such cases can help recognize at-risk populations, and with timely intervention, life-threatening complications can be avoided. Despite limitations of the dataset and inability to establish causality, prospective studies with longer follow-up are warranted.
Source: Cardiology and Therapy - Category: Cardiology Source Type: research
Healthcare-associated infections (HAI) are generally preventable causes of increased cost, morbidity, and mortality. Further, HAI carry penalties in the era of hospital value-based care. However, very little is known about the incidence and outcomes of HAI among patients hospitalized with common cardiovascular conditions. Using a national database, we identified adults aged ≥18 years hospitalized with 5 common cardiovascular conditions, including heart failure (HF), acute myocardial infarction (AMI), coronary artery bypass grafting (CABG), cardiogenic shock, and atrial fibrillation or flutter (AF).
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
AbstractAimsTo evaluate sex ‐specific disparities in acute kidney injury (AKI) complicating acute myocardial infarction‐related cardiogenic shock (AMI‐CS) in the United States.Methods and resultsThis was a retrospective cohort study from 2000 to 2014 from the National Inpatient Sample (20% sample of all hospitals in the United States). Patients>18  years admitted with a primary diagnosis of AMI and concomitant CS that developed AKI were included. The endpoints of interest were the prevalence, trends, and outcomes of men and women with AKI in AMI‐CS. Multivariable hierarchical logistic regression was used to...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Short Communication Source Type: research
Early initiation of mechanical circulatory support improves survival in patients with acute myocardial infarction (MI) complicated by refractory cardiogenic shock. In contrast, the potential benefits of mechanical support in MI patients without overt cardiogenic shock remain unclear. In patients with acute anterior ST elevation MI (STEMI), early mechanical support through intra-aortic balloon counterpulsation (IABC) prior to percutaneous coronary intervention (PCI) did not affect infarct size. However, 6  months after the acute event, the exploratory composite endpoint of time to death, shock or new or worsening heart fa...
Source: International Journal of Cardiology - Category: Cardiology Authors: Tags: Editorial Source Type: research
This article describes a patient who presented with an ST-segment elevation myocardial infarction that quickly developed into acute cardiogenic shock refractory to conventional medical therapy. Extracorporeal membrane oxygenation was used to manage the patient's heart failure and bridge to a long-term left ventricular assist device.
Source: Journal of the American Academy of Physician Assistants - Category: Primary Care Tags: Case Report Source Type: research
ConclusionsEmergency ECLS is a valuable option among patients with AMI-induced CS with low and intermediate IABP SHOCK II risk scores. ECLS weaning is manageable but additional revascularization of all non-culprit lesions is mandatory after ECLS implementation.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
CONCLUSIONS: Emergency ECLS is a valuable option among patients with AMI-induced CS with low and intermediate IABP SHOCK II risk scores. ECLS weaning is manageable but additional revascularization of all non-culprit lesions is mandatory after ECLS implementation. PMID: 31175870 [PubMed - as supplied by publisher]
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
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