Mechanical circulatory support. An expert opinion statement from the Association of Intensive Cardiac Care and Association of Cardiovascular Interventions of the Polish Cardiac Society

Kardiol Pol. 2021 Dec 3. doi: 10.33963/KP.a2021.0169. Online ahead of print.ABSTRACTMechanical circulatory support (MCS) methods are used in patients with both acute and chronic heart failure, who have depleted the options for pharmacological or surgical treatment. The purpose of their use is to partially or completely support the failure ventricles and ensure adequate organ perfusion, which allows patients to restore full cardiovascular capacity, prolonging life and effectively improving its quality. Three most popular devices include intra-aortic balloon pump (IABP), percutaneous assist devices (including Impella, TandemHeart), and venoarterial extracorporeal membrane oxygenation (VA-ECMO). A multidisciplinary approach with the special participation of the Heart Team is required in order to determine the proper MCS strategy, the choice of the supporting method, and the time of its use. The studies published so far do not allow to clearly determine which MCS method is the safest and the most effective. Thus, the site experience and accessibility of the method seem to matter most today. MCS finds particular application in patients with acute coronary syndromes complicated by refractory cardiogenic shock, as well as in patients with acute heart failure of the high potential for reversibility. They can also serve as a back-up for percutaneous coronary interventions of high risk (complex and high-risk indicated PCI, CHIP). The use of appropriate supportive drugs, precise haemody...
Source: Polish Heart Journal - Category: Cardiology Authors: Source Type: research

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Acta Chir Belg. 2022 Jan 25:1-12. Online ahead of print.ABSTRACTThe continuous-flow left ventricular assist device (CF-LVAD) is used to save the lives of patients in the final stage of congestive heart failure, replacing the pump function of the left ventricle. Although quality of life increases significantly, CF-LVAD-related complications might prove fatal, as in the case presented in this paper. A 20-year-old female, during her second pregnancy, presented with signs of heart failure. Emergency caesarean section was necessary to save the baby, but peripartum cardiomyopathy developed in the mother. The use of an implantabl...
Source: Acta Chirurgica Belgica - Category: Surgery Authors: Source Type: research
CONCLUSIONS: Implementation of a temporary MCS program for refractory CS in a limited resource country is feasible. The learning curve effect might have played a role on survival rate since high morbimortality has decreased within time reaching optimal results by the end of the study.PMID:35075937 | DOI:10.1177/03913988211070841
Source: The International Journal of Artificial Organs - Category: Transplant Surgery Authors: Source Type: research
Curr Probl Cardiol. 2021 Dec 19:101086. doi: 10.1016/j.cpcardiol.2021.101086. Online ahead of print.ABSTRACTBACKGROUND: Hospital readmissions post-acute myocardial infarctions (AMIs) are associated with adverse cardiovascular outcomes and also incur huge healthcare costs. Patients with systemic lupus erythematosus (SLE) are at an increased risk of AMI likely due to multi-factorial mechanisms including higher levels of inflammation and accelerated atherosclerosis. We investigated if patients with SLE are at higher risk of hospital readmissions post-AMI compared to the patients without SLE. Furthermore, we sought to assess i...
Source: Atherosclerosis - Category: Cardiology Authors: Source Type: research
AbstractCardiogenic shock (CS) is a complex multifactorial clinical syndrome, developing as a continuum, and progressing from the initial insult (underlying cause) to the subsequent occurrence of organ failure and death. There is a large phenotypic variability in CS, as a result of the diverse aetiologies, pathogenetic mechanisms, haemodynamics, and stages of severity. Although early revascularization remains the most important intervention for CS in settings of acute myocardial infarction, the administration of timely and effective antithrombotic therapy is critical to improving outcomes in these patients. In addition, ot...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Review Source Type: research
We describe the stepwise management of anticoagulation in a coagulopathic patient with persistent cardiogenic shock following a coronary artery bypass procedure who underwent Impella 5.5 placement. A direct thrombin inhibitor-based purge solution was utilized while evaluating for heparin-induced thrombocytopenia. The use of a novel bicarbonate-based purge solution (BBPS) was successfully used due to severe coagulopathy. There were no episodes of pump thrombosis or episodes of severe bleeding on the BBPS and systemic effects of alkalosis and hypernatremia were minimal.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: CASE REPORT Source Type: research
ConclusionsSTE-aVR with multilead ST depression was associated with acutely thrombotic coronary occlusion in only 10% of patients. Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important.
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Conclusion: AKI in the setting of TMVr is common and is associated with worse clinical outcomes. Further studies are needed to determine if optimizing renal function prior to TMVr may improve outcomes, as well as to understand the impact of TMVr itself on renal function.Cardiology
Source: Cardiology - Category: Cardiology Source Type: research
CULPRIT-SHOCK Clinical Trial – Review Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK) trial investigated two strategies for percutaneous coronary interventions (PCI) in acute myocardial infarction with cardiogenic shock [1]. It was a multicenter randomized trial involving 706 patients who were randomized to either immediate PCI of the culprit lesion only with option for staged PCI of non-culprit lesions or immediate multivessel PCI. Primary composite endpoint included death and severe renal failure leading to renal replacement therapy within 30 days after randomization. Primary co...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Angiography and Interventions Coronary Interventions Source Type: blogs
AbstractAimsBecause reported mortality on veno ‐arterial (V‐A) extracorporeal life support (ECLS) substantially varies between centres, the aim of the current analysis was to assess the outcomes between units performing heart transplantation and/or implanting ventricular assist device (HTx/VAD) vs. non‐HTx/VAD units in patients undergoing V‐A ECLS for cardiogenic shock.Methods and resultsSystematic search according to the Preferred Reporting Items for Systematic Reviews and Meta ‐Analyses was performed using PubMed/MEDLINE databases until 30 November 2019. Articles reporting in‐hospital/30‐day mortality and c...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
Ann Thorac Surg. 2021 Mar 18:S0003-4975(21)00522-1. doi: 10.1016/j.athoracsur.2021.02.086. Online ahead of print.ABSTRACTPost-infarction ventricular-septal-rupture (VSR) represents a well-known mechanical complication of myocardial infarction, determining cardiogenic shock with high mortality rates. Surgical correction requires significant expertise to avoid cardiac rupture, uncontrollable bleeding, residual shunts, heart failure and death. In the last year, we observed a substantial increase of VSR at our hospital, related to the delayed presentation of people with acute chest pain to the emergency departments during the ...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Source Type: research
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