International Perfusion Association

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Category: VAD

Superman Impella

The Role of Impella in the Pre-Procedural Management of Post-Infarct Ventricular Septal Defect: A Systematic Review

This systematic review explores the use of the Impella device in patients with post-infarct ventricular septal defect (VSD) prior to definitive treatment. Analyzing 68 patients across 20 studies, the Impella improved hemodynamic stability, reduced left ventricular strain, and delayed urgent intervention. Patients with surgically-placed Impella devices showed lower mortality and fewer complications compared to percutaneous alternatives. While effective, complications like bleeding and hemolysis must be carefully managed.

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December 17, 2024
Five Pillars

Acute Right Ventricular Heart Failure, ECMO, RVAD, Hemodynamic Support, Five Pillars Framework

A conceptual representation of the “Five Pillars” framework for aRHF therapy. The image shows five pillars, each labeled with key aspects: Etiological Treatment, Hemodynamic Support, Ventilation, Fluid Optimization, and Mechanical Support. A heart is balanced on top of these pillars, symbolizing stability. The design is clean and professional, with subtle arrows indicating the interconnectedness of the pillars.

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December 3, 2024
Bad Impella

Efficacy and Safety of Impella in Cardiogenic Shock Following Acute Myocardial Infarction: A Meta-Analysis of Randomized Controlled Trials

This meta-analysis reviewed four randomized controlled trials (442 patients) to evaluate the use of Impella in managing cardiogenic shock (CS) following acute myocardial infarction (AMI). Impella reduced 6-month all-cause mortality (OR: 0.64, 95% CI: 0.43-0.95, P = .03) but showed no significant impact on 30-day mortality. However, Impella was linked to increased risks of major bleeding (OR: 3.61), limb ischemia (OR: 4.91), and sepsis (OR: 2.75). Future research is needed to balance survival benefits against these complications.

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December 3, 2024
VAD Rehab

Effects of Cardiac Rehabilitation in Patients with Ventricular Assist Devices: A Scoping Review

This review explores the impact of cardiac rehabilitation programs on patients with ventricular assist devices (VADs). It highlights the benefits of exercise-based rehabilitation in improving cardiorespiratory fitness and exercise tolerance. The most common approach is high-intensity interval training (HIIT), followed by moderate-intensity exercise. The findings suggest that cardiac rehabilitation is safe and effective for VAD patients, leading to improved health outcomes.

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September 21, 2024

Hospital Readmissions in Patients Supported with Durable Centrifugal-Flow Left Ventricular Assist Devices

The study examines hospital readmissions in patients with centrifugal-flow left ventricular assist devices (CF-LVADs), highlighting the commonality and impact on patient outcomes. Analyzing data from 204 patients, 67.7% experienced heart failure (HF)/LVAD-related readmissions, mainly due to major bleeding, infection, HF exacerbation, and neurological dysfunction. Using machine learning models, several pre-, intra-, and post-operative factors were identified as predictors of readmission risk, which can guide strategies to improve patient management and outcomes.

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May 28, 2024
LVAD

Escalating Surgical Treatment for Left Ventricular Assist Device Infection and Expected Mortality: Clinical Risk Prediction Score

This study evaluates the mortality risk associated with infections in patients with left ventricular assist devices (LVAD). It highlights the development of a clinical risk prediction score based on factors like diabetes, type of Staphylococcus aureus infection, and treatment approaches including surgical debridement and flap reconstruction. Results indicate varying survival rates based on risk scores, suggesting that tailored surgical interventions may improve outcomes for patients with LVAD infections.

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April 23, 2024
Cardiogenic Shock

Identifying and Mitigating Risk of Post-Cardiotomy Cardiogenic Shock in Patients with Ischemic and Non-Ischemic Cardiomyopathy

This study aimed to identify preoperative predictors of post-cardiotomy cardiogenic shock in patients with ischemic and non-ischemic cardiomyopathy, focusing on 238 patients undergoing cardiac surgery. It found that pulmonary artery pulsatility index and pulmonary capillary wedge pressure were key predictors, with the predictors varying between ischemic and non-ischemic conditions. The study highlights the importance of preoperative right heart catheterization in identifying patients at higher risk of cardiogenic shock. Ejection fraction improvements were noted at 12 months post-surgery.

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March 14, 2024
ECMO

Left-Ventricular Unloading With Impella During Refractory Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis evaluates the efficacy of left-ventricular (LV) unloading with Impella, compared to standard venoarterial extracorporeal membrane oxygenation (VA-ECMO), during extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest. Analyzing data from 1014 patients across 32 hospitals, the study finds that ECMELLA (combined Impella and VA-ECMO) is associated with improved survival and neurological outcomes, especially in patients with acute myocardial infarction, compared to VA-ECMO alone. Despite a higher rate of complications, ECMELLA shows promise in enhancing patient recovery, underscoring the need for standardized guidelines for its use in ECPR.

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February 22, 2024
Mechanical Support

Mechanical Circulatory Support – Primer for Consultant Specialists

This article serves as a primer on mechanical life support therapies, focusing on nonrenal extracorporeal life support for cardiac and pulmonary functions. It targets nephrologist consultants involved in treating critically ill patients, often facing acute renal injury from cardiopulmonary shock and mechanical circulatory support. The review underscores the importance of these life-sustaining tools in managing organ failure, either as a bridge to recovery or as a gateway to more permanent mechanical support solutions.

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February 5, 2024
LVAD

Evolution of Mechanical Circulatory Support for Advanced Heart Failure

This comprehensive review explores the significant advancements in Left Ventricular Assist Device (LVAD) therapy, particularly the evolution from early pulsatile flow systems to cutting-edge continuous-flow devices like the HeartMate 3 (HM3) LVAD. The review emphasizes improved survival rates, reduced complications, and enhanced quality of life for patients with advanced heart failure, discussing the dual role of LVADs as a bridge-to-transplantation and destination therapy, as well as emerging technologies and therapies for more effective, patient-centered treatment modalities.

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January 22, 2024
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