International Perfusion Association

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Category: VAD

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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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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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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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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Impella Device

Randomized Trials of Percutaneous Microaxial Flow Pump Devices

The rising use of mechanical circulatory support devices, particularly the Impella percutaneous microaxial flow pump, has become increasingly prevalent in cardiovascular practice for various purposes including hemodynamic support and organ protection. Despite their growing popularity, concerns exist due to limited randomized clinical trial data and potential complications such as vascular issues, cardiac perforations, and stroke, necessitating further research and upcoming trials to evaluate their safety and efficacy.

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Impella ECMO

ECMO and Impella Support Strategies as a Bridge to Surgical Repair of Post-Infarction Ventricular Septal Rupture

This review evaluates the use of Impella and venoarterial extracorporeal membranous oxygenation (VA-ECMO) as strategies to stabilize patients with post-infarct ventricular septal rupture (PIVSR) before surgical repair, based on a case report and a systematic literature review. While both Impella and VA-ECMO have shown better outcomes compared to traditional management, they present unique advantages and challenges; Impella effectively unloads the left ventricle but may cause shunt reversal, whereas VA-ECMO improves organ perfusion but has higher complication risks and may require additional ventricular unloading.

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Impella Image

Modelling and Simulation of the Combined Use of IABP and Impella as a Rescue Procedure in Cardiogenic Shock: An Alternative for Non-Transplant Centres?

This paper investigates the synergistic effect of combining the Intra-Aortic Balloon Pump (IABP) and Impella 2.5 device as mechanical circulatory support in managing cardiogenic shock. Using a cardiovascular system simulator, it demonstrates that this combined approach offers better support in the acute phase of cardiogenic shock than using either device alone, potentially stabilizing patients for transfer to a transplant center.

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Heart Failute

Test Bench for Right Ventricular Failure Reversibility: The Hybrid BiVAD Concept

Patients with biventricular cardiogenic shock, ineligible for heart transplantation, may benefit from a micro-invasive hybrid BiVAD approach, combining the ProtekDuo cannula and the Impella 5.5 trans-aortic pump. This strategy, beyond ECMO, allows for physiological circulation, biventricular unloading, and accurate evaluation of right ventricular function, leading to the possibility of transitioning to less invasive, durable left ventricular assist device (LVAD) implantation.

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Artificial Intelligence-Based Analysis of Body Composition Predicts Outcome in Patients Receiving Long-Term Mechanical Circulatory Support

This study used artificial intelligence to analyze preoperative CT scans of heart failure patients receiving left ventricular assist device (LVAD) implantations, revealing that greater adipose tissue areas are associated with higher postoperative complications and in-hospital mortality. It concluded that preoperative body composition, particularly adipose tissue, can predict poorer outcomes post-LVAD implantation, impacting postoperative quality of life and walking distance.

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Mechanical Circulatory Support in Cardiogenic Shock

The abstract outlines the evolving management of cardiogenic shock, highlighting the transition to using temporary mechanical circulatory support (t-MCS) like IABP, VA-ECMO, Impella, and ECPELLA, informed by advances in circulatory physiology. It emphasizes the importance of selecting appropriate t-MCS devices based on patient-specific conditions, shock stage, and risk, guided by hemodynamic monitoring and a multidisciplinary team approach.

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