1,721,044 research outputs found
Google’s loss of pulse detection: Unwitnessed cardiac arrest ‘witnessed’ by a smartwatch
No full textAcute right ventricular failure post ascending aorta surgery
No full textThis case report describes a case of acute right ventricular failure caused by aortopulmonary fistula post ascending aorta surgery. © 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved
Full percutaneous biventricular support with two Impella pumps: the Bi-Pella approach
No full textExtracorporeal membrane oxygenation is used for acute respiratory distress syndrome, refractory cardiogenic shock, and out-of-hospital cardiac arrest with uncertain neurological status, and, until recently, it was the only minimally invasive option to achieve biventricular support. However, extracorporeal membrane oxygenation increases left ventricular afterload and requires systemic anticoagulation, which is a major contraindication in the context of thrombolytic therapy following an ischaemic stroke. Conversely, the Impella heart pumps by design unload the ventricle and require minimal anticoagulation. We report the first case of mechanical circulatory supported with Impella CP on the left and Impella RP on the right (Abiomed Inc., Danvers, MA) for acute biventricular failure due to suspected acute myocarditis in the context of thrombolytic therapy for ischaemic stroke
Intra-aortic balloon pump during venoarterial extracorporeal membrane oxygenation: still a matter of debate? Contemporary multi-device approach to cardiogenic shock
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Impella Versus VA-ECMO for Patients with Cardiogenic Shock: Preliminary Cost-Effectiveness Analysis in the Italian Context
Full text linkBackground: Cardiogenic shock (CS) is a life-threatening failure of the heart to supply adequate blood, requiring immediate treatment. Although nowadays Impella® heart pumps and veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) are both widely employed in routine clinical practice for the management of patients with CS, extensive comparative information on their cost-effectiveness is lacking. The aim of the present study was to conduct a cost-effectiveness analysis comparing Impella to VA-ECMO in patients with CS from the National Healthcare Service (NHS) perspective in Italy. A secondary objective was to compare costs from both NHS and hospital perspectives.
Methods: A Markov model projected, on a lifetime horizon, life years (LYs), quality-adjusted life years (QALYs) and costs associated with Impella and VA-ECMO. Costs from the NHS perspective were estimated mainly through Italian reimbursement rates, while hospital costs were derived from a clinical center in Italy.
Results: From the NHS perspective, Impella showed lower costs and better life expectancy and patients’ quality of life (50,303€, 1.544 LYs, 0.905 QALYs) compared to VA-ECMO (76,795€, 1.391 LYs, 0.784 QALYs). DRG overall reimbursements for Impella (49,998€) do not completely cover the hospital costs and the cost for the technology (57,770€). Conversely, the hospital cost for the strategy VA-ECMO (52,190€) is lower compared to the NHS overall reimbursements (76,790€).
Conclusions: Our analysis suggests that Impella may be cost-saving over VA-ECMO, whilst also providing better health outcomes for patients with CS; however discrepancies in costs and reimbursement rates were observed, likely due to variability in patient care and hospital resource utilization. Future real-world studies are needed to confirm these findings, but decision-makers can use this data as initial reference for health technology assessments in Italy
Left ventricular assist devices promote changes in the expression levels of platelet microRNAs
Full text linkIntroductionMicroRNAs (miRs) emerged as promising diagnostic and therapeutic biomarkers in cardiovascular diseases. The potential clinical utility of platelet miRs in the setting of left ventricular assist device (LVAD) support is unexplored. MethodsWe prospectively measured the expression levels of 12 platelet miRs involved in platelet activation, coagulation, and cardiovascular diseases in LVAD patients by quantitative real-time polymerase chain reaction. Data were longitudinally measured before LVAD implant and after 1, 6, and 12 months of LVAD support, and compared with those measured in healthy volunteers (controls). In silico analysis was also performed to identify pathways targeted by differentially expressed miRs. ResultsData from 15 consecutive patients and 5 controls were analyzed. Pre-implant expression levels of platelet miR-126, miR-374b, miR-223, and miR-320a were significantly different in patients vs. controls. The expression levels of platelet miR-25, miR-144, miR-320, and miR-451a changed significantly over the course of LVAD support; in silico analysis revealed that these miRs are implicated in both cardiac- and coagulation-associated pathways. Furthermore, the patients who suffered from bleeding (n = 5, 33%) had significantly higher pre-implant expression levels of platelet miR-151a and miR-454 with respect to the patients who did not. The same miRs were also differentially expressed in bleeders following LVAD implantation early before the clinical manifestation of the events. DiscussionThis study provides a proof-of-concept evidence of significant modulation of platelet miRs expression driven by LVADs. The possible existence of a platelet miRs signature predictive of the development of bleeding events warrants further validation studies.IntroductionMicroRNAs (miRs) emerged as promising diagnostic and therapeutic biomarkers in cardiovascular diseases. The potential clinical utility of platelet miRs in the setting of left ventricular assist device (LVAD) support is unexplored. MethodsWe prospectively measured the expression levels of 12 platelet miRs involved in platelet activation, coagulation, and cardiovascular diseases in LVAD patients by quantitative real-time polymerase chain reaction. Data were longitudinally measured before LVAD implant and after 1, 6, and 12 months of LVAD support, and compared with those measured in healthy volunteers (controls). In silico analysis was also performed to identify pathways targeted by differentially expressed miRs. ResultsData from 15 consecutive patients and 5 controls were analyzed. Pre-implant expression levels of platelet miR-126, miR-374b, miR-223, and miR-320a were significantly different in patients vs. controls. The expression levels of platelet miR-25, miR-144, miR-320, and miR-451a changed significantly over the course of LVAD support; in silico analysis revealed that these miRs are implicated in both cardiac- and coagulation-associated pathways. Furthermore, the patients who suffered from bleeding (n = 5, 33%) had significantly higher pre-implant expression levels of platelet miR-151a and miR-454 with respect to the patients who did not. The same miRs were also differentially expressed in bleeders following LVAD implantation early before the clinical manifestation of the events. DiscussionThis study provides a proof-of-concept evidence of significant modulation of platelet miRs expression driven by LVADs. The possible existence of a platelet miRs signature predictive of the development of bleeding events warrants further validation studies
Prolonged Impella 5.0/5.5 support within different pathways of care for cardiogenic shock: the experience of a referral center
Full text linkAims Impella 5.0 and 5.5 are promising low-invasive left ventricle (LV) temporary mechanical circulatory supports (tMCS) for cardiogenic shock due to LV mechanical unloading and are paired with powerful hemodynamic support. This study aimed to analyze data and destinies of patients supported with Impella 5.0/5.5 at a national referral center for cardiogenic shock and to assess the parameters associated with myocardial recovery and successful weaning.Methods A single-center observational study was conducted on all patients treated with Impella 5.0 or 5.5 from March 2018 to July 2023.Results A total of 59 patients underwent Impella 5.0/5.5 implantation due to profound cardiogenic shock, with acute myocardial infarction being the most frequent cause of shock (42 patients, 71%). The median duration of Impella support was 13 days (maximum duration of 52 days). Axillary cannulation was feasible in almost all patients, and 36% were mobilized during support. A total of 44 patients (75%) survived to the next therapy/recovery: 21 patients experienced recovery and 15 and 8 were bridged to long-term LVAD and heart transplantation, respectively. The global survival rate was 66%. The predictors of native heart recovery at multivariate analysis were the number of days on tMCS before upgrade to Impella 5.0/5.5 [hazard ratio (HR) 0.68 (0.51-9) p = 0.0068] and improvement of LVEF within the first 7-10 days of support [HR 4.72 (1.34-16.7), p = 0.016] and improvement of LVEF within the first 7-10 days of support [HR 4.72 (1.34-16.7), p = 0.016.Conclusions Transcatheter systems such as Impella 5.0/5.5 revolutionized the field of tMCS. Myocardial recovery is the primary clinical target. Its prognostication and promotion are key to ensure the most proficuous course for each patient from cardiogenic shock to long-term event-free survival
Impella as Bridge to Durable Left Ventricular Assist Device in Acute Myocardial Infarction Cardiogenic Shock Patients
No full text: Implantation of durable left ventricular assist device (LVAD) in cardiogenic shock (CS) patients after acute myocardial infarction (AMI) poses specific challenges (small left ventricular size, acute infarct area, need for antithrombotic therapy, status Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 1 with impaired organ function and derangements in coagulation and inflammatory parameters) which may affect outcomes. We reviewed data of all AMI-CS patients who were implanted LVAD after Impella support at a referral center with the aim to analyze feasibility, timing, and outcomes of durable LVAD implantation after tMCS with Impella due to AMI-CS. Twenty-one patients were treated between 2013 and 2023: all were in Society for Cardiovascular Angiography & Interventions (SCAI) class D-E and INTERMACS 1-2 at presentation, median LV ejection fraction (EF) and LV end-diastolic diameter (EDD) were 15 (10-20)% and 57 (54-60) mm, respectively. Eleven patients (52%) were supported with Impella CP, seven with Impella 5.0 (33%), and three (14%) with Impella 2.5. Axillary cannulation was performed in nine patients (43%). Five patients (24%) had concomitant venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. Median duration of Impella support was 12 (8-14) days. Overall, the use of Impella was characterized by low rate of complications and allowed successful bridge to durable LVAD in all patients, with 100% 30 day survival rate
Cardiac Biomarker Release after CABG with Different Surgical Techniques
No full textObjective: To investigate the release of cardiac biomarkers (troponin I and CK-MB) in patients undergoing coronary artery bypass graft (CABG) with or without cardiopulmonary bypass (CPB). Design: Prospective study, Setting: University tertiary hospital. Participants: Sixty-five consecutive patients undergoing coronary artery bypass grafting (â¥2 vessel disease, ejection fraction â¥0.35%, elective procedure). Interventions: Cardiac biomarkers were measured before surgery, at intensive care unit arrival, 4 and 18 hours after the end of the procedure. Measurements and Main Results: Cardiac biomarker release was higher in on-pump than in off-pump patients at every time point. On multivariate analysis, CPB (p ⤠0.0001), number of distal grafts (p = 0.005), and hypertension treatment (p = 0.03) were the only independent predictors of peak cardiac troponin release. Conclusions: Cardiac troponin I release after multivessel CABG is associated with the technique. Different values for the normal range should be considered. OPCABG is minimally invasive for the heart as far as myocardial marker release is concerned. © 2004 Elsevier Inc. All rights reserved
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