Temporary Mechanical Circulatory Support for Refractory Heart Failure: the German Heart Center Berlin Experience

Overview

Journal Ann Cardiothorac Surg

Publisher AME Publishing Company

Date 2019 Mar 12

PMID 30854315

Citations 18

Authors

Gaik Nersesian

Felix Hennig

Marcus Muller

Johanna Mulzer

Dmytro Tsyganenko

Christoph Starck

Tom Gromann

Volkmar Falk

Evgenij Potapov

Felix Schoenrath

Affiliations

Soon will be listed here.

Abstract

Background: Temporary mechanical circulatory support (MCS) offers a valuable option for treatment of refractory heart failure. We present our experience with selected MCS devices in cardiogenic shock of different etiologies.

Methods: We retrospectively studied patients who were treated in our institution between 01/2016 and 07/2018. Patients receiving only veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support were excluded. Left ventricular support patients received Impella; right ventricular support was conducted using Levitronix CentriMag.

Results: Thirty-seven patients received an Impella left ventricular assist device (LVAD). Etiology was: acute on chronic ischemic cardiomyopathy (ICMP; n=12), acute myocardial infarction (AMI; n=11), dilated cardiomyopathy (DCMP; n=7) and toxic cardiomyopathy (TCMP; n=2). Two patients presented with postcardiotomy shock and acute myocarditis, respectively. In one case, Takotsubo cardiomyopathy was diagnosed. Impella was used solely in 28 patients (Impella group) with an in-hospital survival of 37%. In nine patients, Impella was used in combination with extracorporeal life support (ECLS) implantation (ECMELLA group)-in-hospital survival was 33%. In the Impella group six patients recovered, six received a long-term VAD and 16 died on device. In the ECMELLA group one patient recovered, three received a long-term VAD and five died. The majority of CentriMag implantations as a right ventricular assist device (RVAD) were necessary after LVAD implantation (n=52); of these patients, 14 recovered, eight received long-term VAD and 30 died. The remaining 17 patients were supported by RVAD due to AMI (n=7); postcardiotomy (n=7); right heart failure after heart transplantation (n=2) and ICMP (n=1). Six of these patients recovered, two required long-term VAD and nine died.

Conclusions: Survival after MCS implantation for left as well as right heart failure in cardiogenic shock remains low, but is superior to that of patients without mechanical support. Short-term MCS remains an option of choice if right, left or biventricular support is needed.

Citing Articles

Current Landscape of Temporary Percutaneous Mechanical Circulatory Support Technology.

Upadhyay R, Alrayes H, Arno S, Kaushik M, Basir M US Cardiol. 2024; 15:e21.

PMID: 39720506 PMC: 11664789. DOI: 10.15420/usc.2021.15.

Temporary extracorporeal life support: single-centre experience with a new concept.

Nersesian G, Lewin D, Ott S, Schoenrath F, Hrytsyna Y, Starck C Interdiscip Cardiovasc Thorac Surg. 2024; 38(4).

PMID: 38490254 PMC: 10980585. DOI: 10.1093/icvts/ivae043.

Dynamic load modulation predicts right heart tolerance of left ventricular cardiovascular assist in a porcine model of cardiogenic shock.

Lamberti K, Keller S, Edelman E Sci Transl Med. 2024; 16(734):eadk4266.

PMID: 38354226 PMC: 11461014. DOI: 10.1126/scitranslmed.adk4266.

Mechanical Circulatory Support Strategies in Takotsubo Syndrome with Cardiogenic Shock: A Systematic Review.

von Mackensen J, Zwaans V, El Shazly A, Van Praet K, Heck R, Starck C J Clin Med. 2024; 13(2).

PMID: 38256608 PMC: 10816930. DOI: 10.3390/jcm13020473.

Forensic, legal, and clinical aspects of deaths associated with implanted cardiac devices.

Federspiel J, Potente S, Abeln K, Hennemann K, Heinbuch S, Burkhard K Front Psychiatry. 2023; 14:1278078.

PMID: 38090699 PMC: 10713765. DOI: 10.3389/fpsyt.2023.1278078.

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