Clinical scenarios for use of transvalvular microaxial pumps in acute heart failure and cardiogenic shock - A European experienced users working group opinion

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:291

Article

Schaefer, Andreas¹  Werner, Nikos²  Westenfeld, Ralf³  Moller, Jacob Eifer⁴  Schulze, P. Christian⁵  Karatolios, Konstantinos⁶  Pappalardo, Federico⁷  Maly, Jiri⁸  Staudacher, Dawid⁹  Lebreton, Guillaume¹⁰  Delmas, Clement¹¹  Hunziker, Patrick¹²  Fritzenwanger, Michael⁵  Napp, L. Christian¹  Ferrari, Markus¹³  Tarantini, Giuseppe¹⁴ 

[1] Hannover Med Sch, Dept Cardiol & Angiol, Hannover, Germany

[2] Univ Heart Ctr, Dept Cardiol, Bonn, Germany

[3] Heinrich Heine Univ, Dept Cardiol Pulmonol & Vasc Med, Dusseldorf, Germany

[4] Univ Hosp Odense, Dept Cardiol, Odense, Denmark

[5] Univ Jena, Dept Cardiol, Jena, Germany

[6] Univ Marburg, Dept Cardiol, Marburg, Germany

[7] Univ Vita Salute San Raffaele, San Raffaele Hosp, Adv Heart Failure & Mech Circulatory Support Prog, Dept Cardiothorac Vasc Anesthesia & Intens Care, Milan, Italy

[8] Inst Clin & Expt Med, Dept Cardiovasc Surg, Prague, Czech Republic

[9] Univ Freiburg, Fac Med, Dept Cardiol & Angiol 1, Heart Ctr,Freiburg Univ, Freiburg, Germany

[10] Hosp Pitie Salpetriere, Dept Cardiovasc Surg, Paris, France

[11] Rangueil Univ Hosp, Dept Cardiol, Toulouse, France

[12] Univ Hosp Basel, Dept Cardiol, Basel, Switzerland

[13] Dr Horst Schmidt Hosp, Dept Cardiol & Intens Care Med, Wiesbaden, Germany

[14] Univ Padua, Dept Cardiol, Padua, Italy

关键词: Cardiogenic shock;    Impella;    ECMO;    Mechanical circulatory support;    Hemodynamics;    LV function;   

DOI  :  10.1016/j.ijcard.2019.05.044

来源: Elsevier

【 摘 要 】

For patients with myocardial infarct-related cardiogenic shock (CS), urgent percutaneous coronary intervention is the recommended treatment strategy to limit cardiac and systemic ischemia. However, a specific therapeutic intervention is often missing in non-ischemic CS cases. Though drug treatment with inotropes and/or vasopressors may be required to stabilize the patient initially, their ongoing use is associated with excess mortality. Coronary intervention in unstable patients often leads to further hemodynamic compromise either during or shortly after revascularization. Support devices like the intra-aortic balloon pump failed to improve clinical outcomes in infarct-related CS. Currently, more powerful and active hemodynamic support devices unloading the left ventricle such as transvalvular microaxial pumps are available and are being increasingly used. However, as for other devices large randomized trials are not yet available, and device use is based on registry data and expert consensus. In this article, a multidisciplinary group of experienced users of transvalvular microaxial pumps outlines the pathophysiological background on hemodynamic changes in CS, the available mechanical support devices, and current guideline recommendations. Furthermore, different hemodynamic situations in several case-based scenarios are used to illustrate candidate settings and to provide the theoretic and scientific rationale for left-ventricular unloading in these scenarios. Finally, organization of shock networks, monitoring, weaning, and typical complications and their prevention are discussed. (C) 2019 The Authors. Published by Elsevier B.V.

【 授权许可】

Free