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Full-Text Articles in Cardiology
Clinical Outcomes For Impella Procedure In Octogenarians, Nonagenarians, And Centenarians: A Retrospective Cohort Study, Tony Elias, Sonika Vatsa, Kyrillos Girgis, Michael Valderrama, Rafail Beshai
Clinical Outcomes For Impella Procedure In Octogenarians, Nonagenarians, And Centenarians: A Retrospective Cohort Study, Tony Elias, Sonika Vatsa, Kyrillos Girgis, Michael Valderrama, Rafail Beshai
Rowan-Virtua Research Day
The Impella, a vital ventricular assist device, has seen extensive use in managing severe heart failure and cardiogenic shock. However, the impact of this procedure on older individuals remains poorly understood. To address this gap, we scrutinized the National Inpatient Sample Database from 2019 to 2020 to elucidate in-hospital outcomes among older patients who underwent the Impella procedure. Among the 8233 patients who underwent Impella insertion, 1389 (16.8%) were in the older population, aged 80 years or older. This subgroup exhibited a higher prevalence of comorbidities such as hypertension, diabetes mellitus, and chronic kidney disease compared to younger patients. Alarmingly, …
An Unusual Case Of Cardiogenic Shock: Coronary Artery Vasospasms, Amanda Bergeron, Maks Mihalj
An Unusual Case Of Cardiogenic Shock: Coronary Artery Vasospasms, Amanda Bergeron, Maks Mihalj
Journal of Shock and Hemodynamics
Coronary artery vasospasms may occur in one or multiple coronary arteries, typically causing transient chest pain or angina. Although rare, it can lead to lethal cardiac arrhythmias, cardiac arrest, or cardiogenic shock and is often misdiagnosed. We report a case of a young man with an atypical presentation of generalized coronary vasospasm leading to cardiac arrest and subsequent cardiogenic shock. The patient required support with veno-arterial extracorporeal membrane oxygenation and Impella. We discuss the risk factors, diagnosis, and treatment of this rare condition.
The Brink Of The Abyss: From Transcatheter Aortic Valve Implantation, To Impella, To Left Ventricular Assist Device Destination Therapy, Jake Kieserman, Megan Sheehan, Marisa Cevasco, Brian Mccauley, Ryan Prentice, Jay Giri, Joyce Wald
The Brink Of The Abyss: From Transcatheter Aortic Valve Implantation, To Impella, To Left Ventricular Assist Device Destination Therapy, Jake Kieserman, Megan Sheehan, Marisa Cevasco, Brian Mccauley, Ryan Prentice, Jay Giri, Joyce Wald
Journal of Shock and Hemodynamics
Acute valvular emergencies are common causes of cardiogenic shock. Patients with critical aortic pathologies causing shock frequently undergo percutaneous interventions for valve replacement. However, in cases of persistent cardiogenic shock after valve replacement, there are limited options for further mechanical support. In this case study, we report a patient with a prior history of aortic valve replacement who presented in cardiogenic shock. After a transcatheter aortic valve-in-valve replacement, he remained in persistent shock with worsening clinical parameters requiring escalating inotropic and vasopressor support. With input from a multidisciplinary care team, an Impella 5.5 (Abiomed, Inc.) was placed through the valve …
Thrompella: Acute Impella Thrombosis During Ecpella Support, Faris Araj, Hurst M. Hall, Amy E. Hackmann
Thrompella: Acute Impella Thrombosis During Ecpella Support, Faris Araj, Hurst M. Hall, Amy E. Hackmann
The VAD Journal
We present a case of acute Impella thrombosis during Ecpella support in a 48-year-old man listed for a heart transplant. After two weeks of Ecpella support, echocardiography revealed a 2.6 x 1.1 cm mobile thrombus attached to the Impella inlet (Video). The Impella and attached thrombus were pulled across the aortic valve into the descending aorta and removed without systemic thromboembolism. Due to the ongoing need for left ventricular venting, a new Impella CP was placed.
Management Of Patients With Refractory Cardiogenic Shock And Cardiointestinal Syndrome With Impella 5.5 As Bridge To Decision: Case Series, Ismael A. Salas De Armas, Bindu Akkanti, Amanda Bergeron, Anju Bhardwaj, Kha Dinh, Ali Shirafkan, Jayeshkumar A. Patel, Manish K. Patel, Carlos R. Manrique Neira, Igor D. Gregoric, Biswajit Kar, Mehmet H. Akay
Management Of Patients With Refractory Cardiogenic Shock And Cardiointestinal Syndrome With Impella 5.5 As Bridge To Decision: Case Series, Ismael A. Salas De Armas, Bindu Akkanti, Amanda Bergeron, Anju Bhardwaj, Kha Dinh, Ali Shirafkan, Jayeshkumar A. Patel, Manish K. Patel, Carlos R. Manrique Neira, Igor D. Gregoric, Biswajit Kar, Mehmet H. Akay
Journal of Shock and Hemodynamics
Patients with advanced heart failure require multi-system management as a majority succumb to end-organ dysfunction, including gastrointestinal sequelae. Temporizing measures, such as early mechanical circulatory support, can assist in the recovery of patients with acute cardiogenic shock. The temporary support can improve patient characteristics to enable future definitive heart failure therapies such as durable left ventricular assist devices and orthotopic heart transplantation. We present two cases of cardiogenic shock that were successfully bridged with an Impella 5.5 (Abiomed). The management enabled the patients to recover from reversible cardiointestinal syndrome and undergo successful definitive therapies.
Coronary Flow And Unloading In Acute Myocardial Infarction Shock, Kiyo Ishikawa
Coronary Flow And Unloading In Acute Myocardial Infarction Shock, Kiyo Ishikawa
Journal of Shock and Hemodynamics
In patients with cardiogenic shock that undergo successful coronary intervention, there are still factors complicating myocardial recovery. There is room for improvement in coronary flow using mechanical circulatory devices, specifically by left ventricular unloading. This idea was further explored in a research study using pigs. Results showed that subjects with acute myocardial infarction who have reduced cardiac contractility and/or high diastolic pressure would benefit from support strategies targeting left ventricular unloading.
Cardiac Tamponade On Ecpella: A Case Report Of A Unique Hemodynamic Picture, Naveed Akhtar, Parth Savsani, Maya Guglin, Roopa Rao
Cardiac Tamponade On Ecpella: A Case Report Of A Unique Hemodynamic Picture, Naveed Akhtar, Parth Savsani, Maya Guglin, Roopa Rao
The VAD Journal
Extracorporeal membrane oxygenation is rapidly becoming a preferred therapy for short-term hemodynamic support in cardiogenic shock, along with the use of devices such as Impella (Abiomed, Andover, MA). The two together can create unique hemodynamics resulting in altered presentation of common hemodynamic conditions such as tamponade. We present a case of a patient with fulminant myocarditis requiring veno-arterial extracorporeal membrane oxygenation and Impella support. The patient later developed a pericardial effusion with atypical tamponade physiology which masked the left ventricular systolic function recovery. We further highlight the complex hemodynamics of cardiac tamponade in patients with such mechanical circulatory support and …
Reversible Mitral Regurgitation As A Complication Of Impella® 5.0, Katrina A. Bidwell, Andrew R. Kolodziej, Maya E. Guglin
Reversible Mitral Regurgitation As A Complication Of Impella® 5.0, Katrina A. Bidwell, Andrew R. Kolodziej, Maya E. Guglin
The VAD Journal
The Impella® is a ventricular assist device used for temporary left ventricular support and has been approved for use since 2008. In this report we present a case of a patient who experienced mitral regurgitation as a complication shortly after placement of an Impella® as well as a brief literature review. To our knowledge this is the first such case demonstrating resolution of iatrogenic mitral regurgitation with removal of the device as opposed to permanent damage.
Temporary And Durable Mechanical Circulatory Support For Single Ventricular Failure In An Adult, Joshua L. Hermsen, Jason W. Smith, Jay D. Pal, Agustin Rubio, S. Carolina Masri, Nahush A. Mokadam, Richard K. Cheng, Claudius Mahr
Temporary And Durable Mechanical Circulatory Support For Single Ventricular Failure In An Adult, Joshua L. Hermsen, Jason W. Smith, Jay D. Pal, Agustin Rubio, S. Carolina Masri, Nahush A. Mokadam, Richard K. Cheng, Claudius Mahr
The VAD Journal
Patients palliated with Fontan circulation requiring mechanical circulatory support pose anatomic and physiologic challenges. We treated a Fontan patient with acute ventricular failure with sequential temporary and durable support devices. Aspects of treatment with each device required modification based on the patient’s anatomy and physiology.