Acute biventricular mechanical circulatory support for cardiogenic shock

Sudeep Kuchibhotla, Michele L. Esposito, Catalina Breton, Robert Pedicini, Andrew Mullin, Ryan O'Kelly, Mark Anderson, Dennis L. Morris, George Batsides, Danny Ramzy, Mark Grise, Duc Thinh Pham, Navin K. Kapur*

*Corresponding author for this work

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background--Biventricular failure is associated with high in-hospital mortality. Limited data regarding the efficacy of biventricular Impella axial flow catheters (BiPella) support for biventricular failure exist. The aim of this study was to explore the clinical utility of percutaneously delivered BiPella as a novel acute mechanical support strategy for patients with cardiogenic shock complicated by biventricular failure. Methods and Results--We retrospectively analyzed data from 20 patients receiving BiPella for biventricular failure from 5 tertiarycare hospitals in the United States. Left ventricular support was achieved with an Impella 5.0 (n=8), Impella CP (n=11), or Impella 2.5 (n=1). All patients received the Impella RP for right ventricular (RV) support. BiPella use was recorded in the setting of acute myocardial infarction (n=11), advanced heart failure (n=7), and myocarditis (n=2). Mean flows achieved were 3.4 1.2 and 3.5 0.5 for left ventricular and RV devices, respectively. Total in-hospital mortality was 50%. No intraprocedural mortality was observed. Major complications included limb ischemia (n=1), hemolysis (n=6), and Thrombolysis in Myocardial Infarction major bleeding (n=7). Compared with nonsurvivors, survivors were younger, had a lower number of inotropes or vasopressors used before BiPella, and were more likely to have both devices implanted simultaneously during the same procedure. Compared with nonsurvivors, survivors had lower pulmonary artery pressures and RV stroke work index before BiPella. Indices of RV afterload were quantified for 14 subjects. Among these patients, nonsurvivors had higher pulmonary vascular resistance (6.8; 95% confidence interval [95% CI], 5.5-8.1 versus 1.9; 95% CI, 0.8-3.0; P<0.01), effective pulmonary artery elastance (1129; 95% CI, 876-1383 versus 458; 95% CI, 263-653; P<0.01), and lower pulmonary artery compliance (1.5; 95% CI, 0.9-2.1 versus 2.7; 95% CI, 1.8-3.6; P<0.05). Conclusions--This is the largest, retrospective analysis of BiPella for cardiogenic shock. BiPella is feasible, reduces cardiac filling pressures and improves cardiac output across a range of causes for cardiogenic shock. Simultaneous left ventricular and RV device implantation and lower RV afterload may be associated with better outcomes with BiPella. Future prospective studies of BiPella for cardiogenic shock are required.

Original languageEnglish (US)
Article numbere006670
JournalJournal of the American Heart Association
Volume6
Issue number10
DOIs
StatePublished - Oct 1 2017

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Cardiogenic Shock
Catheters
Confidence Intervals
Pulmonary Artery
Hospital Mortality
Equipment and Supplies
Survivors
Myocardial Infarction
Lung Compliance
Myocarditis
Ventricular Pressure
Hemolysis
Cardiac Output
Vascular Resistance
Ischemia
Extremities
Heart Failure
Stroke
Prospective Studies
Hemorrhage

Keywords

  • Cardiogenic shock
  • Hemodynamics
  • Mechanical circulatory support
  • Right ventricle-pulmonary arterial coupling
  • Right ventricular failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Kuchibhotla, S., Esposito, M. L., Breton, C., Pedicini, R., Mullin, A., O'Kelly, R., ... Kapur, N. K. (2017). Acute biventricular mechanical circulatory support for cardiogenic shock. Journal of the American Heart Association, 6(10), [e006670]. https://doi.org/10.1161/JAHA.117.006670
Kuchibhotla, Sudeep ; Esposito, Michele L. ; Breton, Catalina ; Pedicini, Robert ; Mullin, Andrew ; O'Kelly, Ryan ; Anderson, Mark ; Morris, Dennis L. ; Batsides, George ; Ramzy, Danny ; Grise, Mark ; Pham, Duc Thinh ; Kapur, Navin K. / Acute biventricular mechanical circulatory support for cardiogenic shock. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 10.
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title = "Acute biventricular mechanical circulatory support for cardiogenic shock",
abstract = "Background--Biventricular failure is associated with high in-hospital mortality. Limited data regarding the efficacy of biventricular Impella axial flow catheters (BiPella) support for biventricular failure exist. The aim of this study was to explore the clinical utility of percutaneously delivered BiPella as a novel acute mechanical support strategy for patients with cardiogenic shock complicated by biventricular failure. Methods and Results--We retrospectively analyzed data from 20 patients receiving BiPella for biventricular failure from 5 tertiarycare hospitals in the United States. Left ventricular support was achieved with an Impella 5.0 (n=8), Impella CP (n=11), or Impella 2.5 (n=1). All patients received the Impella RP for right ventricular (RV) support. BiPella use was recorded in the setting of acute myocardial infarction (n=11), advanced heart failure (n=7), and myocarditis (n=2). Mean flows achieved were 3.4 1.2 and 3.5 0.5 for left ventricular and RV devices, respectively. Total in-hospital mortality was 50{\%}. No intraprocedural mortality was observed. Major complications included limb ischemia (n=1), hemolysis (n=6), and Thrombolysis in Myocardial Infarction major bleeding (n=7). Compared with nonsurvivors, survivors were younger, had a lower number of inotropes or vasopressors used before BiPella, and were more likely to have both devices implanted simultaneously during the same procedure. Compared with nonsurvivors, survivors had lower pulmonary artery pressures and RV stroke work index before BiPella. Indices of RV afterload were quantified for 14 subjects. Among these patients, nonsurvivors had higher pulmonary vascular resistance (6.8; 95{\%} confidence interval [95{\%} CI], 5.5-8.1 versus 1.9; 95{\%} CI, 0.8-3.0; P<0.01), effective pulmonary artery elastance (1129; 95{\%} CI, 876-1383 versus 458; 95{\%} CI, 263-653; P<0.01), and lower pulmonary artery compliance (1.5; 95{\%} CI, 0.9-2.1 versus 2.7; 95{\%} CI, 1.8-3.6; P<0.05). Conclusions--This is the largest, retrospective analysis of BiPella for cardiogenic shock. BiPella is feasible, reduces cardiac filling pressures and improves cardiac output across a range of causes for cardiogenic shock. Simultaneous left ventricular and RV device implantation and lower RV afterload may be associated with better outcomes with BiPella. Future prospective studies of BiPella for cardiogenic shock are required.",
keywords = "Cardiogenic shock, Hemodynamics, Mechanical circulatory support, Right ventricle-pulmonary arterial coupling, Right ventricular failure",
author = "Sudeep Kuchibhotla and Esposito, {Michele L.} and Catalina Breton and Robert Pedicini and Andrew Mullin and Ryan O'Kelly and Mark Anderson and Morris, {Dennis L.} and George Batsides and Danny Ramzy and Mark Grise and Pham, {Duc Thinh} and Kapur, {Navin K.}",
year = "2017",
month = "10",
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doi = "10.1161/JAHA.117.006670",
language = "English (US)",
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journal = "Journal of the American Heart Association",
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Kuchibhotla, S, Esposito, ML, Breton, C, Pedicini, R, Mullin, A, O'Kelly, R, Anderson, M, Morris, DL, Batsides, G, Ramzy, D, Grise, M, Pham, DT & Kapur, NK 2017, 'Acute biventricular mechanical circulatory support for cardiogenic shock', Journal of the American Heart Association, vol. 6, no. 10, e006670. https://doi.org/10.1161/JAHA.117.006670

Acute biventricular mechanical circulatory support for cardiogenic shock. / Kuchibhotla, Sudeep; Esposito, Michele L.; Breton, Catalina; Pedicini, Robert; Mullin, Andrew; O'Kelly, Ryan; Anderson, Mark; Morris, Dennis L.; Batsides, George; Ramzy, Danny; Grise, Mark; Pham, Duc Thinh; Kapur, Navin K.

In: Journal of the American Heart Association, Vol. 6, No. 10, e006670, 01.10.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Acute biventricular mechanical circulatory support for cardiogenic shock

AU - Kuchibhotla, Sudeep

AU - Esposito, Michele L.

AU - Breton, Catalina

AU - Pedicini, Robert

AU - Mullin, Andrew

AU - O'Kelly, Ryan

AU - Anderson, Mark

AU - Morris, Dennis L.

AU - Batsides, George

AU - Ramzy, Danny

AU - Grise, Mark

AU - Pham, Duc Thinh

AU - Kapur, Navin K.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background--Biventricular failure is associated with high in-hospital mortality. Limited data regarding the efficacy of biventricular Impella axial flow catheters (BiPella) support for biventricular failure exist. The aim of this study was to explore the clinical utility of percutaneously delivered BiPella as a novel acute mechanical support strategy for patients with cardiogenic shock complicated by biventricular failure. Methods and Results--We retrospectively analyzed data from 20 patients receiving BiPella for biventricular failure from 5 tertiarycare hospitals in the United States. Left ventricular support was achieved with an Impella 5.0 (n=8), Impella CP (n=11), or Impella 2.5 (n=1). All patients received the Impella RP for right ventricular (RV) support. BiPella use was recorded in the setting of acute myocardial infarction (n=11), advanced heart failure (n=7), and myocarditis (n=2). Mean flows achieved were 3.4 1.2 and 3.5 0.5 for left ventricular and RV devices, respectively. Total in-hospital mortality was 50%. No intraprocedural mortality was observed. Major complications included limb ischemia (n=1), hemolysis (n=6), and Thrombolysis in Myocardial Infarction major bleeding (n=7). Compared with nonsurvivors, survivors were younger, had a lower number of inotropes or vasopressors used before BiPella, and were more likely to have both devices implanted simultaneously during the same procedure. Compared with nonsurvivors, survivors had lower pulmonary artery pressures and RV stroke work index before BiPella. Indices of RV afterload were quantified for 14 subjects. Among these patients, nonsurvivors had higher pulmonary vascular resistance (6.8; 95% confidence interval [95% CI], 5.5-8.1 versus 1.9; 95% CI, 0.8-3.0; P<0.01), effective pulmonary artery elastance (1129; 95% CI, 876-1383 versus 458; 95% CI, 263-653; P<0.01), and lower pulmonary artery compliance (1.5; 95% CI, 0.9-2.1 versus 2.7; 95% CI, 1.8-3.6; P<0.05). Conclusions--This is the largest, retrospective analysis of BiPella for cardiogenic shock. BiPella is feasible, reduces cardiac filling pressures and improves cardiac output across a range of causes for cardiogenic shock. Simultaneous left ventricular and RV device implantation and lower RV afterload may be associated with better outcomes with BiPella. Future prospective studies of BiPella for cardiogenic shock are required.

AB - Background--Biventricular failure is associated with high in-hospital mortality. Limited data regarding the efficacy of biventricular Impella axial flow catheters (BiPella) support for biventricular failure exist. The aim of this study was to explore the clinical utility of percutaneously delivered BiPella as a novel acute mechanical support strategy for patients with cardiogenic shock complicated by biventricular failure. Methods and Results--We retrospectively analyzed data from 20 patients receiving BiPella for biventricular failure from 5 tertiarycare hospitals in the United States. Left ventricular support was achieved with an Impella 5.0 (n=8), Impella CP (n=11), or Impella 2.5 (n=1). All patients received the Impella RP for right ventricular (RV) support. BiPella use was recorded in the setting of acute myocardial infarction (n=11), advanced heart failure (n=7), and myocarditis (n=2). Mean flows achieved were 3.4 1.2 and 3.5 0.5 for left ventricular and RV devices, respectively. Total in-hospital mortality was 50%. No intraprocedural mortality was observed. Major complications included limb ischemia (n=1), hemolysis (n=6), and Thrombolysis in Myocardial Infarction major bleeding (n=7). Compared with nonsurvivors, survivors were younger, had a lower number of inotropes or vasopressors used before BiPella, and were more likely to have both devices implanted simultaneously during the same procedure. Compared with nonsurvivors, survivors had lower pulmonary artery pressures and RV stroke work index before BiPella. Indices of RV afterload were quantified for 14 subjects. Among these patients, nonsurvivors had higher pulmonary vascular resistance (6.8; 95% confidence interval [95% CI], 5.5-8.1 versus 1.9; 95% CI, 0.8-3.0; P<0.01), effective pulmonary artery elastance (1129; 95% CI, 876-1383 versus 458; 95% CI, 263-653; P<0.01), and lower pulmonary artery compliance (1.5; 95% CI, 0.9-2.1 versus 2.7; 95% CI, 1.8-3.6; P<0.05). Conclusions--This is the largest, retrospective analysis of BiPella for cardiogenic shock. BiPella is feasible, reduces cardiac filling pressures and improves cardiac output across a range of causes for cardiogenic shock. Simultaneous left ventricular and RV device implantation and lower RV afterload may be associated with better outcomes with BiPella. Future prospective studies of BiPella for cardiogenic shock are required.

KW - Cardiogenic shock

KW - Hemodynamics

KW - Mechanical circulatory support

KW - Right ventricle-pulmonary arterial coupling

KW - Right ventricular failure

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Kuchibhotla S, Esposito ML, Breton C, Pedicini R, Mullin A, O'Kelly R et al. Acute biventricular mechanical circulatory support for cardiogenic shock. Journal of the American Heart Association. 2017 Oct 1;6(10). e006670. https://doi.org/10.1161/JAHA.117.006670