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Preoperative Impella therapy in patients with ventricular septal rupture and cardiogenic shock: haemodynamic and organ function outcomes
Ist Teil von
Interdisciplinary cardiovascular and thoracic surgery, 2024-08, Vol.39 (2)
Ort / Verlag
England: Oxford University Press
Erscheinungsjahr
2024
Quelle
Alma/SFX Local Collection
Beschreibungen/Notizen
Abstract
OBJECTIVES
We examined the effects of preoperative Impella treatment on haemodynamic stability, organ recovery and postoperative outcomes in patients with postinfarction ventricular septal rupture (PIVSR) and cardiogenic shock (CS).
METHODS
Between April 2018 and February 2024, the data of 10 of 15 patients with PIVSR and CS who underwent Impella therapy were analysed. Emergency surgery was contingent on haemodynamic stability with the Impella/ECpella, except in the presence of organ failure. We utilized a generalized linear mixed model to evaluate organ ischaemia through changes in blood parameters upon admission and at subsequent intervals post-Impella insertion.
RESULTS
Preoperative Impella or combined Impella and ECpella (5 patients each) support was provided, with diagnoses and operations occurring at an average of 4 days (interquartile range: 2–5) and 8 days (interquartile range: 2–14) after myocardial infarction, respectively. Treatment significantly reduced lactate, alanine aminotransferase, creatine kinase-MB and troponin I levels (P ≤ 0.05 for all). Conversely, no significant change was noted in the aspartate aminotransferase level or the estimated glomerular filtration rate. Haemoglobin and platelet counts decreased despite transfusions (P < 0.001). No surgical deaths occurred; however, 70% of the patients required prolonged mechanical ventilation, and 80% were transferred to other facilities for rehabilitation.
CONCLUSIONS
Impella or ECpella treatment can improve haemodynamic and organ failure outcomes in patients with PIVSR and CS. However, the risks of prolonged support, including haemorrhagic events and the need for extended rehabilitation, point to a need for comparative studies to optimize support duration.
Despite recent advancements in early revascularization strategies that have reduced the incidence of postinfarction ventricular septal rupture (PIVSR) to 0.2%, PIVSR remains a lethal complication [1, 2].
Graphical Abstract
Sprache
Englisch
Identifikatoren
ISSN: 2753-670X
eISSN: 2753-670X
DOI: 10.1093/icvts/ivae137
Titel-ID: cdi_proquest_miscellaneous_3083681857
Format
–
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