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Mechanical circulatory support for Takotsubo syndrome: a systematic review and meta-analysis
Ist Teil von
International journal of cardiology, 2020-10, Vol.316, p.31-39
Ort / Verlag
Netherlands: Elsevier B.V
Erscheinungsjahr
2020
Link zum Volltext
Quelle
Elsevier ScienceDirect Journals Complete
Beschreibungen/Notizen
Cardiogenic shock occurs in 10%–15% of patients with Takotsubo syndrome (TS). For several reasons catecholamines, and especially inotropes, should be avoided in TS. Temporary mechanical circulatory support (MCS) appears attractive as bridge-to-recovery, but prospective studies are lacking. Here we analyze the available literature on MCS use in patients with TS.
PubMed/Medline was systematically screened until December 2019. 18 studies reporting pooled data of 5629 TS patients, of whom 227 had received MCS, were considered for a qualitative synthesis. 81 articles from 2003 through 2019 reporting individual data of 93 MCS cases were included in a meta-analysis. Median age was 57 (IQR: 43–68) years, 83.9% were women, and a physical trigger could be identified in 74.1% of cases. Median left ventricular ejection fraction (LVEF) before MCS was 20% (IQR: 15–25) and comparable between groups defined by MCS device. An apical TS type was present in 76.1% of cases. The overall number of publications on MCS for TS increased over time, as did those using veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and Impella, while those using intra-aortic balloon pump declined. MCS-related complications were not regularly reported. Median time on MCS was 3 (IQR: 2–7) days, with an overall survival of 94.6%.
MCS for TS-related shock is increasingly reported, with a growing use of V-A ECMO and Impella. Currently available clinical data support this approach. Prospective studies are needed to evaluate safety and efficacy of different devices as well as timing of MCS in this special patient population.
•Use of mechanical circulatory support (MCS) for Takotsubo Syndrome (TS) is increasing•Available literature on MCS use in TS: 18 observational studies and 93 reported cases•V-A ECMO and Impella are the most frequently reported MCS devices in recent years•V-A ECMO is the preferred device in the case of TS with pheochromocytoma or cardiac arrest•Survival in patients receiving MCS for TS is 94.6% (reporting bias may be present, prospective studies are needed)