Extracorporeal life support system during cardiovascular procedures: Insights from the German Lifebridge registry.
Aged
Blood Loss, Surgical
/ prevention & control
Coronary Artery Bypass, Off-Pump
/ adverse effects
Erythrocyte Transfusion
/ statistics & numerical data
Extracorporeal Membrane Oxygenation
/ adverse effects
Feasibility Studies
Female
Follow-Up Studies
Germany
/ epidemiology
Heart Valve Prosthesis Implantation
/ adverse effects
Hospital Mortality
Humans
Intraoperative Care
/ adverse effects
Male
Middle Aged
Percutaneous Coronary Intervention
/ adverse effects
Postoperative Hemorrhage
/ epidemiology
Prospective Studies
Registries
/ statistics & numerical data
Tertiary Care Centers
/ statistics & numerical data
Treatment Outcome
extracorporeal life support
high-risk
mechanical circulatory support
percutaneous coronary intervention
Journal
Artificial organs
ISSN: 1525-1594
Titre abrégé: Artif Organs
Pays: United States
ID NLM: 7802778
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
05
02
2020
revised:
13
06
2020
accepted:
17
06
2020
pubmed:
28
6
2020
medline:
14
9
2021
entrez:
28
6
2020
Statut:
ppublish
Résumé
The frequency of mechanical circulatory support (MCS) device application has increased in recent years. Besides implantation in the emergency setting, such as circulatory arrest, MCS is also increasingly used electively to ensure hemodynamic stability in high-risk patients, for example, during percutaneous coronary interventions (PCI), valve interventions or off-pump coronary bypass surgery. Lifebridge (Zoll Medical GmbH, Germany) is a compact percutaneous MCS device widely used in daily clinical routine. The present study aimed to investigate the indications, feasibility, and outcomes after use of Lifebridge in cardiac interventions, evaluating a large-scale multicenter database. A total of 60 tertiary cardiovascular centers were questioned regarding application and short-term outcomes after the use of the Lifebridge system (n = 160 patients). Out of these 60 centers, eight consented to participate in the study (n = 39 patients), where detailed data were collected using standardized questionnaires. Demographic and clinical characteristics of the patient population, procedural as well as follow-up data were recorded and analyzed. In 60 interrogated centers, Lifebridge was used in 74% of emergency cases and 26% in the setting of planned interventions. The subcohort interrogated in detail displayed the same distribution of application scenarios, while the main cardiovascular procedure was high-risk PCI (82%). All patients were successfully weaned from the device and 92% (n = 36) of the patients studied in detail survived after 30 days. As assessed 30 days after insertion of the device, bleeding requiring red blood cell (RBC) transfusion constituted the main complication, occurring in 49% of cases. In our analysis of clinical data, the use of Lifebridge in cardiac intervention was shown to be feasible. Further prospective studies are warranted to identify patients who benefit from hemodynamic MCS support despite the increased rate of RBC transfusion due to challenges in access sites during cardiovascular procedures.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1259-1266Informations de copyright
© 2020 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.
Références
Shah M, Patnaik S, Patel B, Ram P, Garg L, Agarwal M, et al. Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States. Clin Res Cardiol. 2018;107(4):287-303.
Baumann S, Werner N, Ibrahim K, Westenfeld R, Al-Rashid F, Sinning J-M, et al. Indication and short-term clinical outcomes of high-risk percutaneous coronary intervention with microaxial Impella® pump: results from the German Impella® registry. Clin Res Cardiol. 2018;107(8):653-7.
Jung C, Schlosser M, Figulla H-R, Ferrari M. Providing macro- and microcirculatory support with the Lifebridge system during high-risk PCI in cardiogenic shock. Heart Lung Circ. 2009;18(4):296-8.
Ferrari M, Kruzliak P, Spiliopoulos K. An insight into short- and long-term mechanical circulatory support systems. Clin Res Cardiol. 2015;104(2):95-111.
Bierbach B, Bomberg H, Pritzer H, Prabhu S, Petzina R, Kempski O, et al. Off-pump coronary artery bypass prevents visceral organ damage. Interact Cardiovasc Thorac Surg. 2014;18(6):717-26.
Autschbach R, Rauch T, Engel M, Brose S, Ullmann C, Diegeler A, et al. A new intracardiac microaxial pump: first results of a multicenter study. Artif Organs. 2001;25(5):327-30.
Singh V, Damluji AA, Mendirichaga R, Alfonso CE, Martinez CA, Williams D, et al. Elective or emergency use of mechanical circulatory support devices during transcatheter aortic valve replacement. J Interv Cardiol. 2016;29(5):513-22.
Almalla M, Kersten A, Altiok E, Marx N, Schröder JW. Hemodynamic support with Impella ventricular assist device in patients undergoing TAVI: a single center experience. Catheter Cardiovasc Interv. 2020;95(3):357-62.
Ludeman DJ, Schwartz BG, Burstein S. Impella-assisted balloon aortic valvuloplasty. J Invasive Cardiol. 2012;24(1):E19-E20.
Briguori C, Focaccio A, D'Amore C, Selvetella L, Lonobile T. Elective mechanical circulatory support in the percutaneous treatment of patients with combined complex coronary artery disease and severe aortic valve stenosis. J Invasive Cardiol. 2019;31(3):52-6.
Masyuk M, Abel P, Hug M, Wernly B, Haneya A, Sack S, et al. Real-world clinical experience with the percutaneous extracorporeal life support system: results from the German Lifebridge® Registry. Clin Res Cardiol. 2020;109(1):46-53.
The Kidney Disease Improving Global Outcomes (KDIGO) Working Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:124-38.
Kaku Y, Nakano J, Pham DT. Successful support of cardiogenic shock due to a ruptured papillary muscle using an Impella 5.0. Artif Organs. 2020. Online ahead of print. doi:10.1111/aor.13662.
Ouweneel DM, Henriques JPS. Percutaneous cardiac support devices for cardiogenic shock: current indications and recommendations. Heart. 2012;98(16):1246-54.
Werdan K, Gielen S, Ebelt H, Hochman JS. Mechanical circulatory support in cardiogenic shock. Eur Heart J. 2014;35(3):156-67.
Farooq V, van Klaveren D, Steyerberg EW, Meliga E, Vergouwe Y, Chieffo A, et al. Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II. Lancet. 2013;381(9867):639-50.
Dangas GD, Kini AS, Sharma SK, Henriques JPS, Claessen BE, Dixon SR, et al. Impact of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump on prognostically important clinical outcomes in patients undergoing high-risk percutaneous coronary intervention (from the PROTECT II randomized trial). Am J Cardiol. 2014;113(2):222-8.
Alkhouli M. Left ventricular unloading in ST-elevation myocardial infarction without cardiogenic shock. Artif Organs. 2020. Online ahead of print. doi:10.1111/aor.13721.
O'Neill WW, Kleiman NS, Moses J, Henriques JPS, Dixon S, Massaro J, et al. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation. 2012;126(14):1717-27.
Davila CD, Sharma S, Krishnamoorthy P, Rengifo-Moreno P, Palacios IF, O'Neill W, et al. Prevalence and clinical correlates of extended mechanical support in patients undergoing high-risk percutaneous coronary intervention in current clinical practice: insights from the cVAD registry. Cardiovasc Revasc Med. 2020;21(3):342-7.
Osswald A, Schmack B, Ruhparwar A. Impella 5.0 as short-term mechanical circulatory support following mitral valve surgery in high risk patients. Artif Organs. 2019;43(12):1182-4.
Sjauw KD, Konorza T, Erbel R, Danna PL, Viecca M, Minden H-H, et al. Supported high-risk percutaneous coronary intervention with the Impella 2.5 device the Europella registry. J Am Coll Cardiol. 2009;54(25):2430-4.
Maini B, Naidu SS, Mulukutla S, Kleiman N, Schreiber T, Wohns D, et al. Real-world use of the Impella 2.5 circulatory support system in complex high-risk percutaneous coronary intervention: the USpella Registry. Catheter Cardiovasc Interv. 2012;80(5):717-25.
Flaherty MP, Pant S, Patel SV, Kilgore T, Dassanayaka S, Loughran JH, et al. Hemodynamic support with a microaxial percutaneous left ventricular assist device (Impella) protects against acute kidney injury in patients undergoing high-risk percutaneous coronary intervention. Circ Res. 2017;120(4):692-700.
Flaherty MP, Moses JW, Westenfeld R, Palacios I, O'Neill WW, Schreiber TL, et al. Impella support and acute kidney injury during high-risk percutaneous coronary intervention: the Global cVAD Renal Protection Study. Catheter Cardiovasc Interv. 2020;95(6):1111-21.
Ait Ichou J, Larivée N, Eisenberg MJ, Suissa K, Filion KB. The effectiveness and safety of the Impella ventricular assist device for high-risk percutaneous coronary interventions: a systematic review. Catheter Cardiovasc Interv. 2018;91(7):1250-60.
Pilgrim T, Vetterli F, Kalesan B, Stefanini GG, Räber L, Stortecky S, et al. The impact of anemia on long-term clinical outcome in patients undergoing revascularization with the unrestricted use of drug-eluting stents. Circ Cardiovasc Interv. 2012;5(2):202-10.
Sabatine MS, Morrow DA, Giugliano RP, Burton PBJ, Murphy SA, McCabe CH, et al. Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation. 2005;111(16):2042-9.
Chatterjee S, Wetterslev J, Sharma A, Lichstein E, Mukherjee D. Association of blood transfusion with increased mortality in myocardial infarction: a meta-analysis and diversity-adjusted study sequential analysis. JAMA Intern Med. 2013;173(2):132-9.
Sherwood MW, Wang Y, Curtis JP, Peterson ED, Rao SV. Patterns and outcomes of red blood cell transfusion in patients undergoing percutaneous coronary intervention. JAMA. 2014;311(8):836-43.
Robinson SD, Janssen C, Fretz EB, Berry B, Chase AJ, Siega AD, et al. Red blood cell storage duration and mortality in patients undergoing percutaneous coronary intervention. Am Heart J. 2010;159(5):876-81.
Nikolsky E, Mehran R, Sadeghi HM, Grines CL, Cox DA, Garcia E, et al. Prognostic impact of blood transfusion after primary angioplasty for acute myocardial infarction: analysis from the CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) Trial. JACC Cardiovasc Interv. 2009;2(7):624-32.
Kwok CS, Sherwood MW, Watson SM, Nasir SB, Sperrin M, Nolan J, et al. Blood transfusion after percutaneous coronary intervention and risk of subsequent adverse outcomes: a systematic review and meta-analysis. JACC Cardiovasc Interv. 2015;8(3):436-46.