Zusammenfassung
Die Prognose der Herzinsuffizienz hat sich in den letzten Jahren durch die Einführung verschiedener neuer Therapien stetig verbessert, dennoch ist die 5‑Jahres-Mortalität mit >50 % ...sowohl der systolischen auch der diastolischen Herzinsuffizienz immer noch sehr hoch. Mögliche Therapieoptionen sind die medikamentöse Therapie, die Device-Therapie sowie die interventionelle Therapie der chronischen Herzinsuffizienz.
Aims
Patients suffering from cardiogenic shock (CS) have a high mortality and morbidity. The Impella percutaneous left-ventricular assist device (LVAD) decreases LV preload, increases cardiac output, ...and improves coronary blood flow. We aimed to review and meta-analyze available data comparing Impella versus intra-aortic pump (IABP) counterpulsation or medical treatment in CS due to acute myocardial infarction or post-cardiac arrest.
Methods and results
Study-level data were analyzed. Heterogeneity was assessed using the
I
2
statistic. Risk rates were calculated and obtained using a random-effects model (DerSimonian and Laird). Four studies were found suitable for the final analysis, including 588 patients. Primary endpoint was short-term mortality (in-hospital or 30-day mortality).
In a meta-analysis of four studies comparing Impella versus control, Impella was not associated with improved short-term mortality (in-hospital or 30-day mortality; RR 0.84; 95% CI 0.57–1.24;
p
= 0.38;
I
2
55%). Stroke risk was not increased (RR 1.00; 95% CI 0.36–2.81;
p
= 1.00;
I
2
2 0%), but risk for major bleeding (RR 3.11 95% CI 1.50–6.44;
p
= 0.002;
I
2
0%) and peripheral ischemia complications (RR 2.58; 95% CI 1.24–5.34;
p
= 0.01;
I
2
0%) were increased in the Impella group.
Conclusion
In patients suffering from severe CS due to AMI, the use of Impella is not associated with improved short-time survival but with higher complications rates compared to IABP and medical treatment. Better patient selection avoiding Impella implantation in futile situations or in possible lower risk CS might be necessary to elucidate possible advantages of Impella in future studies.
We report on our experience with the BerlinHeart Excor system in adults and paediatric patients who underwent placement of the mechanical support device under emergency conditions and demonstrate the ...exceptional advantages and the considerable versatility of the system.
Since 2003, 29 consecutive patients (25 adults and 4 infants) with ages ranging from 10 months to 54 years underwent implantation of an Excor system. Main underlying heart diseases in adults were acute myocardial infarction (n = 9), dilative cardiomyopathy (n = 6), acute myocarditis (n = 6), whereas most of the children suffered from dilative cardiomyopathy. Ten patients had undergone implantation of an extracorporeal membrane oxygenation system.
In 26 cases, a left ventricular assist device (LVAD) was implanted, while 3 patients had biventricular support. The support interval of all patients surviving the perioperative period lasted from 30 to 412 days, mean period of support until heart transplantation or explantation was 184 +/- 117 days. Severe complications were rare.
The Excor paracorporeal mechanical support system is an excellent and highly versatile device for the support of patients of all ages and different types of underlying heart disease in the mid-term and long-term. The implant procedure and the perioperative management are simple, and complication rates are low.
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