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1.
Artif Organs ; 48(7): 771-780, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38400638

RESUMO

BACKGROUND: This study evaluated the outcomes of patients with cardiogenic shock (CS) supported with Impella 5.0 or 5.5 and identified risk factors for in-hospital mortality. METHODS: Adults with CS who were supported with Impella 5.0 or 5.5 at a single institution were included. Patients were stratified into three groups according to their CS etiology: (1) acute myocardial infarction (AMI), (2) acute decompensated heart failure (ADHF), and (3) postcardiotomy (PC). The primary outcome was survival, and secondary outcomes included adverse events during Impella support and length of stay. Multivariable logistic regression was performed to identify risk factors for in-hospital mortality. RESULTS: One hundred and thirty-seven patients with CS secondary to AMI (n = 47), ADHF (n = 86), and PC (n = 4) were included. The ADHF group had the highest survival rates at all time points. Acute kidney injury (AKI) was the most common complication during Impella support in all 3 groups. Increased rates of AKI and de novo renal replacement therapy were observed in the PC group, and the AMI group experienced a higher incidence of bleeding requiring transfusion. Multivariable analysis demonstrated diabetes mellitus, elevated pre-insertion serum lactate, and elevated pre-insertion serum creatinine were independent predictors of in-hospital mortality, but the etiology of CS did not impact mortality. CONCLUSIONS: This study demonstrates that Impella 5.0 and 5.5 provide effective mechanical support for patients with CS with favorable outcomes, with nearly two-thirds of patients alive at 180 days. Diabetes, elevated pre-insertion serum lactate, and elevated pre-insertion serum creatinine are strong risk factors for in-hospital mortality.


Assuntos
Coração Auxiliar , Mortalidade Hospitalar , Choque Cardiogênico , Humanos , Choque Cardiogênico/terapia , Choque Cardiogênico/mortalidade , Choque Cardiogênico/etiologia , Masculino , Coração Auxiliar/efeitos adversos , Feminino , Idoso , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento , Estudos Retrospectivos , Injúria Renal Aguda/terapia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/mortalidade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/complicações
2.
J Card Surg ; 36(10): 3884-3888, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34148246

RESUMO

We report a case of acute right ventricular failure in a patient with cardiogenic shock on left-sided mechanical circulatory support with Impella 5.0. The patient was successfully bridged to heart transplantation using additional right-sided support with Protek Duo. Key learning points of the case include prompt recognition of acute right ventricular failure in patients on left-sided support, early consideration of right-ventricular mechanical support platforms, and timely deployment of right-sided mechanical support.


Assuntos
Insuficiência Cardíaca , Transplante de Coração , Coração Auxiliar , Insuficiência Cardíaca/complicações , Humanos , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Resultado do Tratamento
3.
Heart Int ; 16(1): 49-58, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36275351

RESUMO

Tricuspid regurgitation is a complex disease that carries a poor prognosis, and surgical repair is associated with high mortality. In light of the success of other transcatheter-based valve interventions, transcatheter tricuspid therapy has recently seen exponential use both clinically and in innovation. Given the rapid development of many tricuspid systems and multiple on-going clinical trials, the aim of this review is to highlight the current state of transcatheter tricuspid therapeutics and to provide an up-to-date view of their clinical use, outcomes and future directions.

5.
J Pediatr Adolesc Gynecol ; 22(1): e15-9, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19232289

RESUMO

BACKGROUND: Pediatric pelvic fractures often appear radiographically benign despite significant injury to viscera. Vaginal injuries are rare, and therefore require a high index of suspicion. CASE: A 26-year-old female patient who sustained a pelvic fracture in a motorcycle accident at the age of 10 presented with vaginal stenosis precluding sexual intercourse. Patient menstruated through a fistula in the distal vaginal vault. Radiographic and dye studies showed almost complete vaginal obstruction with heterotopic ossification. An extensive 30-year review of the literature was conducted looking for documented cases of vaginal injuries secondary to pelvic injury. SUMMARY AND CONCLUSION: This is the only recorded case of a long-term vaginal complication with subsequent heterotopic ossification secondary to pelvic fracture. Preventing debilitating long-term sequelae from vaginal injuries requires close patient follow-up and age-appropriate assessments.


Assuntos
Constrição Patológica/etiologia , Fraturas Ósseas/complicações , Ossificação Heterotópica/complicações , Ossos Pélvicos/lesões , Vagina/lesões , Acidentes de Trânsito , Adulto , Criança , Constrição Patológica/diagnóstico , Feminino , Consolidação da Fratura , Humanos , Motocicletas , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/etiologia , Ossos Pélvicos/diagnóstico por imagem , Radiografia , Disfunções Sexuais Fisiológicas/etiologia , Tempo , Fatores de Tempo
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