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1.
Kardiologiia ; 61(1): 104-108, 2021 Feb 10.
Artigo em Russo | MEDLINE | ID: mdl-33706693

RESUMO

This article presents a clinical case of successful transcatheter aortic valve implantation in an elderly patient with critical aortic stenosis at the stage of systolic dysfunction with development of genuine cardiogenic shock. The role of transcatheter aortic valve implantation in the pathogenetic treatment of acute heart failure due to decompensated aortic stenosis was briefly discussed.


Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Idoso , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Humanos , Choque Cardiogênico/etiologia , Choque Cardiogênico/cirurgia , Resultado do Tratamento
2.
Am Heart J ; 233: 39-47, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33338464

RESUMO

BACKGROUND: Cardiogenic shock (CS) is a systemic disorder associated with dismal short-term prognosis. Given its time-dependent nature, mechanical circulatory support may improve survival. Intra-aortic balloon pump (IABP) had gained widespread use because of the easiness to implant and the low rate of complications; however, a randomized trial failed to demonstrate benefit on mortality in the setting of acute myocardial infarction. Acute decompensated heart failure with cardiogenic shock (ADHF-CS) represents a growing resource-intensive scenario with scant data and indications on the best management. However, a few data suggest a potential benefit of IABP in this setting. We present the design of a study aimed at addressing this research gap. METHODS AND DESIGN: The Altshock-2 trial is a prospective, randomized, multicenter, open-label study with blinded adjudicated evaluation of outcomes. Patients with ADHF-CS will be randomized to early IABP implantation or to vasoactive treatments. The primary end point will be 60 days patients' survival or successful bridge to heart replacement therapy. The key secondary end point will be 60-day overall survival; 60-day need for renal replacement therapy; in-hospital maximum inotropic score, maximum duration of inotropic/vasopressor therapy, and maximum sequential organ failure assessment score. Safety end points will be in-hospital occurrence of bleeding events (Bleeding Academic Research Consortium >3), vascular access complications and systemic (noncerebral) embolism. The sample size for the study is 200 patients. IMPLICATIONS: The Altshock-2 trial will provide evidence on whether IABP should be implanted early in ADHF-CS patients to improve their clinical outcomes.


Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Balão Intra-Aórtico , Choque Cardiogênico/cirurgia , Doença Aguda , Fármacos Cardiovasculares/uso terapêutico , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Estudos Prospectivos , Terapia de Substituição Renal , Tamanho da Amostra , Choque Cardiogênico/complicações , Choque Cardiogênico/tratamento farmacológico , Fatores de Tempo
3.
PLoS One ; 15(8): e0238046, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833995

RESUMO

BACKGROUND: There are limited data on the complications with a percutaneous left ventricular assist device (pLVAD) vs. intra-aortic balloon pump (IABP) in acute myocardial infarction-cardiogenic shock (AMI-CS). OBJECTIVE: To assess the trends, rates and predictors of complications. METHODS: Using a 17-year AMI-CS population from the National Inpatient Sample, AMI-CS admissions receiving pLVAD and IABP support were evaluated for vascular, lower limb amputation, hematologic, neurologic and acute kidney injury (AKI) complications. In-hospital mortality, hospitalization costs and length of stay in pLVAD and IABP cohorts with complications was studied. RESULTS: Of 168,645 admissions, 7,855 (4.7%) receiving pLVAD support. The pLVAD cohort had higher comorbidity, cardiac arrest (36.1% vs. 29.7%) and non-cardiac organ failure (74.7% vs. 56.9%) rates. Complications were higher in pLVAD compared to IABP cohort-overall 69.0% vs. 54.7%; vascular 3.8% vs. 2.1%; lower limb amputation 0.3% vs. 0.3%; hematologic 36.0% vs. 27.7%; neurologic 4.9% vs. 3.5% and AKI 55.4% vs. 39.1% (all p<0.001 except for amputation). Non-White race, higher comorbidity, organ failure, and extracorporeal membrane oxygen use were predictors of complications for both cohorts. The pLVAD cohort with complications had higher in-hospital mortality (45.5% vs. 33.1%; adjusted odds ratio 1.65 [95% confidence interval 1.55-1.75]), shorter duration of hospital stay, and higher hospitalization costs compared to the IABP cohort with complications (all p<0.001). These results were consistent in propensity-matched pairs. CONCLUSIONS: AMI-CS admissions receiving pLVAD had higher rates of complications compared to the IABP, with worse in-hospital outcomes in the cohort with complications.


Assuntos
Coração Auxiliar/efeitos adversos , Balão Intra-Aórtico/efeitos adversos , Infarto do Miocárdio/complicações , Complicações Pós-Operatórias/etiologia , Choque Cardiogênico/complicações , Choque Cardiogênico/cirurgia , Doença Aguda , Idoso , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Choque Cardiogênico/terapia
4.
J Cardiothorac Surg ; 15(1): 138, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32532284

RESUMO

BACKGROUND: Acute aortic dissection (AAD) is a rare, but a life-threatening condition which can lead to coronary, brachiocephalic or branch vessel malperfusion, as well as aortic valve insufficiency, or aortic rupture. Mortality of surgical treatment in high-risk or elderly patients with Type A Acute aortic dissection (TAAAD) still remains high, and treatment for such patients remains controversial. CASE PRESENTATION: A new surgical approach which entails "stepwise external wrapping (SEW)" using a zero-porosity artificial graft was developed in extremely high-risk patients with TAAAD. Herein, we described its surgical details and showed two representative cases which was successfully done. CONCLUSIONS: Our SEW procedure is a feasible alternative to conventional graft replacement for TAAAD in extremely high-risk or aged patients, although the gold standard consists of surgical replacement of the dissected aorta. (129 words).


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/instrumentação , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Implante de Prótese Vascular/métodos , Tamponamento Cardíaco/cirurgia , Ponte Cardiopulmonar , Ecocardiografia , Feminino , Humanos , Masculino , Choque Cardiogênico/cirurgia , Esternotomia , Tomografia Computadorizada por Raios X
5.
Int Heart J ; 61(3): 616-619, 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32418970

RESUMO

We experienced a 33-year-old patient with D-looped transposition of the great arteries (D-TGA) and a history of Senning operation who was referred to our institute with cardiogenic shock and subsequently underwent urgent paracorporeal ventricular assist device (VAD) implantation, which was a first in Japan, that was eventually converted to a durable VAD. Central venous pressure was maintained relatively high to obtain VAD filling and recover end-organ dysfunction, given the migration of the inflow cannula due to rich trabeculae carneae of the anatomical right ventricle (systemic ventricle in this case).


Assuntos
Coração Auxiliar , Implantação de Prótese , Choque Cardiogênico/cirurgia , Transposição dos Grandes Vasos , Adulto , Transposição das Grandes Artérias , Feminino , Humanos , Transposição dos Grandes Vasos/cirurgia
6.
Ann Thorac Surg ; 110(3): e199-e200, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32114040

RESUMO

Cardiogenic shock is a life-threatening condition requiring fast and efficient diagnostic and therapeutic measures. In this case, the history of several cardiac surgeries hindered finding the correct diagnosis initially. After an ultima ratio cardiac redo operation the underlying cause was found intraoperatively: a defective mechanical valve prosthesis with migration of one of the two leaflets. Strikingly, this happened with a contemporary On-X prosthesis only 4 years after implantation. Timely echocardiography is of utmost importance in patients with prosthetic heart valves presenting in heart failure.


Assuntos
Migração de Corpo Estranho/diagnóstico por imagem , Próteses Valvulares Cardíacas/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Falha de Prótese/efeitos adversos , Choque Cardiogênico/etiologia , Adulto , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/cirurgia , Humanos , Masculino , Desenho de Prótese , Choque Cardiogênico/diagnóstico por imagem , Choque Cardiogênico/cirurgia
7.
Interact Cardiovasc Thorac Surg ; 30(5): 711-714, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32087016

RESUMO

Impella® pumps are increasingly utilized in patients in cardiogenic shock. We report on a case series where Impella support was insufficient, and a switch to venoarterial extracorporeal membrane oxygenation (VA ECMO) became necessary. ECMO patients with previous Impella devices were identified utilizing our institutional ECMO database. Since 2014, 10 patients with a mean age of 62 ± 3 years were identified. Despite correct placement of all Impella pumps, cardiogenic shock persisted with progressive multi-organ failure (Impella type 2.5/CP n = 6/4 patients). Femoro-femoral VA ECMO was implanted percutaneously on the contralateral side with the Impella initially left on standby but retracted into the descending aorta for transport reasons after a mean support time of 20 ± 8 h. All patients were able to unload their heart by left ventricular ejection with a blood pressure amplitude of 15 ± 3 mmHg on VA ECMO support. After VA ECMO implantation haemodynamic parameters improved significantly within 24 h of support (mean serum lactate levels decreased from 92 ± 17 to 44 ± 10 mg/dl, P = 0.031). Survival to hospital discharge was 70%. These data indicate that the Impella 2.5® and CP® might not be sufficient in profound cardiogenic shock. Comparative studies are necessary to specify which patient population benefits from which type of circulatory support.


Assuntos
Coração Auxiliar/estatística & dados numéricos , Hemodinâmica/fisiologia , Choque Cardiogênico/cirurgia , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Choque Cardiogênico/fisiopatologia
10.
Interact Cardiovasc Thorac Surg ; 30(2): 312-315, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31652322

RESUMO

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does concurrent use of intra-aortic balloon pump (IABP) improve survival in patients with cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO)?'. Altogether 472 papers were found using the reported search, of which 3 level 2 systematic reviews represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The reported comparative outcomes were mortality, weaning off extracorporeal membrane oxygenation (ECMO), vascular complications and non-vascular complications. One systematic review demonstrated significantly lower in-hospital mortality with concurrent use of IABP and VA-ECMO, while the other 2 studies showed no difference in mortality. One paper reported on the weaning success from ECMO and demonstrated significantly higher weaning success with concurrent IABP usage. Another paper reported on the complications and showed no differences in vascular and non-vascular complications. We conclude that there was no significant improvement in survival with the concurrent use of IABP and VA-ECMO for a cardiogenic shock as compared to the use of VA-ECMO alone. However, the concurrent use of IABP with VA-ECMO improved weaning success from VA-ECMO. The incidence of vascular and non-vascular complications was similar with or without IABP usage.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Oxigenação por Membrana Extracorpórea/métodos , Coração Auxiliar , Balão Intra-Aórtico/métodos , Choque Cardiogênico/cirurgia , Saúde Global , Mortalidade Hospitalar , Humanos , Incidência , Choque Cardiogênico/epidemiologia , Taxa de Sobrevida/tendências
12.
Eur Heart J Acute Cardiovasc Care ; 9(2): 158-163, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31246097

RESUMO

OBJECTIVES: To evaluate the effects of left ventricular support with the microaxial left ventricular pump using the Impella device on the renal resistive index assessed by Doppler ultrasonography in haemodynamically stable patients with cardiogenic shock following myocardial infarction. METHODS: A non-randomised interventional single-centre study. Consecutive patients with cardiogenic shock supported with an Impella were included during May 2018 and October 2018. The renal resistive index determined as a quotient of (peak systolic velocity - end diastolic velocity)/ peak systolic velocity was obtained using Doppler ultrasound; invasive blood pressure was determined in radial artery simultaneously for safety reasons. RESULTS: A total of 15 patients were measured. The renal resistive index was determined in both kidneys in 13 patients and for one kidney in two patients, respectively. The mean difference between right and left renal resistive index was 0.026 ± 0.023 (P=0.72). When increasing the Impella microaxillar mechanical support by a mean of 0.44 L/min (±0.2 L/min), the renal resistive index decreased significantly from 0.66 ± 0.08 to 0.62 ± 0.06 (P<0.001) consistently in all patients, whereas systolic or diastolic blood pressure remained unchanged. CONCLUSIONS: Microaxillar mechanical support by the Impella device in haemodynamically stable patients with cardiogenic shock led to a significant reduction of the renal resistive index without affecting systolic or diastolic blood pressure. This observation is consistent with the notion that Impella support may promote renal organ protection by enhancing renal perfusion.


Assuntos
Lesão Renal Aguda/fisiopatologia , Coração Auxiliar/efeitos adversos , Rim/fisiopatologia , Infarto do Miocárdio/complicações , Choque Cardiogênico/etiologia , Lesão Renal Aguda/etiologia , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Feminino , Hemodinâmica/fisiologia , Humanos , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto/métodos , Intervenção Coronária Percutânea/efeitos adversos , Artéria Radial/fisiologia , Estudos Retrospectivos , Choque Cardiogênico/cirurgia , Resultado do Tratamento , Ultrassonografia Doppler/métodos
13.
J Artif Organs ; 23(2): 105-112, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31873827

RESUMO

Over the last years, different case reports/studies have demonstrated that in patients with acute pulmonary embolism (PE) and refractory shock mechanical circulatory support (MCS) with Impella RP® (Abiomed, Inc, Danvers, Mass) increases the chances of survival, significantly unloading the right ventricle and improving both the cardiac output and the mean pulmonary artery pressure. We reviewed the medical literature about the use of Impella RP in patients with acute PE and refractory shock using PubMed (MEDLINE), Scopus, Cochrane library, and Google Scholar databases. The final research was conducted in July 2019. The results evidenced that available data are currently scant to definitively assess the real role Impella RP® in patient with acute PE and refractory shock. However, preliminary data seems to be very promising. Further larger studies are needed to confirm the safety and efficacy of MCS in these patients. A multidisciplinary assessment, using the PERT team, must be performed case by case to determine the need of MCS.


Assuntos
Coração Auxiliar , Embolia Pulmonar/cirurgia , Choque Cardiogênico/cirurgia , Hemodinâmica/fisiologia , Humanos , Embolia Pulmonar/complicações , Choque Cardiogênico/complicações , Resultado do Tratamento
14.
J Cardiovasc Surg (Torino) ; 61(2): 220-225, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30747502

RESUMO

BACKGROUND: Type A aortic dissection is a surgical emergency with a high morbidity and mortality. Strokes occur in up to 25% and are among the most feared complications. This study aims to evaluate factors linked to stroke development and the implications of strokes on outcomes. METHODS: Patients from 2000-2014 were stratified based on the development of stroke. Factors were compared between the groups using chi-square or Fisher's exact tests for categorical variables, and independent two-group t-tests for continuous variables. Impact on survival at 30 days, 1 and 5 years were evaluated using the life-test method. RESULTS: Two hundred patients were analyzed. Forty (20%) developed a stroke. Preoperative factors associated with stroke were female gender (34% vs. 14% P=0.01), presentation with shock (32% vs. 17%; P=0.035), and history of stroke (64% vs. 17%; P<0.001). Femoral cannulation was the only technical variable associated with stroke (49% vs. 32%; P=0.035). Stroke patients had a higher rate of pneumonia (41% vs. 11%; P<0.001), respiratory failure (36% vs. 7%; P<0.001), hemodialysis requirement (38% vs. 16%; P=0.015), and longer hospital stay (23.9±17.8 days vs. 16.1±13.5 days; P=0.012). Stroke was associated with a lower survival probability at 30 days (0.73 vs. 0.89), 1 year (0.56 vs. 0.78), and 5 years (0.29 vs. 0.70) (P<0.001). CONCLUSIONS: Patients who developed stroke after type A dissection repair had higher complication rates and a higher mortality rate at 30 days, 1 year, and 5 years. Femoral cannulation was the only technical factor associated with a higher rate of strokes.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Causas de Morte , Acidente Vascular Cerebral/epidemiologia , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Implante de Prótese Vascular/métodos , Causalidade , Distribuição de Qui-Quadrado , Bases de Dados Factuais , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/mortalidade , Choque Cardiogênico/cirurgia , Análise de Sobrevida , Fatores de Tempo
15.
Ann Thorac Surg ; 109(2): e145-e146, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31563488

RESUMO

The left ventricular assist device Impella 5.0 (Abiomed Inc, Danvers, MA) has become widely accepted as a temporary mechanical circulatory support for patients in cardiogenic shock. The Impella 5.0 is placed through an anastomosed graft. When removing the device, blood clot formation has been noted in the anastomosed graft. The blood clot has been reported to dislodge and embolize distally, causing acute limb ischemia. Here, we present our simple, inexpensive, and effective "loop and snare" technique for safer device removal, preventing distal embolic complications. In our experience of 6 patients who had Impella 5.0 removal with this technique, the distal embolic complication was 0%.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Remoção de Dispositivo/métodos , Embolia/prevenção & controle , Coração Auxiliar/efeitos adversos , Choque Cardiogênico/cirurgia , Embolia/etiologia , Humanos
16.
Artigo em Inglês | MEDLINE | ID: mdl-33399285

RESUMO

We describe the insertion of the Impella 5.0, a peripherally placed mechanical cardiovascular microaxial pump, in a patient with ischemic left ventricular dysfunction. The Impella is a 7 Fr device capable of achieving a flow of 4.0-5.0 L/min; its use necessitates an open arterial cut-down. A subclavicular incision is used to access the right or left axillary artery. A 10-mm tube graft is anastomosed to the artery through which the Impella 5.0 is inserted. The device traverses the tube graft and is advanced via the aorta, across the aortic valve, to its final position (inflow toward the ventricular apex and outflow above the aorta). The device may remain in situ for 10 days until recovery or until further supports are instituted. Our goal is to demonstrate the insertion of the Impella 5.0 device in a patient with cardiogenic shock whose situation was further complicated by coronavirus disease 2019.


Assuntos
Circulação Assistida , Coração Auxiliar , Implantação de Prótese , Infarto do Miocárdio com Supradesnível do Segmento ST , Choque Cardiogênico , Adulto , Circulação Assistida/instrumentação , Circulação Assistida/métodos , /terapia , Cateterismo Cardíaco/métodos , Humanos , Masculino , Decúbito Ventral/fisiologia , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Choque Cardiogênico/etiologia , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/cirurgia , Resultado do Tratamento
17.
J Interv Cardiol ; 2019: 7598581, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31777471

RESUMO

Objective: To identify outcomes of patients undergoing emergency transcatheter aortic valve replacement (TAVR) and determine predictors of in-hospital mortality. Background: Emergency TAVR has emerged as a viable treatment strategy for patients with decompensated severe aortic stenosis and/or regurgitation; however, data on patients undergoing emergency TAVR are limited. Methods: All emergency TAVR procedures were identified from a single tertiary academic center between January 2015 and August 2018. Results: 31 patients underwent emergency TAVR due to cardiogenic shock (26 patients), electrical instability with incessant ventricular tachycardia (2 patients), severe refractory angina (2 patients), and decompensated heart failure with hypoxemic respiratory failure requiring mechanical ventilation (1 patient). Mechanical circulatory support (MCS) was used in 16 (51.6%). MCS initiation occurred immediately prior to TAVR in 10 patients and placed post-TAVR in 6 patients. 6 patients died before hospital discharge (in-hospital mortality 19.4%). 1-year and 2-year survival rates were 61.0% and 55.9%, respectively. Univariate predictors of in-hospital mortality were preprocedural pulmonary artery pulsatility index (PAPi) ≤1.8 (66.7% vs. 20.0%, p=0.01), intraprocedural cardiopulmonary resuscitation (CPR) (83.3% vs 4.0%, p ≤ 0.001), acute kidney injury post-TAVR (80.0% vs. 4.2%, p ≤ 0.001), initiation of dialysis post-TAVR (60.0% vs. 4.2%, p ≤ 0.001), and MCS initiation post-TAVR (50.0% vs. 12.0%, p=0.03). MCS initiation before TAVR was associated with improved survival compared with post-TAVR initiation. Conclusion: Emergency TAVR in extreme risk patients with acute decompensated heart failure or cardiogenic shock secondary to severe aortic valve disease is associated with high in-hospital mortality rates. Careful patient selection taking into account right heart function, assessed by PAPi, and early utilization of MCS may improve survival following emergency TAVR.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Emergências , Mortalidade Hospitalar , Substituição da Valva Aórtica Transcateter/mortalidade , Lesão Renal Aguda/mortalidade , Idoso , Angina Instável/cirurgia , Reanimação Cardiopulmonar , Oxigenação por Membrana Extracorpórea , Feminino , Insuficiência Cardíaca/cirurgia , Humanos , Período Intraoperatório , Masculino , Fluxo Pulsátil , Diálise Renal/mortalidade , Insuficiência Respiratória/cirurgia , Choque Cardiogênico/cirurgia , Taquicardia Ventricular/cirurgia , Washington/epidemiologia
18.
Tunis Med ; 97(3): 476-483, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31729723

RESUMO

BACKGROUND: Cardiogenic shock complicating ST elevation myocardial infarction is burdened by a high mortality. There is only limited evidence for the management except for early revascularization and the relative ineffectiveness of intra-aortic balloon pump. AIM: Our objectives were to evaluate outcome and predictors of early all-cause 30-day mortality in the setting of cardiogenic shock complicating ST elevation myocardial infarction. METHODS: From January 2009 to August 2018, all patients who presented within the first 48 hours of ST elevation myocardial infarction complicated by cardiogenic shock and receiving invasive management were prospectively included. RESULTS: The study cohort comprised 122 consecutive patients. The mean age was 65±12 years and 74.5% of patients were males. Left ventricular failure was the most common etiology of cardiogenic shock (72.1%) and mechanical complications occurred in 8.2% of cases. Percutaneous coronary interventions were proposed for all patients and performed in a primary setting in 72.1%. A high prevalence of no reflow was noted (15.6%). Multivessel coronary artery disease was noted in 64.8% and multivessel percutaneous coronary interventions at the index procedure were performed in 22.1% of cases. Intra-aortic balloon pump was used in 17.2% of patients. The 30-day mortality was 58.2%. The only predictor of early mortality was the immediate multivessel percutaneous coronary intervention (OR=4.1, 95%CI 1.1-14.5; p=0.031). CONCLUSION: Despite invasive management strategies, 30-day mortality of cardiogenic shock complicating ST elevation myocardial infarction remained as high as 58.2%. Immediate multivessel percutaneous coronary intervention was the only predictor of early mortality.


Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/cirurgia , Idoso , Estudos de Coortes , Comorbidade , Feminino , Humanos , Balão Intra-Aórtico/efeitos adversos , Balão Intra-Aórtico/mortalidade , Masculino , Pessoa de Meia-Idade , Mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Complicações Pós-Operatórias/mortalidade , Prevalência , Prognóstico , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Choque Cardiogênico/complicações , Choque Cardiogênico/epidemiologia , Resultado do Tratamento
19.
J Pak Med Assoc ; 69(11): 1663-1667, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31740874

RESUMO

OBJECTIVE: To assess the frequency of acute coronary syndrome patients with cardiogenic shock and not undergoing revascularisation, their in- hospital outcome and reasons underlying management decisions. METHODS: The retrospective cross-sectional study was conducted at Tabba Heart Institute, Karachi, and comprised data from July 2013 to December 2017 of acute coronary syndrome with hypotension and not having under gone revascularisation. Data was analyzed using Stata 12.1. RESULTS: Of the 383 patients, 55(14.3%) did not undergo revascularisation. Overall mean age was 63.2±9.8years. Overall mortality was 45(81.8%). Revascularisation was intended in 28(51%) patients of whom 19(68%) died before undergoing cardiac catheterisation. Another 9(32%) patients died after cardiac catheterisation but before revascularisation. Common clinical reasons in the remaining 27(49%) patients not considered for revascularisation were hypoxic brain injury secondary to cardiac arrest, patient refusal, perceived patient frailty, multi-organ failure, sepsis or pre-existing stroke/ malignancy. CONCLUSIONS: Cardiogenic shock complicating myocardial infarction not treated by revascularization had a very poor early outcome. In the two-third of patients before treatment was initiated, there was cardiac arrest with failed resuscitation or poor recovery.


Assuntos
Revascularização Miocárdica/estatística & dados numéricos , Choque Cardiogênico/epidemiologia , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/cirurgia , Idoso , Cateterismo Cardíaco/estatística & dados numéricos , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/cirurgia , Revascularização Miocárdica/mortalidade , Paquistão/epidemiologia , Estudos Retrospectivos , Choque Cardiogênico/mortalidade , Choque Cardiogênico/cirurgia , Resultado do Tratamento
20.
Curr Opin Cardiol ; 34(6): 650-655, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31567501

RESUMO

PURPOSE OF REVIEW: With the continuous innovation in mechanical circulatory support as an option for the management of patients in cardiogenic shock from myocardial infarction, it is important to understand the current evidence and recommendations for the use of these devices for patients who require or underwent coronary artery bypass surgery. RECENT FINDINGS: The use of mechanical circulatory support (MCS) in patients with cardiogenic shock who require or underwent coronary artery bypass surgery has not been well studied. Observational studies have shown that the use of intra-aortic balloon pump or percutaneous ventricular assist devices prior to revascularization lead to better survival. Extracorporeal membrane oxygenation (ECMO) still carries significant risk of mortality and complications; the use of additional MCS devices for left ventricular unloading during ECMO improves outcomes. SUMMARY: MCS will continue to play an important role in coronary artery surgery patients. Multidisciplinary Cardiac Shock Team can assist in proper patient selection and device choice, whereas prospective clinical trials are required to provide evidence-based guidance towards the management of these patients.


Assuntos
Circulação Assistida/métodos , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Infarto do Miocárdio/cirurgia , Choque Cardiogênico/cirurgia , Circulação Assistida/instrumentação , Doença da Artéria Coronariana/complicações , Oxigenação por Membrana Extracorpórea , Coração Auxiliar , Humanos , Balão Intra-Aórtico , Infarto do Miocárdio/etiologia , Estudos Prospectivos , Choque Cardiogênico/etiologia
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