Discordance between aPTT and anti‐Xa in monitoring heparin anticoagulation in mechanical circulatory support

Early Mechanical Circulatory Support is Associated with Improved Outcomes in Cardiogenic Shock Due to End-Stage Heart Failure

Patients suffering from acute cardiac graft rejection can die because of hemodynamic collapse while being treated with vigorous immunosuppressive therapies. There is little pediatric data on the use of mechanical circulatory support (MCS) in patients with acute cardiac graft rejection accompanied by hemodynamic instability. This report reviews our experience using MCS in patients with severe acute allograft rejection and cardiogenic shock. Between July 1995 and December 2006, 7 of 117 heart transplant recipients (6%) had MCS placed in 8 cases of acute graft rejection with hemodynamic instability. Devices used were BioMedicus (five), Thoratec (two), and extracorporeal membrane oxygenation machine (one). Mean age was 12 +/- 6.6 years. Median duration of support was 7.5 days (range, 3-28 days). Medical therapy applied included pulse steroids (eight), antithymocyte globulin (five), intravenous immunoglobulins (five), and plasmapheresis (five). Eighty-eight percent (seven of eight cases) weaned from MCS. Five patients weaned to recovery and two were bridged to retransplant. Five of the seven patients weaned (71%) were discharged home, all with normal left ventricular function. Median follow-up was 3.0 years (4.5 months to 3.5 years). One-year survival is 50% and 3 year survival is 38%. Mechanical circulatory support can be applied in patients with acute cardiac graft rejection causing hemodynamic instability with acceptable weaning and discharge rates. Unfortunately, late survival for this cohort remains poor.

Recent analyses establish that heart transplantation is increasing among adults with congenital heart disease (ACHD), but the effects of pretransplant mechanical circulatory support (MCS) on perioperative and post-transplant outcomes have not been examined in the ACHD population. Scientific Registry of Transplant Recipients data on all adult heart transplants from September 1987 to September 2012 (n = 47 160) were classified based on primary diagnosis codes as CHD or non-CHD and MCS or non-MCS. Demographic, procedural, outcome and survival variables were compared between MCS and non-MCS ACHD patient groups. MCS was used in 83 (6.8%) ACHD patients compared with 8625 (18.8%) patients without CHD (P < 0.001). MCS as a fraction of ACHD transplants increased over time (P = 0.002). MCS patients spent more time on the wait list, had a higher baseline serum creatinine and were more likely to be male, status 1A, hospitalized, in the ICU and/or on a ventilator prior to transplant. However, MCS patients experienced equivalent short-term survival (30-day mortality = 10.8% in MCS vs 13.5% in non-MCS, P = 0.62) and overall survival by Kaplan-Meier analysis (P = 0.57). MCS patients had a longer post-transplant length of stay and were more likely to be transfused, but otherwise had no significant differences in adverse outcomes. MCS is less commonly used in adult CHD patients compared with all patients undergoing heart transplant, but has been increasing over time. Within the ACHD population, patients with MCS have a higher risk profile, but except for increased transfusion rate and longer length of stay, do not experience less favourable post-transplant outcomes.

Epidemiology of infection in mechanical circulatory support: A global analysis from the ISHLT Mechanically Assisted Circulatory Support Registry.

ObjectiveThe survival benefit of using mechanical circulatory support (MCS) in patients with acute myocardial infarction (AMI) is still controversial. It is necessary to explore the impact on clinical outcomes of...

Mechanical circulatory support in refractory cardiogenic shock due to influenza virus-related myocarditis.

Introduction: Recent studies have shown a rise in temporary mechanical circulatory support (MCS) use among patients requiring heart transplants(HT) in the United States. However, there is a lack of data on the potential risk factors for death among HT patients who also used MCS. We, therefore, explored the National Inpatient Sample(NIS) database to investigate further. Methods: All procedures for HT in adults via the 2016-2020 NIS were retained for our study. The use of MCS was also identified via procedural codes based on previous studies. We estimated factors that could influence mortality among MCS patients via multivariable regression analysis. Results: Our selection criteria yielded 14545 cases of HT between 2016-2020, and an estimated 31.6%(4590) patients used MCS. A higher mortality rate in MCS patients was reported as 10.1% (465 cases out of 4590) did not survive (vs. 3.1% in non-MCS patients, aOR 3.473, 95% CI 2.966-4.066, p&lt;0.01). In the MCS cohort, patients who died were older (mean age 56.13 vs. 53.65 years), with a higher mean Charlson Comorbidity Index (CCI) score ( mean score of 6.03 vs. 4.30, p&lt;0.01). Factors that contributed to an increased odds of death included Weekend admissions (aOR 1.413, 95% CI 1.086-1.839, p=0.10), Hispanics (vs. Whites, aOR 1.926, 95% CI 1.398-2.652, p&lt;0.01), history of peripheral vascular disease (PVD) (aOR 4.426, 95% CI 2.712-7.221, p&lt;0.01), obesity (aOR 1.668, 95% CI 1.238-2.248, p&lt;0.01), age ≥60years (aOR 1.982, 95% CI 1.593-2.466, p&lt;0.01), and patients covered by private insurance forms (vs. Medicare, aOR 1.341, 95% CI 1.067-1.685, p=0.012). Meanwhile, those with lipid disorders (aOR 0.313, 95% CI 0.234-0.418, p&lt;0.01) and a history of stroke (aOR 0.484, 95% CI 0.246-0.954, p=0.036) showed lower mortality risks. Conclusions: Patients who used MCS and are now undergoing HT are at a higher risk of death. Weekend admissions, Hispanics, PVD, obesity, age ≥60 years, and private insurance were linked with higher risks in the MCS cohort, while a history of stroke and lipid disorders had lower risks. Thus, physicians must address these risk factors in their choice of care and provide the appropriate steps to reduce mortality.

BackgroundDespite limited beneficial evidence, mechanical circulatory support (MCS) is commonly used in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS). In this Dutch registry, we investigated MCS usage, associated patient...

ObjectivesTo describe the contemporary trends in the use of mechanical circulatory support (MCS) in patients with acute myocardial infarction and cardiogenic shock (AMICS). To evaluate survival benefit with early application...

Mechanical Circulatory Support Following Out-of-Hospital Cardiac Arrest: Insights From the National Cardiogenic Shock Initiative

Desensitization in Mechanical Circulatory Support Patients Awaiting Heart Transplantation: What is the Post-Transplant Outcome?

(714) - Comparison of 6 Month Hospitalizations in Mechanical Circulatory Support Patients vs Heart Transplant Patients

Three year post heart transplant outcomes of desensitized durable mechanical circulatory support patients

Cardiogenic shock in acute myocardial infarction is a life-threatening syndrome characterized by systemic hypoperfusion that can rapidly progress to multiple organ failure and death. There are various mechanical circulatory support devices and configurations available to support patients, each with unique pathophysiological characteristics. The aim. To investigate the effectiveness and causes of adverse outcomes of extracorporeal membrane oxygenation in the treatment of patients with cardiogenic shock. Materials and methods. Between January 2024 and December 2024, 11 patients underwent venous-arterial extracorporeal membrane oxygenation in the state of cardiogenic shock at the Kovel-ECMO hospital district. Results The survival rate was 72.0 % (8 patients). The successful cannulation rate was 100 %. The median cannulation time was 15 minutes. The median time before extracorporeal membrane oxygenation was 54 minutes. The median age was 50 years, and 100 % were male. Conclusions. When using temporary mechanical circulatory support in patients with cardiogenic shock, a positive result was obtained in 72.0 % of patients.

The optimal device for mechanical circulatory support (MCS) in patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) remains unknown. Therefore, in this study we aimed to analyze which MCS (intra-aortic balloon pumping (IABP) or IMPELLA) is associated with better outcomes in patients with AMI-related CS. This systematic review and meta-analysis used a random-effects model to account for potential heterogeneity. Risk ratios (RRs) and 95% confidence intervals (CIs) were used for the dichotomous outcomes. The PubMed, Web of Science, and CENTRAL databases were searched up to April 30, 2023. The risk of bias was evaluated using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2) tool, and the certainty of evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Two randomized controlled trials were included in the meta-analysis. For the primary outcome of 30-day survival, IMPELLA probably improves the outcome by a small amount compared with IABP (RR0.94 [95% CI 0.5-1.53], 29 fewer per 1,000 [95% CI from 204 fewer to 258 more], low certainty of evidence). We could not show a survival benefit of IMPELLA compared with IABP in patients with AMI complicated by CS. Further investigation is required to resolve this issue.