Intra-aortic Balloon Counterpulsation Research Articles

STEMI in young patients: what are we dealing with?

Abstract Funding Acknowledgements None. Background/Introduction Acute Myocardial Infarction with ST-segment Elevation (STEMI) in young adults is infrequent, with an incidence ranging from 2-12%. Our objective is to analyse the clinical characteristics, management, and prognosis of patients aged 45 years or younger with STEMI activation. Methods We conducted a retrospective review of the "Code Infarct" registry at our hospital from January 2020 to March 2023. Out of the 867 codes, 51 patients aged 45 or younger were selected. We studied clinical, angiographic, and echocardiographic parameters. Results Table 1 presents the baseline and clinical characteristics of the patients. The median time from symptom onset to the first medical contact was 126 (30-160) minutes, and the median ischemic time was 226 (122-270) minutes. Figure 1 displays the angiographic findings. Atherothrombotic disease was responsible in 78.4% of patients, with 75% of them having single-vessel coronary disease with similar involvement of the right and anterior descending coronary arteries. Five patients (9.8%) experienced spontaneous dissection, with the majority being women (80%). In 5 cases (9.8%), coronary arteries were found to be normal. The second most commonly used antiplatelet agent was prasugrel (64.7%). Fibrinolysis was performed in 5 patients (9.8%). Only 3 patients (5.9%) required inotropic/vasopressor therapy, and 2 (3.9%) received intra-aortic balloon counterpulsation. The most common complication during hospitalization was the occurrence of tachyarrhythmias (27.4%), followed by heart failure (7.8%). At discharge, 52.9% had a left ventricular ejection fraction (LVEF) >55%, 49.3% had LVEF between 40-55%, and only 7.8% had LVEF <40%. The median length of hospital stay was 5.7 (3-6) days, and there were no in-hospital deaths. One-year survival was 98%. Conclusions Atherothrombotic disease is the leading cause of STEMI in individuals aged 45 or younger in our population. Smoking and dyslipidaemia are the most prevalent risk factors. Ischemic time is longer than desired in this group, mainly due to a delay from symptom onset to initial medical contact. Promoting primary prevention and raising awareness about the clinical signs and importance of early diagnosis in STEMI could help reduce ischemic time in this population.Characteristics and Clinical PresentatioCoronary angiography findings.

Study of the course of recurrent myocardial infarction in the acute stage within the framework the hospital register

Aim. To study the features of the course of primary and recurrent myocardial infarction and compare their prognosis in the acute stage of the disease within the framework of the hospital register of the vascular center.Material and methods. The data from the acute coronary syndrome register of N. V. Sklifosovsky Research Institute for Emergency Medicine were used. The inclusion criteria were: transmural acute myocardial infarction (AMI) with ST-segment elevation (codes I21.0-I21.3 according to the International Classification of Diseases); permanent residence in Moscow and the Moscow region. The described part of the study included all patients with transmural myocardial infarction (codes I21.0-I.21.3) admitted from January 1, 2017 to December 31, 2017. Of the AMI patients admitted during this period (n=329), 214 met the inclusion criteria, with primary AMI in 153 and recurrent AMI in 61.Results. Patients with recurrent AMI were significantly older, more often had a disability group. Smoking and arterial hypertension were more frequent risk factors among patients with recurrent AMI than in primary AMI. All indices reflecting the severity of coronary artery disease and its complications were also significantly more common in the group with recurrent AMI. Diabetes mellitus was more common in these patients. Taking medications before hospitalization, as well as the regularity of this intake, were significantly more common in patients who had repeated AMI. The mortality rate of patients with recurrent AMI was 4.6 times higher than that of patients with primary AMI. Such complications as atrial fibrillation and flutter, intracardiac conduction disturbance requiring temporary endocardial stimulator placement, acute heart failure requiring intra-aortic balloon counterpulsation, respiratory failure requiring artificial ventilation, cardiogenic shock were significantly more common in patients with recurrent AMI. Kaplan-Meyer curves clearly demonstrate the differences in hospital mortality among the two groups of patients. These curves also clearly show that patients with primary AMI died mostly in the first days of the disease, but patients with recurrent AMI could die at a much later date, up to 12 days after admission. Analysis of factors determining the mortality risk during hospitalization showed that recurrent AMI is an independent predictor of death.Conclusion. The results of our work indicate the need for prompt identification of patients who had previously undergone AMI upon their admission to the vascular center, as well as the development of more active prevention tactics for such patients.

Extracorporeal membrane oxygenation in acute myocardial infarction complicated with acute heart failure

Extracorporeal membrane oxygenation is used in acute heart failure that is resistant to drug therapy and intra-aortic balloon counterpulsation. Colleagues from America practice the use of ECMO with a cardiac index above 2.0 l/min. In our case, the application of ECMO at a cardiac index of 1.3 l/min with the discharge of the patient from the hospital with a satisfactory result of treatment is described. This article represent a clinical case of ECMO application in refractory acute heart failure and a multidisciplinary approach to the treatment of complicated myocardial infarction.

ПРОГНОЗИРОВАНИЕ НЕБЛАГОПРИЯТНЫХ КЛИНИЧЕСКИХ ИСХОДОВ ПАЦИЕНТОВ С КАРДИОГЕННЫМ ШОКОМ ПОСЛЕ ОПЕРАЦИЙ НА ОТКРЫТОМ СЕРДЦЕ ПРИ ПОДКЛЮЧЕНИИ ВНУТРИАОРТАЛЬНОЙ БАЛЛОННОЙ КОНТРАПУЛЬСАЦИИ

Aim. To determine preimplantation risk factors and predictors of unfavorable outcome in patients with cardiogenic shock after open-heart surgery, who had an intraoperative system of mechanical circulatory support – intra-aortic balloon contrapulsation. Methods. A retrospective study was conducted at the Republican Scientific and Practical Center “Cardiology” for 2015–2020. It included 66 patients who underwent heart surgery on bypass and who intraoperatively developed cardiogenic shock, refractory to drug therapy, which resulted in the use of intra-aortic balloon counterpulsation. The diagnosis of cardiogenic shock was determined based on the generally accepted criteria, as well as based on the SCAI (Society for Cardiovascular Angiography and Interventions) classification of shock: systolic blood pressure < 90 mmHg for > 30 minutes or the need for infusion of vasopressors or inotropes to achieve the blood pressure of ≥ 90 mm Hg. The Pearson Chi-square test used for nonparametric analysis of qualitative characteristics. The predictors were identified based on logistic regression. Differences were considered significant at p < 0.05 (5%).Results. Risk factors for adverse outcome in case of CS before the use of IABP were: age over 65 years OR = 6.04 [95% CI 1.73 – 21.06], p = 0.003; female gender OR = 3.24 [95% CI 1.064 – 9.873], p = 0.048; vasoactive and inotropic support of more than 42 points OR = 7.85 [95% CI 2.33 – 26.45], p = 0.001; blood lactate of more than 4.7 mmol/l OR = 4.12 [95% CI 1.27 – 13.37], p = 0.014; blood acidity pH < 7.33 OR = 6.34 [95% CI 1.97 – 20.37], p = 0.003; base deficit BE > –5.6 OR = 7.32 [95% CI 2.19 – 24.42], p = 0.001. According to the β-coefficients of the logistic regression equation, predictors were scored as follows: age > 65 years = 2 points, VIP > 42 = 2 points, lactate > 4.7 mmol/L = 1 point. The cumulative probability of 30-day mortality was as follows: 9% when defined as 1 point, 20% – 2 points, 55% – 3 points, 60% – 4 points, 75% – 5 points (Chi-square 24.1; df = 5; p = 0.001). Conclusions. Cardiogenic shock is a fatal complication in cardiac surgery. The use of vasopressor and inotropic drugs has an important role in the treatment of CS; however, escalation of catecholamine doses leads to the progression of multiple organ failure due to hypoperfusion and hypoxia of target organs. Therefore, the use of intra-aortic balloon counterpulsation can improve the results of CS treatment. However, the effect of IABP is limited to increasing cardiac output by no more than 1 l/minute. Based on the calculator we developed, when determining a high risk of an unfavorable outcome of the IABP use, options for circulatory support should be considered including extracorporeal membrane oxygenation, ventricular assist device.

Case Report: Pre-emptive intra-aortic balloon counterpulsation in patients with aortic regurgitation initiated after cross-clamping during cardiopulmonary bypass

Preoperative implantation of an intra-aortic balloon pump has been shown to reduce mortality in high-risk cardiac surgery cases. However, one main contraindication for its use is severe aortic regurgitation. We describe a case of safe and beneficial use in a patient presenting with moderate to severe aortic regurgitation and highly reduced ejection fraction undergoing aortic valve replacement.

Effects of intra-aortic balloon pump on in-hospital outcomes and 1-year mortality in patients with acute myocardial infarction complicated by cardiogenic shock

BackgroundThe role of intra-aortic balloon counterpulsation (IABP) in cardiogenic shock complicating acute myocardial infarction (AMI) is still a subject of intense debate. In this study, we aim to investigate the effect of IABP on the clinical outcomes of patients with AMI complicated by cardiogenic shock undergoing percutaneous coronary intervention (PCI).MethodsFrom the Medical Information Mart for Intensive Care (MIMIC)-IV 2.2, 6017 AMI patients were subtracted, and 250 patients with AMI complicated by cardiogenic shock undergoing PCI were analyzed. In-hospital outcomes (death, 24-hour urine volumes, length of ICU stays, and length of hospital stays) and 1-year mortality were compared between IABP and control during the hospital course and 12-month follow-up.ResultsAn IABP was implanted in 30.8% (77/250) of patients with infarct-related cardiogenic shock undergoing PCI. IABP patients had higher levels of Troponin T (3.94 [0.73–11.85] ng/ml vs. 1.99 [0.55–5.75] ng/ml, p-value = 0.02). IABP patients have a longer length of ICU and hospital stays (124 [63–212] hours vs. 83 [43–163] hours, p-value = 0.005; 250 [128–435] hours vs. 170 [86–294] hours, p-value = 0.009). IABP use was not associated with lower in-hospital mortality (33.8% vs. 33.0%, p-value = 0.90) and increased 24-hour urine volumes (2100 [1455–3208] ml vs. 1915 [1110–2815] ml, p-value = 0.25). In addition, 1-year mortality was not different between the IABP and the control group (48.1% vs. 48.0%; hazard ratio 1.04, 95% CI 0.70–1.54, p-value = 0.851).ConclusionIABP may be associated with longer ICU and hospital stays but not better short-and long-term clinical prognosis.

Survey on Cardiogenic Shock and the Use of ECMO and Impella in Spanish Cardiac Critical Care Units

Background: Previous studies suggest variability in the management of cardiogenic shock (CS). Methods: An anonymous survey was sent to Spanish hospitals. Results: We obtained 50 answers, mainly from cardiologists (36–72%). The annual average of ECMOs is 16.7 ± 11.3 applications in CS patients and of Impellas is 8.7 ± 8.3 applications in CS patients. Intra-aortic balloon counterpulsation is used in the majority of CS ECMOs (31–62%), and Impella is used in 7 (14%). In 36 (72%) cases, ECMO is used as a treatment for cardiac arrest. In 10 cases, ECMO removal is percutaneous (20%). In 25 (50%) cases, age is a relative contraindication; 17 have a mobile ECMO team (34%); and 23 (46%) have received ECMO patients from other centers in the last year. Pre-purged ECMO is only used in 16 (32%). ECMO implantation is carried out under ultrasound guidance in 31 (62%), only with angiography in 3 (6%) and with both in 11 (22%). The Swan–Ganz catheter is used routinely in 8 (16%), only in doubtful cases in 24 (48%), and in most cases in 8 (16%). The ECMO awake strategy is used little or not at all in 28 (56%), in selected cases in 17 (34%), and routinely in 5 (10%). Conclusion: Our study shows a huge variation in the management of patients with CS.

Aortic valve replacement after previous TAVI

Endovascular surgery for aortic valve defects has proven itself well in elderly patients with severe comorbidities competing with the underlying disease. However, the risk of dysfunction resulting from structural degeneration of bioprosthetic heart valve and prosthetic valve endocarditis remains high. Repeated surgeries are associated with complications, but open surgery is the only method of treatment in this group of patients.Objective: to describe a series of reinterventions for prosthetic valve dysfunction occurring after TAVI.Material and methods. From 2015 to 2022, at the Department of Emergency Surgery for Acquired Heart Diseases (Head, Professor R.M. Muratov), Bakulev Research Center for Cardiovascular Surgery, 6 reoperations were performed in patients who had previously undergone transcatheter aortic valve implantation (TAVI). The average age of patients at the time of TAVI and at the time of reoperation was 70.6 years (62–83) and 74.3 years (70–84), respectively. The EuroSCORE II predicted risk of mortality at the time of reintervention was 42.2% (21.7–87.6). The mean time to reoperation was 42 months. Indications for reoperation were early active prosthetic endocarditis (4 cases) and structural valve degeneration (2 cases).Results. At the hospital stage, 1 patient died of acute heart failure; the operation was performed for vital indications in conditions of extreme initial severity. In three patients, the early postoperative period was uneventful. One patient required intra-aortic balloon counterpulsation (IABP) due to heart failure, and 1 patient was implanted with permanent pacemaker. The average time of hospitalization was 14 days. Patients with active prosthetic endocarditis received a 6-week course of antibiotic therapy. The function of the implanted valves was satisfactory.Conclusions. Aortic valve replacement after previous TAVI is an emergency operation and represents the only way to treat valve dysfunction. Under active prosthetic endocarditis, timely surgery can save this patient cohort.

The attitudes about life-sustaining treatment among cardiac surgery ICU patients and their families.

To investigate the attitudes among cardiac surgery ICU patients and their families regarding life-sustaining treatment. A total of 172 pairs of patients in the cardiac surgery ICU of Nanjing First Hospital and their family members were enrolled in this study that examined their attitudes toward life-sustaining treatment using a willingness to care for life-sustaining treatment questionnaire. The consistency of the attitudes of patients and family members toward life-sustaining treatment was analyzed by the chi-square test with a paired design. The most popular life-sustaining treatment for cardiac ICU patients was noninvasive mechanical ventilation (79.1%); the most unpopular was intra-aortic balloon counterpulsation (48.3%). Most patients and their families had not considered electric defibrillation (65.7%), but most understood and were willing to permit cardiopulmonary resuscitation (76.2%). Few family members agreed that patients should receive a pacemaker (25.0%). The consistency of life support attitudes of patients and their families ranged from 12.8% to 60.5% for procedures both would agree to, 1.2% to 19.8% for procedures they were unwilling to permit, and 0.6% to 39.0% for procedures they had not considered. Kappa values ranged from 0.218 to 0.597 (P < 0.05), with general consistency. Cardiac surgery ICU patients families are generally consistent in their attitudes toward life-sustaining treatment, and family members' choices are not representative of patients' wishes.

PO-04-232 PERCUTANEOUS STELLATE GANGLION BLOCKADE FOR ELECTRICAL STORM: LARGE SINGLE CENTRE EXPERIENCE

Electrical storm (ES) is defined as three or more episodes of ventricular arrhythmia requiring defibrilltaion or anti tachycardia pacing within a day.Some times electrical storm may not respond to anti-arrhythmic drugs alone.Increased sympathetic activity plays significant role in electrical storm.Stellate ganglion blockade reduces sympathetic activity and helpful in reduction of ventricular arrhythmias. We aimed to study the effectiveness and outcomes of percutaneous stellate ganglion blockade (SGB) in the patients with drug-refractory electrical storm. The study included patients with a drug-refractory electrical storm. Before giving SGB, at least two anti-arrhythmic drugs(AAD) were given before SGB. Bupivacaine was injected in the vicinity of the stellate ganglion under Ultrasound quidance. A total of 83 procedures were performed on 56 patients (71% males, 60+6 years).Fourty three patients (76%) had ischemic heart disease. Nearly 66%(37/56) of patients were free from ventricular arrhythmias(VA) at 24 hours after left SGB and 51%(29/56) were arrhythmia free at 72 hours. Bilateral SGB was done in 16 patients who had failed left-sided SGB with a success rate of 36%. Heart failure and shock were documented in 65% and 55% respectively. Twenty Five (44%) patients were on both Intra-aortic balloon counterpulsation and inotrope support. All-cause mortality was 32% (18/56). Cardiovascular mortality was 28% (16/56). Septic shock in one patient and Ischemic brain stroke was the cause of death in the other patient. VA recurrence, poor left ventricular ejection fraction, and failed stellate ganglion blockade were associated with increased mortality. Procedure-related complications like transient bradycardia(16%), hematoma(14%), hoarseness of voice (10%), persistent ptosis(5%), and monoparesis(3.5%) were noted, all of which were resolved within two weeks of post-procedure. SGB helps to stabilize the hemodynamic status of the patients with electrical storm. It also provides time for

Ultra-fast track extubation protocol following cardiovascular surgery: Predictors of failure and outcomes.

Identifying independent predictor factors of failure of ultra-fast track (UFT) extubation and to compare in-hospital outcomes with UFT extubation versus fast track (FT) extubation after cardiovascular surgery in adults. Retrospective analysis of 1498 consecutive patients aged over 18 years-old undergoing cardiovascular surgery at a single institution. Between December 2014 and December 2016, FT extubation was used (N = 713) while, between December 2016 and December 2018, all patients were preoperatively considered suitable for UFT extubation (N = 785). In this instance, a standardized anaesthetic protocol was applied in all cases. The decision to not extubate in the operating room (OR) was based on intraoperative haemodynamic and ventilation. Extubation in the OR was possible in 699 (89%) patients. Significant independent predictors factors of UFT extubation failure were: preoperative NYHA class III-IV, myocardial infarction within two days prior to surgery, preoperative intra-aortic balloon counterpulsation, urgent/emergent surgery, intraoperative transfusion of platelets and intraoperative inotropic and vasopressor support. UFT extubation was associated with lower rates of cardiovascular complications such as congestive cardiac insufficiency (OR: 1,57; 95% CI: 1,13-2,19; p = 0,008) and new-onset postoperatory atrial fibrillation (OR: 1,40; 95% CI: 1,06-1,86; p = 0,020). Patient extubated in the OR presented lower risk of overall complications, shorter intensive care unit stay and higher short-term survival, although, no statistically significance was found when performing the multivariate adjustment. A routine immediate extubation in the OR following adult cardiovascular surgery is a feasible and safe practice, associated with low cardiovascular morbidity.

(808) Hemodynamic Response after Intra-Aortic Balloon Counter-Pulsation in Cardiac Amyloidosis and Cardiogenic Shock

(808) Hemodynamic Response after Intra-Aortic Balloon Counter-Pulsation in Cardiac Amyloidosis and Cardiogenic Shock

Adjusted mortality of extracorporeal membrane oxygenation for acute myocardial infarction patients in cardiogenic shock.

Cardiogenic shock (CS) is a common cause of death following acute myocardial infarction (MI). This study aimed to evaluate the adjusted mortality of venoarterial extracorporeal membrane oxygenation (VA-ECMO) with intra-aortic balloon counterpulsation (IABP) for patients with MI-CS. We included 300 MI patients selected from a multinational registry and categorized into VA-ECMO + IABP (N = 39) and no VA-ECMO (medical management ± IABP) (N = 261) groups. Both groups' 30-day and 1-year mortality were compared using the weighted Kaplan-Meier, propensity score, and inverse probability of treatment weighting methods. Adjusted incidences of 30-day (VA-ECMO + IABP vs No VA-ECMO, 77.7% vs 50.7; P = .083) and 1-year mortality (92.3% vs 84.8%; P = .223) along with propensity-adjusted and inverse probability of treatment weighting models in 30-day (hazard ratio [HR], 1.57; 95% confidence interval [CI], 0.92-2.77; P = .346 and HR, 1.44; 95% CI, 0.42-3.17; P = .452, respectively) and 1-year mortality (HR, 1.56; 95% CI, 0.95-2.56; P = .076 and HR, 1.33; 95% CI, 0.57-3.06; P = .51, respectively) did not differ between the groups. However, better survival benefit 30 days post-ECMO could be supposed (31.6% vs 83.4%; P = .022). Therefore, patients with MI-CS treated with IABP with additional VA-ECMO and those not supported with ECMO have comparable overall 30-day and 1-year mortality risks. However, VA-ECMO-supported survivors might have better long-term clinical outcomes.

Outcome of implementation of the project aimed to prevent cardiovascular diseases in the regional vascular center

Highlights. The article presents an analysis of the outcome of the project dedicated to cardiovascular disease prevention in the Regional Vascular Center, the analysis involved the assessment of changes in the characteristics of deceased patients. The study made it possible to identify changes in mortality rate, the impact of new diagnostic and treatment techniques and administrative decisions on the change in mortality, as well as aspects that prevent further reduction in mortality.Aim. To assess the results of the implementation of new methodological approaches to cardiovascular diseases prevention, myocardial infarction in particular, in the Regional Vascular Center.Methods. The study involved the analysis of the data (entered in real time) from the Emergency Cardiac Care Department of the Сardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, and data from the Department`s database containing anamnestic and clinical characteristics of patients, and recording of deaths in the period from 2014 to 2019. Statistical data processing was performed using the StatSoft Statistica software (ver. 10.0).Results. From 2014 to 2019, percutaneous coronary intervention (PCI) in myocardial infarction (MI) increased from 48 to 67.4% (p˂0.05); the primary PCI in MI with ST segment elevation (STEMI) increased from 24% to 32% (p˂0.001), the overall frequency of PCI in STEMI (primary + rescue + delayed) increased from 59.6% to 73% (p˂0.05); PCI in MI without ST segment elevation (NSTEMI) increased from 23.9% to 43.9% (p˂0.001), the frequency of intra-aortic balloon counterpulsation increased from 0.6% to 1.5% (p˂0.05), the frequency of mechanical ventilation did not change (8,3 and 8,5%), moreover the widespread use of ticagrelor and prasugrel was noted. At the same time, hospital mortality of patients with MI decreased from 9.8 to 8.0% (p&gt;0,05): in patients with STEMI it decreased from 10.7% to 7.7% (p = 0.047), in patients with NSTEMI there was no change in mortality, it remained equal to 8–9%. Implementation of coronary reperfusion strategies that do not involve streptokinase is associated with a decrease in hospital mortality of patients with STEMI.Conclusion. The widespread introduction of modern invasive and medicinal technologies has led to a decrease in mortality of patients with STEMI. Further increasing the number of available invasive procedures – PCI, intra-aortic balloon counterpulsation and mechanical ventilation for the purposes of reducing mortality of patients with MI seems questionable.

Impact of intra-aortic balloon counterpulsation on all-cause mortality among patients with Takotsubo syndrome complicated by cardiogenic shock: results from the German-Italian-Spanish (GEIST) registry.

Takotsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction and can be complicated by cardiogenic shock (CS). However, few data are available on optimal care in TTS complicated by CS. Aim of this study was to evaluate short- and long-term impact of intra-aortic balloon pumping (IABP) on mortality in this setting. In a multi-centre, international registry on TTS, 2248 consecutive patients were enrolled from 38 centres from Germany, Italy, and Spain. Of the 2248 patients, 212 (9.4%) experienced CS. Patients with CS had a higher prevalence of diabetes (27% vs. 19%), male sex (25% vs. 10%), and right ventricular involvement (10% vs. 5%) (P < 0.01 in all cases). Forty-three patients with CS (20% of 212) received IABP within 8 h (interquartile range 4-18) after admission. No differences in terms of age, gender, cardiovascular risk factors, and admission left ventricular ejection fraction were found among patients with and without IABP. There were no significant differences in terms of 30-day mortality (16% vs. 17%, P = 0.98), length of hospitalization (18.9 vs. 16.7 days, P = 0.51), and need of invasive ventilation (35% vs. 41%, P = 0.60) among two groups: 30-day survival was not significantly different even after propensity score adjustment (log-rank P = 0.73). At 42-month follow-up, overall mortality in patients with CS and TTS was 35%, not significantly different between patients receiving IABP and not (37% vs. 35%, P = 0.72). In a large multi-centre observational registry, the use of IABP was not associated with lower mortality rates at short- and long-term follow-up in patients with TTS and CS.

Invasive versus Conservative Treatment Approach among Older Adult Patients Admitted with Acute ST-Segment Elevation Myocardial Infarction.

Primary percutaneous coronary intervention (PCI) is the preferred treatment strategy for patients with ST-elevation myocardial infarction (STEMI); however, its efficacy remains unclear in very older adult patients with STEMI. This retrospective single-center observational study included 530 patients aged &gt;75 years admitted to Tel Aviv Sourasky Medical Center with a diagnosis of acute STEMI. Primary PCI was performed for patients with symptoms ≤12 hours in duration, while the other patients were conservatively treated. We evaluated 30-day mortality and complications occurring during hospitalization based on data from patient records. Among the study patients, only 28/530 (5%) were conservatively treated. In-hospital complications, including the use of inotropes or intra-aortic balloon counterpulsation and the need for mechanical ventilation, did not differ significantly between the groups. The only parameter that showed a trend toward significance was the incidence of heart failure during hospitalization (p=0.042). The risk for 30-day mortality was substantially higher in the conservative treatment group than in the invasive treatment group (27% vs. 10%; p = 0.02). Our data suggested that despite concerns regarding the safety of the primary PCI strategy in the older adult STEMI population, this treatment strategy was associated with a survival benefit.

Tactics of Surgical Treatment of Postinfarction Ventricular Septum Rupture Depending on the Time after the Development of an Acute Myocardial Infarction

The article is dedicated to topical issues of the tactics of surgical treatment of postinfarction ventricular septum rupture (PIVSR). Based on the study of the peculiarities of surgical treatment of ventricular septal defect in patients with different deadlines for surgical intervention after the development of acute myocardial infarction (AMI), the most appropriate approach to the correction of PIVSR in such patients was determined. In particular, taking into account mortality risk (42 %), the most reasonable is the use of wait-and-see tactics in the management of patients with PIVSR at the early stages after the development of AMI. At the same time, the decision on the timing of surgical intervention should be made individually, taking into account the clinical condition of the patient and the course of the postinfarction heart remodeling. Special attention is paid to the analysis of the effectiveness of the use of intra-aortic balloon counterpulsation and the time intervals of surgical intervention from the moment of hospitalization in patients with PIVSR. It was found that clinical course of coronary heart disease complicated by PIVSR can be extremely unpredictable not only in the early postinfarction period, but also up to 2 months after the development of AMI. In addition, when planning the amount of surgical intervention, it is necessary to take into account the presence of multivessel atherosclerotic lesions of the coronary arteries in patients with PIVSR, regardless of the timing after the development of AMI.

Continuous monitoring of brain perfusion by cerebral oximetry after spontaneous return of circulation in cardiac arrest: a case report

BackgroundCerebral resuscitation determines the prognosis for patients who have experienced sudden death, and brain protection is the focus of clinical treatment. Cerebral resuscitation depends on the timing and quality of cardiopulmonary resuscitation (CPR). At present, cerebral oxygen monitoring is used mainly to monitor the quality of external cardiac compression and provide a prognosis for the nervous system. However, after the return of autonomous circulation, it is necessary to conduct continuous monitoring to ensure measures are taken timeously since hemodynamic instability, brain edema, and other factors may cause occult brain injury, and invasive arterial pressure cannot represent cerebral perfusion.Case presentationBy using continuous cerebral oxygen monitoring after CPR and the return of spontaneous circulation, a patient who was witnessed to have experienced sudden death in the hospital was found to have insufficient cerebral perfusion; he underwent timely intra-aortic balloon counterpulsation to improve his hemodynamics and cerebral perfusion. The patient went on to achieve a good neurological prognosis.ConclusionCerebral oxygen monitoring should be conducted throughout the treatment period; physicians should understand cerebral perfusion in real time and implement timely intervention measures to reduce occult brain injury and improve the neurological prognosis of patients.

Mechanical Circulatory Support in Cardiovascular Surgical Patients: Single Center Practice and Experience

Background: In view of the role of mechanical circulatory support in patients with severe cardiac insufficiency during perioperative period, we searched the relevant articles on mechanical circulatory support at Fuwai Hospital, and analyzed the indications and complications of different mechanical circulatory support methods. Methods: Relevant studies were identified by computerized searches of PubMed, Ovid, Embase, Cochrane Library, Wanfang Data, VIP Data, Chinese BioMedical Literature &amp; Retrieval System (SinoMed), and China National Knowledge Infrastructure (CNKI), using search words (“intra-aortic balloon counter pulsation” OR “IABP” OR “extracorporeal membrane oxygenation” OR “ECMO” OR “ventricular assist device” OR “VAD”) AND (“Fuwai” OR “fuwai”). All studies concerning the application of IABP, ECMO, and VAD at Fuwai Hospital were included, exclusion criteria included: (1) studies published as review, case report or abstract; (2) animal or cell studies; (3) duplicate publications; (4) studies lacking information about outcomes of interest. Results: A total of 36 literatures were selected for analysis. The specific mechanical circulatory support methods of ECMO and VAD retrieved from the studies were VA-ECMO and LVAD. The number of cases using IABP, ECMO, LVAD was 1968, 972, 67; and the survival rate was 80.4%, 54.9%, 56.7%, respectively. The major complications of IABP, ECMO and LVAD were hemorrhage (1.2%, 35.9% and 14.5%), infection (3.7%, 12.7% and 9.7%), acute kidney injury (9.1%, 29.6% and 6.5%), the secondary complications were limb ischemia, neurological events, cardiovascular events and thrombosis. Conclusions: The present study suggested that, IABP, ECMO and VAD, either alone or in combination, were effective and safe mechanical circulation support when managing cardiovascular surgical patients with severe hemodynamic instability at Fuwai Hospital.

Intra-aortic balloon pump in patients with myocardial infarction and cardiogenic shock of stages A and B

This article presents two clinical cases of patients with myocardial infarction and stage A (at risk) and B (beginning) cardiogenic shock who underwent intra-aortic balloon counterpulsation (IABP). In patients with a high risk of classic cardiogenic shock and/or the no-reflow phenomenon, stenting of the infarct-related coronary artery during this type of mechanical circulatory support was performed without complications. Theoretical and practical aspects of using IABP at different stages of cardiogenic shock are discussed.