PMID- 20950980
OWN - NLM
STAT- MEDLINE
DCOM- 20111028
LR  - 20220408
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 57
IP  - 6
DP  - 2011 Feb 8
TI  - The percutaneous ventricular assist device in severe refractory cardiogenic 
      shock.
PG  - 688-96
LID - 10.1016/j.jacc.2010.08.613 [doi]
AB  - OBJECTIVES: We evaluated the efficacy and safety of the percutaneous ventricular 
      assist device (pVAD) in patients in severe refractory cardiogenic shock (SRCS) 
      despite intra-aortic balloon pump (IABP) and/or high-dose vasopressor support. 
      BACKGROUND: SRCS is associated with substantial mortality despite IABP 
      counterpulsation. Until recently, there was no rapid, minimally invasive means of 
      providing increased hemodynamic support in SRCS. METHODS: A total of 117 patients 
      with SRCS implanted with TandemHeart pVAD (CardiacAssist, Inc., Pittsburgh, 
      Pennsylvania) were studied, of whom 56 patients (47.9%) underwent active 
      cardiopulmonary resuscitation immediately before or at the time of implantation. 
      Data was collected regarding clinical characteristics, hemodynamics, and 
      laboratory values. RESULTS: Eighty patients had ischemic and 37 patients had 
      nonischemic cardiomyopathy. The average duration of support was 5.8 +/- 4.75 days. 
      After implantation, the cardiac index improved from median 0.52 (interquartile 
      range [IQR]: 0.8) l/(min.m(2)) to 3.0 (IQR:0.9) l/(min.m(2)) (p < 0.001). The 
      systolic blood pressure and mixed venous oxygen saturation increased from 75 
      (IQR:15) mm Hg to 100 (IQR:15) mm Hg (p < 0.001) and 49 (IQR:11.5) to 69.3 
      (IQR:10) (p < 0.001), respectively. The urine output increased from 70.7 (IQR: 
      70) ml/day to 1,200 (IQR: 1,620) ml/day (p < 0.001). The pulmonary capillary 
      wedge pressure, lactic acid level, and creatinine level decreased, respectively, 
      from 31.53 +/- 10.2 mm Hg to 17.29 +/- 10.82 mm Hg (p < 0.001), 24.5 (IQR: 74.25) 
      mg/dl to 11 (IQR: 92) mg/dl (p < 0.001), and 1.5 (IQR: 0.95) mg/dl to 1.2 (IQR: 
      0.9) mg/dl (p = 0.009). The mortality rates at 30 days and 6 months were 40.2% 
      and 45.3%, respectively. CONCLUSIONS: The pVAD rapidly reversed the terminal 
      hemodynamic compromise seen in patients with SRCS refractory to IABP and 
      vasopressor support.
CI  - Copyright (c) 2011 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Kar, Biswajit
AU  - Kar B
AD  - Divisions of Cardiology and Cardiothoracic Surgery, Texas Heart Institute at St. 
      Luke's Episcopal Hospital, Baylor College of Medicine, Houston, 77030, USA. 
      kar@bcm.tmc.edu
FAU - Gregoric, Igor D
AU  - Gregoric ID
FAU - Basra, Sukhdeep S
AU  - Basra SS
FAU - Idelchik, Gary M
AU  - Idelchik GM
FAU - Loyalka, Pranav
AU  - Loyalka P
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
DEP - 20101014
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
CIN - J Am Coll Cardiol. 2011 Feb 8;57(6):697-9. PMID: 21292128
MH  - Adult
MH  - Aged
MH  - Cardiomyopathies/complications/mortality/*therapy
MH  - Female
MH  - *Heart-Assist Devices/adverse effects
MH  - Hemodynamics
MH  - Humans
MH  - Intra-Aortic Balloon Pumping
MH  - Male
MH  - Middle Aged
MH  - Shock, Cardiogenic/etiology/mortality/*therapy
MH  - Texas/epidemiology
EDAT- 2010/10/19 06:00
MHDA- 2011/10/29 06:00
CRDT- 2010/10/19 06:00
PHST- 2010/03/26 00:00 [received]
PHST- 2010/08/12 00:00 [revised]
PHST- 2010/08/17 00:00 [accepted]
PHST- 2010/10/19 06:00 [entrez]
PHST- 2010/10/19 06:00 [pubmed]
PHST- 2011/10/29 06:00 [medline]
AID - S0735-1097(10)03899-4 [pii]
AID - 10.1016/j.jacc.2010.08.613 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2011 Feb 8;57(6):688-96. doi: 10.1016/j.jacc.2010.08.613. Epub 
      2010 Oct 14.