PMID- 36271639
OWN - NLM
STAT- MEDLINE
DCOM- 20230202
LR  - 20230202
IS  - 1525-1594 (Electronic)
IS  - 0160-564X (Linking)
VI  - 47
IP  - 2
DP  - 2023 Feb
TI  - Outcomes of systemic bivalirudin and sodium bicarbonate purge solution for 
      Impella 5.5.
PG  - 361-369
LID - 10.1111/aor.14428 [doi]
AB  - BACKGROUND: Impella 5.5 (Abiomed; Danvers, MA) (IMP5) is a commonly used, 
      surgically implanted, tMCS device that requires systemic anticoagulation and 
      purge solution to avoid pump failure. To avoid heparin-induced thrombocytopenia 
      (HIT) from unfractionated heparin (UFH) use, our program has explored the utility 
      of bivalirudin (BIV) for systemic anticoagulation and sodium bicarbonate-dextrose 
      purge solution (SBPS) in IMP5.5. METHODS: This single center, retrospective study 
      included 34 patients supported on IMP5.5 with BIV based AC and SBPS between 
      December 1st 2020 to December 1st 2021.The efficacy and safety end points were 
      incidence of development of HIT, Tissue Plasminogen Activator (tPA) use for 
      suspected pump thrombosis, stroke, and device failure as well as clinically 
      significant bleeding. RESULTS: The median duration of IMP5.5 support was 9.8 days 
      (IQR: 6-15). Most patients were bridged to HTX (58%) followed by recovery (27%) 
      and LVAD implantation (15%). Patients were therapeutic on bivalirudin for 64% of 
      their IMP5.5 support. One patient (2.9%) suffered from ischemic stroke and 26.5% 
      (9) patients developed clinically significant bleeding. tPA was administered to 
      7(21%) patients. One patient in the entire cohort developed HIT. CONCLUSIONS: Our 
      experience supports the use of systemic BIV and SBPS as a method to avoid heparin 
      exposure in a patient population predisposed to the development of HIT.
CI  - (c) 2022 International Center for Artificial Organ and Transplantation (ICAOT) and 
      Wiley Periodicals LLC.
FAU - Bashline, Michael
AU  - Bashline M
AD  - Heart and Vascular Institute, University of Pittsburgh Medical Center, 
      Pittsburgh, Pennsylvania, USA.
FAU - DiBridge, Julie
AU  - DiBridge J
AD  - Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, 
      Pennsylvania, USA.
FAU - Klass, Wyatt J
AU  - Klass WJ
AD  - Heart and Vascular Institute, University of Pittsburgh Medical Center, 
      Pittsburgh, Pennsylvania, USA.
FAU - Morelli, Brian
AU  - Morelli B
AD  - Heart and Vascular Institute, University of Pittsburgh Medical Center, 
      Pittsburgh, Pennsylvania, USA.
FAU - Kaczorowski, David
AU  - Kaczorowski D
AD  - Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, 
      Pennsylvania, USA.
FAU - Schmidhofer, Mark
AU  - Schmidhofer M
AD  - Heart and Vascular Institute, University of Pittsburgh Medical Center, 
      Pittsburgh, Pennsylvania, USA.
FAU - Horn, Edward T
AU  - Horn ET
AD  - Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, 
      Pennsylvania, USA.
FAU - Gomez, Hernando
AU  - Gomez H
AD  - Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, 
      Pennsylvania, USA.
FAU - Ramanan, Raj
AU  - Ramanan R
AD  - Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, 
      Pennsylvania, USA.
FAU - Hickey, Gavin W
AU  - Hickey GW
AD  - Heart and Vascular Institute, University of Pittsburgh Medical Center, 
      Pittsburgh, Pennsylvania, USA.
FAU - Rivosecchi, Ryan M
AU  - Rivosecchi RM
AUID- ORCID: 0000-0002-0631-1358
AD  - Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, 
      Pennsylvania, USA.
LA  - eng
PT  - Journal Article
DEP - 20221031
PL  - United States
TA  - Artif Organs
JT  - Artificial organs
JID - 7802778
RN  - 9005-49-6 (Heparin)
RN  - 0 (Anticoagulants)
RN  - TN9BEX005G (bivalirudin)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
RN  - 8MDF5V39QO (Sodium Bicarbonate)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
SB  - IM
MH  - Humans
MH  - *Heparin/adverse effects
MH  - Anticoagulants/adverse effects
MH  - Tissue Plasminogen Activator/adverse effects
MH  - Sodium Bicarbonate
MH  - Retrospective Studies
MH  - Hirudins/adverse effects
MH  - Peptide Fragments/adverse effects
MH  - Hemorrhage/chemically induced
MH  - *Thrombocytopenia
MH  - Recombinant Proteins/adverse effects
MH  - Treatment Outcome
OTO - NOTNLM
OT  - VAD axial flow
OT  - antithrombotic therapy
OT  - cardiac assist and artificial heart
OT  - cardiac surgery
OT  - cardiothoracic surgery
OT  - purge solution
EDAT- 2022/10/23 06:00
MHDA- 2023/02/03 06:00
CRDT- 2022/10/22 02:12
PHST- 2022/07/09 00:00 [revised]
PHST- 2022/03/20 00:00 [received]
PHST- 2022/10/13 00:00 [accepted]
PHST- 2022/10/23 06:00 [pubmed]
PHST- 2023/02/03 06:00 [medline]
PHST- 2022/10/22 02:12 [entrez]
AID - 10.1111/aor.14428 [doi]
PST - ppublish
SO  - Artif Organs. 2023 Feb;47(2):361-369. doi: 10.1111/aor.14428. Epub 2022 Oct 31.