| The percutaneous ventricular assist device in severe refractory cardiogenic shock. | |
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MedLine Citation:
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PMID: 20950980 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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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. |
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Authors:
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Biswajit Kar; Igor D Gregoric; Sukhdeep S Basra; Gary M Idelchik; Pranav Loyalka |
Publication Detail:
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Type: Journal Article Date: 2010-10-14 |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 57 ISSN: 1558-3597 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-02-04 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 688-96 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Divisions of Cardiology and Cardiothoracic Surgery, Texas Heart Institute at St. Luke's Episcopal Hospital and Baylor College of Medicine, Houston, Texas; Michael E. Debakey VA Medical Center, Houston, Texas. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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