Catheter-Based Cardiopulmonary Nerve Stimulation Impacts Left Ventricular Contractility And Relaxation: First In Human Experience
HFSA ePoster Library. Cuchiara M. 09/11/21; 343495; 26
Michael Cuchiara
REGULAR CONTENT
Login now to access Regular content available to all registered users.
Abstract
Discussion Forum (0)
Introduction: Cardiogenic shock in the setting of severe AS (CS-AS) is associated with poor outcomes. While transcatheter aortic valve replacement (TAVR) is widely accepted in high-risk patients with AS, the optimal approach in the CS-AS population is yet to be defined. We evaluated outcomes in 5 patients with CS-AS treated with a novel strategy of Impella insertion as an extended bridge to TAVR.
Methods: We identified five patients with CS-AS treated at our center who received an axillary Impella from April 2017-April 2019. In most cases, a 12x40 mm balloon was used to perform BAV prior to Impella insertion. After being stabilized by Impella, the patient was evaluated for TAVR and additional catheter-based interventions performed as indicated. During the TAVR procedure, the Impella power level was decreased and the device withdrawn into the ascending aorta immediately before the TAVR valve was deployed. Clinical and laboratory data were collected from the electronic medical record.
Results: The median (range) age was 65 (61-87) years old and 80% were male (Table 1). On admission, most patients (80%) presented with stage D or E CS. One patient developed PEA during placement of the axillary graft and was placed on femoral VA-ECMO; to avoid the need for BAV, an Impella CP was placed as a vent and provided support after the decannulation of ECMO. In all other patients, an Impella 5.0 was placed following BAV. Once stabilized on Impella support, one patient required PCI and another patient with mitral valve flail received a MitraClip. After a median (range) of 7 (5-14) days of Impella support, TAVR was successfully performed in all patients (Table 2). All patients survived to discharge. Four patients (80%) were alive at most recent follow up contact (average of 28 months post-TAVR).
Conclusions: For CS-AS patients, extended use of Impella stabilized patients to allow for a thorough multi-disciplinary evaluation, semi-elective TAVR and other interventions during the hospitalization. A strategy of initial Impella support followed by an extended bridge to TAVR is a feasible, safe, and effective approach to supporting CS-AS patients.
Methods: We identified five patients with CS-AS treated at our center who received an axillary Impella from April 2017-April 2019. In most cases, a 12x40 mm balloon was used to perform BAV prior to Impella insertion. After being stabilized by Impella, the patient was evaluated for TAVR and additional catheter-based interventions performed as indicated. During the TAVR procedure, the Impella power level was decreased and the device withdrawn into the ascending aorta immediately before the TAVR valve was deployed. Clinical and laboratory data were collected from the electronic medical record.
Results: The median (range) age was 65 (61-87) years old and 80% were male (Table 1). On admission, most patients (80%) presented with stage D or E CS. One patient developed PEA during placement of the axillary graft and was placed on femoral VA-ECMO; to avoid the need for BAV, an Impella CP was placed as a vent and provided support after the decannulation of ECMO. In all other patients, an Impella 5.0 was placed following BAV. Once stabilized on Impella support, one patient required PCI and another patient with mitral valve flail received a MitraClip. After a median (range) of 7 (5-14) days of Impella support, TAVR was successfully performed in all patients (Table 2). All patients survived to discharge. Four patients (80%) were alive at most recent follow up contact (average of 28 months post-TAVR).
Conclusions: For CS-AS patients, extended use of Impella stabilized patients to allow for a thorough multi-disciplinary evaluation, semi-elective TAVR and other interventions during the hospitalization. A strategy of initial Impella support followed by an extended bridge to TAVR is a feasible, safe, and effective approach to supporting CS-AS patients.
Introduction: Cardiogenic shock in the setting of severe AS (CS-AS) is associated with poor outcomes. While transcatheter aortic valve replacement (TAVR) is widely accepted in high-risk patients with AS, the optimal approach in the CS-AS population is yet to be defined. We evaluated outcomes in 5 patients with CS-AS treated with a novel strategy of Impella insertion as an extended bridge to TAVR.
Methods: We identified five patients with CS-AS treated at our center who received an axillary Impella from April 2017-April 2019. In most cases, a 12x40 mm balloon was used to perform BAV prior to Impella insertion. After being stabilized by Impella, the patient was evaluated for TAVR and additional catheter-based interventions performed as indicated. During the TAVR procedure, the Impella power level was decreased and the device withdrawn into the ascending aorta immediately before the TAVR valve was deployed. Clinical and laboratory data were collected from the electronic medical record.
Results: The median (range) age was 65 (61-87) years old and 80% were male (Table 1). On admission, most patients (80%) presented with stage D or E CS. One patient developed PEA during placement of the axillary graft and was placed on femoral VA-ECMO; to avoid the need for BAV, an Impella CP was placed as a vent and provided support after the decannulation of ECMO. In all other patients, an Impella 5.0 was placed following BAV. Once stabilized on Impella support, one patient required PCI and another patient with mitral valve flail received a MitraClip. After a median (range) of 7 (5-14) days of Impella support, TAVR was successfully performed in all patients (Table 2). All patients survived to discharge. Four patients (80%) were alive at most recent follow up contact (average of 28 months post-TAVR).
Conclusions: For CS-AS patients, extended use of Impella stabilized patients to allow for a thorough multi-disciplinary evaluation, semi-elective TAVR and other interventions during the hospitalization. A strategy of initial Impella support followed by an extended bridge to TAVR is a feasible, safe, and effective approach to supporting CS-AS patients.
Methods: We identified five patients with CS-AS treated at our center who received an axillary Impella from April 2017-April 2019. In most cases, a 12x40 mm balloon was used to perform BAV prior to Impella insertion. After being stabilized by Impella, the patient was evaluated for TAVR and additional catheter-based interventions performed as indicated. During the TAVR procedure, the Impella power level was decreased and the device withdrawn into the ascending aorta immediately before the TAVR valve was deployed. Clinical and laboratory data were collected from the electronic medical record.
Results: The median (range) age was 65 (61-87) years old and 80% were male (Table 1). On admission, most patients (80%) presented with stage D or E CS. One patient developed PEA during placement of the axillary graft and was placed on femoral VA-ECMO; to avoid the need for BAV, an Impella CP was placed as a vent and provided support after the decannulation of ECMO. In all other patients, an Impella 5.0 was placed following BAV. Once stabilized on Impella support, one patient required PCI and another patient with mitral valve flail received a MitraClip. After a median (range) of 7 (5-14) days of Impella support, TAVR was successfully performed in all patients (Table 2). All patients survived to discharge. Four patients (80%) were alive at most recent follow up contact (average of 28 months post-TAVR).
Conclusions: For CS-AS patients, extended use of Impella stabilized patients to allow for a thorough multi-disciplinary evaluation, semi-elective TAVR and other interventions during the hospitalization. A strategy of initial Impella support followed by an extended bridge to TAVR is a feasible, safe, and effective approach to supporting CS-AS patients.
Code of conduct/disclaimer available in General Terms & Conditions
{{ help_message }}
{{filter}}