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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Meta-Analysis of Usefulness of Percutaneous Left Ventricular Assist Devices for High-Risk Percutaneous Coronary
Alexandros Briasoulis1, Tesfaye Telila1, Mohan Palla1
1Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
Insights
Percutaneous left ventricular assist devices (PVADs) support high-risk PCI patients. Impella and TandemHeart devices show comparable short-term mortality and bleeding rates in this population.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- High-risk percutaneous coronary intervention (PCI) is complex, involving patients with extensive coronary artery disease, reduced left ventricular function, and high surgical risk.
- Percutaneous left ventricular assist devices (PVADs) offer crucial hemodynamic support in these challenging PCI cases.
Purpose of the Study:
- To systematically evaluate the impact of PVADs on mortality, myocardial infarction, and complication rates in patients undergoing high-risk PCI.
- To compare the periprocedural outcomes of Impella and TandemHeart devices in high-risk PCI.
Main Methods:
- A systematic literature search was conducted across MEDLINE, PUBMED, EMBASE, and Cochrane for prospective controlled trials and cohort studies.
- Studies focused on patients receiving hemodynamic support with PVADs during high-risk PCI.
- Primary outcomes included 30-day mortality, 30-day myocardial infarction, major bleeding, and vascular complications.
Main Results:
- The analysis included 12 studies with 1,346 participants using Impella 2.5 L and 8 cohort studies with 205 participants using TandemHeart.
- Short-term mortality rates were 3.5% for Impella and 8% for TandemHeart.
- Major bleeding rates were 7.1% for Impella and 3.6% for TandemHeart.
Conclusions:
- Both Impella and TandemHeart PVADs demonstrate comparable periprocedural outcomes in patients undergoing high-risk PCI.
- PVADs provide essential hemodynamic support for high-risk PCI, with similar safety and efficacy profiles between the two devices studied.
Abstract:
High-risk percutaneous coronary intervention (PCI) is often offered to patients with extensive coronary artery disease, decreased left ventricular function, and co-morbid conditions that increase surgical risk. In these settings, percutaneous left ventricular assist devices (PVADs) can be used for hemodynamic support. To assess the effects of PVAD use on mortality, myocardial infarction, and complication rates in patients undergoing high-risk PCI, we systematically searched the electronic databases, MEDLINE, PUBMED, EMBASE, and Cochrane for prospective controlled trials and cohort studies of patients that received hemodynamic support with PVADs for high-risk PCI. The primary outcome measures were 30-day all-cause mortality, 30-day myocardial infarction rates, periprocedural major bleeding, and vascular complications. We included 12 studies with 1,346 participants who underwent Impella 2.5 L device placement and 8 cohort studies with 205 patients that received TandemHeart device for high-risk PCI. Short-term mortality rates were 3.5% and 8% and major bleeding rates were 7.1% and 3.6% with Impella and TandemHeart, respectively. Both devices are associated with comparable periprocedural outcomes in patients undergoing high-risk PCI.
