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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
Percutaneous left ventricular assist device vs. intra-aortic balloon pump in patients with severe left ventricular
Fang-Bin Hu1,2, Lian-Qun Cui1
1Department of Cardiology, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China.
Insights
Percutaneous left ventricular assist devices (PLVAD) do not improve early survival compared to intra-aortic balloon pumps (IABP) in severe left ventricular dysfunction patients. PLVAD use increased non-major adverse cardiac and cerebrovascular events (non-MACCE) rates.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Cardiology
Background:
- Intra-aortic balloon pump (IABP) and percutaneous left ventricular assist devices (PLVAD) are used for hemodynamic stabilization.
- Their comparative effectiveness in severe left ventricular dysfunction is debated.
Purpose of the Study:
- To compare clinical outcomes of PLVAD versus IABP in patients with severe left ventricular dysfunction undergoing percutaneous coronary intervention (PCI) or ventricular tachycardia (VT) ablation.
Main Methods:
- Meta-analysis of randomized controlled trials (RCTs) and prospective observational studies.
- Included 4 RCTs and 2 observational studies with 348 patients receiving PLVAD and 340 receiving IABP.
Main Results:
- No significant difference in early mortality (in-hospital or 30-day) between PLVAD and IABP groups (RR = 1.03, P = 0.89).
- PLVAD group showed a significantly higher rate of composite, in-hospital, non-major adverse cardiac and cerebrovascular events (non-MACCE) (RR = 1.30, P = 0.04).
Conclusions:
- PLVAD does not improve early survival over IABP in severe left ventricular dysfunction patients undergoing PCI or VT ablation.
- PLVAD use is associated with an increased in-hospital non-MACCE rate compared to IABP.
Objective:
Although controversial, the intra-aortic balloon pump (IABP) and percutaneous left ventricular assist device (PLVAD) are widely used for initial hemodynamic stabilization. We performed a meta-analysis to compare the clinical outcomes of these two devices in patients with severe left ventricular (LV) dysfunction undergoing percutaneous coronary intervention (PCI) or ventricular tachycardia (VT) ablation.
Methods:
MEDLINE, EMBASE, the Cochrane Registry of Controlled Trials, and reference lists of relevant articles were searched. We included randomized controlled trials (RCTs) and prospective observational studies. Meta-analysis was conducted using a random effects model.
Results:
The quantitative analysis included 4 RCTs and 2 observational studies. A total of 348 patients received PLVAD and 340 received IABP. Meta-analysis revealed that early mortality rates (in-hospital or 30-day) did not differ between the PLVAD and IABP groups (relative risk (RR) = 1.03, 95% confidence interval (CI) = 0.70-1.51, P = 0.89). Significant differences were observed between the two groups in the composite, in-hospital, non-major adverse cardiac and cerebrovascular events (MACCE) rate (RR = 1.30, 95% CI = 1.01-1.68, P = 0.04).
Conclusions:
Compared with IABP, PLVAD with active circulatory support did not improve early survival in those with severe left ventricular dysfunction undergoing either PCI or VT ablation, but increased the in-hospital non-MACCE rate.
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