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Impella Mechanical Circulatory Support for Takotsubo Syndrome With Shock: A Retrospective Multicenter Analysis.

Publication ,  Journal Article
Napp, LC; Westenfeld, R; Møller, JE; Pappalardo, F; Ibrahim, K; Bonello, L; Wilkins, C; Pershad, A; Mannino, SF; Schreiber, TL; Hall, PA ...
Published in: Cardiovasc Revasc Med
July 2022

OBJECTIVES: To analyze the characteristics and outcome of Impella mechanical circulatory support (MCS) for Takotsubo syndrome (TS) with cardiogenic shock. BACKGROUND: TS is an acute heart failure syndrome characterized by transient severe reduction of left ventricular (LV) systolic function, with cardiogenic shock occurring in around 10% of patients. Since inotropes should be avoided due to their role in TS pathogenesis and aggravation of LV outflow tract obstruction, the use of MCS as treatment is a viable treatment option, however, studies are lacking. METHODS: The catheter-based ventricular assist device (cVAD) registry and local MCS databases were screened for TS patients with cardiogenic shock (TS-CS) supported with an Impella percutaneous ventricular assist device (pVAD). Patient and treatment characteristics and in-hospital outcomes were retrospectively analyzed. RESULTS: At 10 US and European centers, 16 TS-CS patients supported with an Impella pVAD were identified between December 2013 and May 2018 (mean age, 61.8 ± 15.5 years; 87.5% women). LV ejection fraction (LVEF) at presentation was severely reduced (mean, 19.4 ± 8.3%). Prior to MCS, 13 patients (81.3%) were mechanically ventilated, 4 patients (25.0%) had been resuscitated, and mean serum lactate was 4.7 ± 3.5 mmol/L. Mean duration of Impella support was 1.9 ± 1.0 days (range, 1-4 days). Thirteen patients (81.3%) survived to discharge, and all survivors experienced cardiac recovery with significant improvement of LVEF at discharge compared to baseline (20.4 ± 8.8 vs. 52.9 ± 12.0, P < 0.001). CONCLUSIONS: This is the first series of TS-CS patients supported with an Impella pVAD. Mortality was low, and LV systolic function recovered in all survivors. Prospective studies of Impella support in this special condition are warranted.

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Published In

Cardiovasc Revasc Med

DOI

EISSN

1878-0938

Publication Date

July 2022

Volume

40

Start / End Page

113 / 119

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Takotsubo Cardiomyopathy
  • Shock, Cardiogenic
  • Retrospective Studies
  • Prospective Studies
  • Middle Aged
  • Male
  • Humans
  • Heart-Assist Devices
  • Female
 

Citation

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Chicago
ICMJE
MLA
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Napp, L. C., Westenfeld, R., Møller, J. E., Pappalardo, F., Ibrahim, K., Bonello, L., … Bauersachs, J. (2022). Impella Mechanical Circulatory Support for Takotsubo Syndrome With Shock: A Retrospective Multicenter Analysis. Cardiovasc Revasc Med, 40, 113–119. https://doi.org/10.1016/j.carrev.2021.11.018
Napp, L Christian, Ralf Westenfeld, Jacob E. Møller, Federico Pappalardo, Karim Ibrahim, Laurent Bonello, Charles Wilkins, et al. “Impella Mechanical Circulatory Support for Takotsubo Syndrome With Shock: A Retrospective Multicenter Analysis.Cardiovasc Revasc Med 40 (July 2022): 113–19. https://doi.org/10.1016/j.carrev.2021.11.018.
Napp LC, Westenfeld R, Møller JE, Pappalardo F, Ibrahim K, Bonello L, et al. Impella Mechanical Circulatory Support for Takotsubo Syndrome With Shock: A Retrospective Multicenter Analysis. Cardiovasc Revasc Med. 2022 Jul;40:113–9.
Napp, L. Christian, et al. “Impella Mechanical Circulatory Support for Takotsubo Syndrome With Shock: A Retrospective Multicenter Analysis.Cardiovasc Revasc Med, vol. 40, July 2022, pp. 113–19. Pubmed, doi:10.1016/j.carrev.2021.11.018.
Napp LC, Westenfeld R, Møller JE, Pappalardo F, Ibrahim K, Bonello L, Wilkins C, Pershad A, Mannino SF, Schreiber TL, Hall PA, Medjamia AM, Haurand JM, Sieweke J-T, Schäfer A, Grines CL, Burkhoff D, Moses JW, Ohman EM, O’Neill WW, Kapur NK, Bauersachs J. Impella Mechanical Circulatory Support for Takotsubo Syndrome With Shock: A Retrospective Multicenter Analysis. Cardiovasc Revasc Med. 2022 Jul;40:113–119.
Journal cover image

Published In

Cardiovasc Revasc Med

DOI

EISSN

1878-0938

Publication Date

July 2022

Volume

40

Start / End Page

113 / 119

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Takotsubo Cardiomyopathy
  • Shock, Cardiogenic
  • Retrospective Studies
  • Prospective Studies
  • Middle Aged
  • Male
  • Humans
  • Heart-Assist Devices
  • Female