Mechanical circulatory support as bridge to urgent structural intervention

Mechanical circulatory support as bridge to urgent structural intervention Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/42/3776/4931201 by Ed 'DeepDyve' Gillespie user on 13 November 2018 3776 K. Szummer et al. between hospital process performance and outcomes among patients with acute 34. Fokkema ML,James SK,AlbertssonP,AkerblomA,CalaisF,ErikssonP,JensenJ, coronary syndromes. JAMA 2006;295:1912–1920. Nilsson T, de Smet BJ, Sjogren I, Thorvinger B,LagerqvistB.Populationtrendsinpercu- 32. Stukel TA, Lucas FL, Wennberg DE. Long-term outcomes of regional variations . taneous coronary intervention: 20-year results from the SCAAR (Swedish Coronary in intensity of invasive vs medical management of Medicare Patients with acute . Angiography and Angioplasty Registry). J Am Coll Cardiol 2013;61:1222–1230. myocardial infarction. JAMA 2005;293:1329–1337. 35. Damman P, Jernberg T, Lindahl B, de Winter RJ, Jeppsson A, Johanson P, Held C, 33. Hakkinen U, Hartikainen J, Juntunen M, Malmivaara A, Peltola M, Tierala I. James SK. Invasive strategies and outcomes for non-ST-segment elevation acute Analysing current trends in care of acute myocardial infarction using PERFECT coronary syndromes: a twelve-year experience from SWEDEHEART. data. Ann Med 2011;43:S14–S21. EuroIntervention 2016;12:1108–1116. doi:10.1093/eurheartj/ehy110 CARDIOVASCULAR FLASHLIGHT Online publish-ahead-of-print 12 March 2018 .................................................................................................................................................... Patrick Horn, Malte Kelm, and Ralf Westenfeld* Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Du¨sseldorf, Moorenstr. 5, D-40225 Du¨sseldorf, Germany * Corresponding author. Tel: 149 211 8118800, Fax: 149 211 8118812, Email: ralf.westenfeld@med.uni-duesseldorf.de A 79-year-old woman was admitted in the emergency department as late comer in cardiogenic shock due to subacute non-ST-eleva- tion myocardial infarction, which clinically occurred 8 days prior. Coronary angiography depicted occlusion of a small circumflex ar- tery. Revascularization was deemed unreasonable in the light of normal CK and elevated LDH/troponin serum levels. The patient was haemodynamically compromised with elevated lactate and imminent renal and liver failure. Acute Physiology and Chronic Health Evaluation (APACHE II) Score was 25 points correspond- ing to an in-hospital mortality of 51%. Percutaneous mechanical circulatory support (Impella CP) was implanted and haemody- namics stabilized over 48 h along with recovery of renal as well as liver function. However, cardiac functional recovery was ham- pered by severe mitral regurgitation (MR) with concomitant pro- lapse of the posterior leaflet. Our Heart Team decision was to perform percutaneous mitral valve repair with the MitraClip sys- tem under Impella support (Panel A). Prior to MitraClip, left atrial pressure (LAP) was elevated indicating severe MR. As the per- formance level of the Impella was decreased, systemic arterial pressure decreased, and LAP even further increased (Panel B). Implantation of two clips reduced MR to a mild degree, and the dependence of LAP on systemic arterial pressure and Impella sup- port was attenuated (Panel C). The Impella was weaned and ex- planted the same day. The patient was discharged at New York Heart Association (NYHA) II 7 days after admission. This case is the first report of a critically ill patient bridged by mechanical circulatory support to urgent percutaneous mitral repair. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal Oxford University Press

Mechanical circulatory support as bridge to urgent structural intervention

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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
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0195-668X
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1522-9645
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10.1093/eurheartj/ehy110
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Abstract

Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/42/3776/4931201 by Ed 'DeepDyve' Gillespie user on 13 November 2018 3776 K. Szummer et al. between hospital process performance and outcomes among patients with acute 34. Fokkema ML,James SK,AlbertssonP,AkerblomA,CalaisF,ErikssonP,JensenJ, coronary syndromes. JAMA 2006;295:1912–1920. Nilsson T, de Smet BJ, Sjogren I, Thorvinger B,LagerqvistB.Populationtrendsinpercu- 32. Stukel TA, Lucas FL, Wennberg DE. Long-term outcomes of regional variations . taneous coronary intervention: 20-year results from the SCAAR (Swedish Coronary in intensity of invasive vs medical management of Medicare Patients with acute . Angiography and Angioplasty Registry). J Am Coll Cardiol 2013;61:1222–1230. myocardial infarction. JAMA 2005;293:1329–1337. 35. Damman P, Jernberg T, Lindahl B, de Winter RJ, Jeppsson A, Johanson P, Held C, 33. Hakkinen U, Hartikainen J, Juntunen M, Malmivaara A, Peltola M, Tierala I. James SK. Invasive strategies and outcomes for non-ST-segment elevation acute Analysing current trends in care of acute myocardial infarction using PERFECT coronary syndromes: a twelve-year experience from SWEDEHEART. data. Ann Med 2011;43:S14–S21. EuroIntervention 2016;12:1108–1116. doi:10.1093/eurheartj/ehy110 CARDIOVASCULAR FLASHLIGHT Online publish-ahead-of-print 12 March 2018 .................................................................................................................................................... Patrick Horn, Malte Kelm, and Ralf Westenfeld* Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Du¨sseldorf, Moorenstr. 5, D-40225 Du¨sseldorf, Germany * Corresponding author. Tel: 149 211 8118800, Fax: 149 211 8118812, Email: ralf.westenfeld@med.uni-duesseldorf.de A 79-year-old woman was admitted in the emergency department as late comer in cardiogenic shock due to subacute non-ST-eleva- tion myocardial infarction, which clinically occurred 8 days prior. Coronary angiography depicted occlusion of a small circumflex ar- tery. Revascularization was deemed unreasonable in the light of normal CK and elevated LDH/troponin serum levels. The patient was haemodynamically compromised with elevated lactate and imminent renal and liver failure. Acute Physiology and Chronic Health Evaluation (APACHE II) Score was 25 points correspond- ing to an in-hospital mortality of 51%. Percutaneous mechanical circulatory support (Impella CP) was implanted and haemody- namics stabilized over 48 h along with recovery of renal as well as liver function. However, cardiac functional recovery was ham- pered by severe mitral regurgitation (MR) with concomitant pro- lapse of the posterior leaflet. Our Heart Team decision was to perform percutaneous mitral valve repair with the MitraClip sys- tem under Impella support (Panel A). Prior to MitraClip, left atrial pressure (LAP) was elevated indicating severe MR. As the per- formance level of the Impella was decreased, systemic arterial pressure decreased, and LAP even further increased (Panel B). Implantation of two clips reduced MR to a mild degree, and the dependence of LAP on systemic arterial pressure and Impella sup- port was attenuated (Panel C). The Impella was weaned and ex- planted the same day. The patient was discharged at New York Heart Association (NYHA) II 7 days after admission. This case is the first report of a critically ill patient bridged by mechanical circulatory support to urgent percutaneous mitral repair. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.

Journal

European Heart JournalOxford University Press

Published: Nov 7, 2018

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