The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery
Abstract
:1. Introduction
2. Cardiac Surgery/Percutaneous Procedures-Related Injuries and How They Affect Ventricular Performance
3. Principle of Ventricular Unloading
4. Benefits of Left Ventricular Unloading
5. Cardioprotective Devices That Unload the Heart:
5.1. Ventricular Assist Devices
5.1.1. Devices That Unload the Heart
Tandemheart
Impella Family Devices
Novel Device: Protek Duo
5.1.2. Devices That Do Not Unload the Heart but Provide Hemodynamic Support
VA-ECMO
IABP
Surgical BiVAD
5.2. Myocardial Cooling Devices and Techniques
5.2.1. The Topical Myocardial Cooling Device
5.2.2. Topical Neck Cooling
5.3. Transcutaneous Vagus Stimulation
5.4. Pressure-Controlled Intermittent Coronary Sinus Occlusion
- PiCSO immediately improved microvascular function after PCI in STEMI patients;
- PiCSO positively influenced coronary microcirculatory vasodilation;
- PiCSO-assisted PCI demonstrated a smaller infarct size at 6 months;
- PiCSO showed promising results in treating inferior STEMI [102].
5.5. Supersaturated Oxygen Therapy
6. Newer Therapeutic Techniques in High-Risk Populations (Cardiogenic Shock and PCI)
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Uses in PCI and Cardiac Surgery | ||||
---|---|---|---|---|
Ventricular Support | Advantages | Disadvantages/Limitations | ||
Devices that provide cardioprotection by improving hemodynamics or providing circulatory support | TandemHeart [39,40,41,42] | Left ventricular support | Hemodynamics improvement before and during PCI | No significant improvement in mortality Data limited to observational studies Need of anticoagulant therapy before placement Invasive device: need of interatrial communication |
Impella family devices [14,42,43] | Left ventricular support Impella RP: right ventricular support | Hemodynamics improvement before and during PCI Small size cannula Approved by the US Food and Drug Administration for high-risk PCI | No significant improvement in mortality Significant major bleeding complications Need of anticoagulant therapy before placement May induce right heart failure | |
VA-ECMO [19,32,44,45] | Biventricular support | Provides circulatory and respiratory support, ideal for patients undergoing biventricular failure Some studies show procedural success and no difference in outcomes compared to Impella family devices when used in high-risk PCI | More research is needed to conclude its efficacy in high-risk PCI | |
Protek Duo [45,46,47,48,49] | Right ventricular support | Safe and feasible treatment in patients with acute right heart failure resulting from implementing a left ventricular assist device. In conjunction with TandemHeart, may offer up to a month of circulatory support. Minimal invasive percutaneous full right heart support ProtekDuo as a bridge to lung transplant and heart-lung transplant | Efficacy and safety data on this device are limited. Drains only from the superior vena cava, making it harder to place it correctly in shorter patients. More expensive than a standard ECMO cannula (> USD 20,000) | |
IABP [50,51,52] | Left ventricular support | Cost-effective method No need for anticoagulant therapy before placement | Poor performance in patients with poor left ventricular function undergoing artery bypass surgery and cardiogenic shock | |
BiVAD [11,53,54] | Biventricular support | Good outcomes when used in patients with chronic or acute biventricular failure as a bridge to transplant or recovery Beneficial in patients undergoing right-sided heart failure | Need of sternotomy Ventricular arrhythmias after device placement More research needed to assess its efficacy in high-risk PCI | |
IABP+ ECMO [20] | Biventricular support | May reduce mortality when treating profound cardiogenic shock (CS) Hemodynamics improvement before and during PCI | Only small observational studies available, not enough for concluding efficacy. Poor data concerning IABP+ECMO in PCI | |
Impella + VA-ECMO [21] | Biventricular support | May reduce mortality when treating profound CS Hemodynamics improvement before and during PCI | Only small observational studies are available, which is not enough to conclude efficacy. Poor data concerning Impella+ECMO in PCI | |
Devices that provide cardioprotection by the preservation of myocardial properties | Myocardial cooling devices [4,10,55] | NA | Used in people after induced cardiac arrest following surgery. May minimize ischemia–reperfusion injury, thereby improving cardiac surgery outcomes after cardiac arrest. Efficacious and easy to use in all pediatric cardiac surgeries. Key therapy in patients undergoing cardiopulmonary bypass surgery requiring cardiac arrest | Risk of widespread intravascular crumpling Although it has been shown to have good results in clinical trials, more research is needed to show the same results in human trials |
Other approaches | Transcutaneous vagus stimulation [56,57] | NA | Non-invasive therapy Can induce intermittent cardiac asystole and can be used as an “on-off” switch for performing cardiac surgeries | More research is needed to assess all the advantages and risks for its use in cardiac surgery [57] |
Pressure controlled intermittent coronary sinus occlusion [58,59,60] | NA | Increases the mean coronary sinus pressure and coronary sinus pulse pressure after a PCI PiCSO-assisted PCI has demonstrated smaller infarct size after 6 months | Limited to treating anterior ST-elevated myocardial infarction More research needed | |
Supersaturated oxygen therapy [61,62,63] | NA | Reduces infarct size. Improves reperfusion injury. Reduces endothelial edema and capillary vasodilation. Can be started 5 min after successful revascularization, without delaying primary PC | Relatively new therapy with unknown long-term outcomes |
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Abdul-Rahman, T.; Lizano-Jubert, I.; Garg, N.; Tejerina-Marion, E.; Awais Bukhari, S.M.; Luisa Ek, A.; Wireko, A.A.; Mares, A.C.; Sikora, V.; Gupta, R. The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery. Healthcare 2023, 11, 1094. https://doi.org/10.3390/healthcare11081094
Abdul-Rahman T, Lizano-Jubert I, Garg N, Tejerina-Marion E, Awais Bukhari SM, Luisa Ek A, Wireko AA, Mares AC, Sikora V, Gupta R. The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery. Healthcare. 2023; 11(8):1094. https://doi.org/10.3390/healthcare11081094
Chicago/Turabian StyleAbdul-Rahman, Toufik, Ileana Lizano-Jubert, Neil Garg, Emilio Tejerina-Marion, Syed Muhammad Awais Bukhari, Ana Luisa Ek, Andrew Awuah Wireko, Adriana C. Mares, Vladyslav Sikora, and Rahul Gupta. 2023. "The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery" Healthcare 11, no. 8: 1094. https://doi.org/10.3390/healthcare11081094
APA StyleAbdul-Rahman, T., Lizano-Jubert, I., Garg, N., Tejerina-Marion, E., Awais Bukhari, S. M., Luisa Ek, A., Wireko, A. A., Mares, A. C., Sikora, V., & Gupta, R. (2023). The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery. Healthcare, 11(8), 1094. https://doi.org/10.3390/healthcare11081094