Mechanical Circulatory Support Strategies in Takotsubo Syndrome with Cardiogenic Shock: A Systematic Review

被引:7
作者
von Mackensen, Johanna K. R. [1 ,2 ]
Zwaans, Vanessa I. T. [1 ,2 ]
El Shazly, Ahmed [1 ,2 ]
Van Praet, Karel M. [3 ,4 ]
Heck, Roland [1 ,2 ]
Starck, Christoph T. [1 ,2 ,5 ]
Schoenrath, Felix [1 ,2 ,5 ]
Potapov, Evgenij V. [1 ,2 ,5 ]
Kempfert, Joerg [1 ,2 ,5 ]
Jacobs, Stephan [1 ,2 ,5 ]
Falk, Volkmar [1 ,2 ,5 ,6 ,7 ,8 ,9 ,10 ]
Wert, Leonhard [1 ,2 ]
机构
[1] Deutsch Herzzentrum Charite, Med Heart Ctr Charite, Dept Cardiothorac & Vasc Surg, D-13353 Berlin, Germany
[2] German Heart Inst, D-13353 Berlin, Germany
[3] ASZ Hosp Aalst, Dept Cardiothorac Surg, B-9300 Aalst, Belgium
[4] Hartctr OLV Aalst, Cardiac Surg Dept, B-9300 Aalst, Belgium
[5] DZHK German Ctr Cardiovasc Res, Partner Site, D-10785 Berlin, Germany
[6] Charite Univ Med Berlin, Dept Cardiothorac Surg, D-10117 Berlin, Germany
[7] Free Univ Berlin, D-10117 Berlin, Germany
[8] Humboldt Univ, D-10117 Berlin, Germany
[9] Berlin Inst Hlth, D-10117 Berlin, Germany
[10] Swiss Fed Inst Technol, Dept Hlth Sci & Technol, CH-8093 Zurich, Switzerland
关键词
Takotsubo; stress cardiomyopathy; cardiogenic shock; mechanical circulatory support; ECLS; IABP; Impella; EXTRACORPOREAL MEMBRANE-OXYGENATION; TAKO-TSUBO CARDIOMYOPATHY; REFRACTORY HEART-FAILURE; STRESS CARDIOMYOPATHY; LIFE-SUPPORT; LIVER; PHEOCHROMOCYTOMA; IMPELLA; PATIENT;
D O I
10.3390/jcm13020473
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Takotsubo syndrome is, by definition, a reversible form of acute heart failure. If cardiac output is severely reduced, Takotsubo syndrome can cause cardiogenic shock, and mechanical circulatory support can serve as a bridge to recovery. To date, there are no recommendations on when to use mechanical circulatory support and on which device is particularly effective in this context. Our aim was to determine the best treatment strategy. Methods: A systematic literature research and analysis of individual patient data was performed in MEDLINE/PubMed according to PRISMA guidelines. Our research considered original works published until 31 July 2023. Results: A total of 93 publications that met the inclusion criteria were identified, providing individual data from 124 patients. Of these, 62 (50%) were treated with veno-arterial extracorporeal life support (va-ECLS), and 44 (35.5%) received a microaxial left ventricular assist device (Impella). Eighteen patients received an Impella CP and twenty-one an Impella 2.5. An intra-aortic balloon pump (IABP) without other devices was used in only 13 patients (10.5%), while other devices (BiVAD or Tandem Heart) were used in 5 patients (4%). The median initial left ventricular ejection fraction was 20%, with no difference between the four device groups except for the IABP group, which was less affected by cardiac output failure (p = 0.015). The overall survival was 86.3%. Compared to the other groups, the time to cardiac recovery was shorter with Impella (p < 0.001). Conclusions: Though the Impella treatment is new, our analysis may show a significant benefit of Impella compared to other MCS strategies for cardiogenic shock in Takotsubo syndrome.
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页数:22
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