Pauley Heart Center, VCU Medical Center, Richmond, VA.
Einstein Medical Center, Philadelphia, PA.
Am Heart J. 2018 May;199:115-121. doi: 10.1016/j.ahj.2017.09.007. Epub 2017 Sep 28.
Management of patients requiring temporary, mechanical hemodynamic support during high- risk percutaneous coronary intervention (PCI) or in cardiogenic shock is rapidly evolving. With the availability of the Impella 2.5, CP, 5.0, LD, and RP percutaneous mechanical circulatory support devices, there is a need for continued surveillance of outcomes. Three factors underline the importance of a registry for these populations. First, large randomized trials of hemodynamic support, involving cardiogenic shock, are challenging to conduct. Second, there is increasing interest in the use of registries to provide "real-world" experience and to allow the flexibility to evaluate individual patient uses and outcomes. Third, current, large databases have not captured the specific impact of mechanical support treatment of cardiogenic shock. The predecessor to the catheter-based ventricular assist devices registry, known as USpella, began in 2009 with paper data acquisition but beginning in 2011 transferred to electronic data capture, enrolling 3,339 patients through 2016. Throughout, registry data have been used to assess the outcomes of Impella therapy, leading to 8 publications and 4 Food and Drug Administration premarket approvals covering multiple indications and Impella devices. Going forward, the registry will continue to assess not only in-hospital outcomes but long-term follow-up to 1 year. In addition, data management will be enhanced to assess quality and clinical experiences. The registry will also provide a mechanism for postmarketing surveillance. This manuscript reviews the ongoing catheter-based ventricular assist devices registry design, management, and contributions of the registry data. The upgraded registry will provide a more robust opportunity to assess acute and late outcomes of current and future device use worldwide.
The current catheter-based ventricular assist devices registry is an international database documenting outcomes with temporary Impella hemodynamic support. The registry has supported 8 publications and 4 Food and Drug Administration premarket approvals since its inception in 2009. The current registry is more robust containing outcomes up to 1 year postprocedure.
在高危经皮冠状动脉介入治疗(PCI)或心源性休克期间需要临时机械血液动力学支持的患者的管理正在迅速发展。随着 Impella 2.5、CP、5.0、LD 和 RP 经皮机械循环支持设备的出现,需要持续监测结果。有三个因素强调了这些人群的登记册的重要性。首先,涉及心源性休克的血液动力学支持的大型随机试验很难进行。其次,人们越来越有兴趣使用登记册提供“真实世界”的经验,并允许灵活评估个别患者的使用和结果。第三,当前的大型数据库尚未捕捉到机械支持治疗心源性休克的具体影响。被称为 USpella 的基于导管的心室辅助设备登记册的前身于 2009 年开始进行纸质数据采集,但从 2011 年开始转为电子数据采集,到 2016 年共登记了 3339 名患者。在整个过程中,登记册数据一直被用于评估 Impella 治疗的结果,导致 8 篇出版物和 4 项食品和药物管理局(FDA)上市前批准涵盖多个适应症和 Impella 设备。展望未来,该登记册将继续评估不仅是住院期间的结果,而且是长达 1 年的长期随访。此外,数据管理将得到加强,以评估质量和临床经验。该登记册还将为上市后监测提供一种机制。本文回顾了正在进行的基于导管的心室辅助设备登记册设计、管理和登记册数据的贡献。自 2009 年成立以来,该升级后的登记册将为评估当前和未来设备在全球范围内的使用的急性和晚期结果提供更有力的机会。
目前的基于导管的心室辅助设备登记册是一个国际数据库,记录了临时 Impella 血液动力学支持的结果。自 2009 年成立以来,该登记册已支持了 8 篇出版物和 4 项食品和药物管理局(FDA)上市前批准。目前的登记册更加健壮,包含了 1 年术后的结果。