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Impella装置:对其发展、应用以及对心源性休克和高危经皮冠状动脉介入治疗影响的全面综述

Impella devices: a comprehensive review of their development, use, and impact on cardiogenic shock and high-risk percutaneous coronary intervention.

作者信息

Fishkin Tzvi, Isath Ameesh, Naami Edmund, Aronow Wilbert S, Levine Avi, Gass Alan

机构信息

Departments of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA.

Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA.

出版信息

Expert Rev Cardiovasc Ther. 2023 Jul-Dec;21(9):613-620. doi: 10.1080/14779072.2023.2244874. Epub 2023 Aug 8.

Abstract

INTRODUCTION

Impella devices have emerged as a critical tool for temporary mechanical circulatory support (TMCS) in the management of cardiogenic shock (CS) and high-risk percutaneous coronary interventions (PCI). The purpose of this review is to examine the history of the different Impella devices, their hemodynamic profiles, and how the data supports their use.

AREAS COVERED

This review covers the development and specifications of the Impella 2.5, Impella CP, Impella 5.0/Left Direct (LD), Impella RP, and Impella 5.5 devices. This review also covers the clinical trials that illuminate the Impella devices' use in their appropriate clinical contexts. These studies examine the effectiveness of Impella devices and have begun to yield promising results, demonstrating improved survival rates when compared to the historically high mortality rates associated with CS. It is important to weigh the benefits of Impella devices in light of their contraindications. A literature search was conducted by searching the PubMed database for reviews, meta-analyses, and clinical trials pertinent to Impella devices.

EXPERT OPINION

Impella devices are a crucial tool for management of patients undergoing high-risk PCI and those with CS. There is evidence that early Impella implantation is beneficial in the treatment of patients presenting with CS. Further randomized controlled trials are needed to better elucidate the benefits of Impella devices in various clinical settings.

摘要

引言

Impella装置已成为心源性休克(CS)管理和高风险经皮冠状动脉介入治疗(PCI)中临时机械循环支持(TMCS)的关键工具。本综述的目的是研究不同Impella装置的历史、它们的血流动力学特征,以及数据如何支持其应用。

涵盖领域

本综述涵盖了Impella 2.5、Impella CP、Impella 5.0/左向直接(LD)、Impella RP和Impella 5.5装置的开发和规格。本综述还涵盖了阐明Impella装置在其适当临床环境中应用的临床试验。这些研究检验了Impella装置的有效性,并已开始产生有前景的结果,与CS相关的历史高死亡率相比,生存率有所提高。根据其禁忌症权衡Impella装置的益处很重要。通过在PubMed数据库中搜索与Impella装置相关的综述、荟萃分析和临床试验进行了文献检索。

专家意见

Impella装置是管理接受高风险PCI患者和CS患者的关键工具。有证据表明,早期植入Impella对治疗CS患者有益。需要进一步的随机对照试验,以更好地阐明Impella装置在各种临床环境中的益处。

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