John Kevin John, Hernandez-Montfort Jaime, Kanwar Manreet K, Li Song, Garan Arthur Reshad, Sinha Shashank S, Abraham Jacob, Vallabhajosyula Saraschandra, Li Borui, Kong Qiuyue, Sangal Paavni, Burkhoff Daniel, Kapur Navin K
From The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts.
Advanced Heart Failure Program, Baylor Scott and White Health, Temple, Texas.
ASAIO J. 2025 May 1;71(5):379-386. doi: 10.1097/MAT.0000000000002348. Epub 2024 Nov 13.
Acute right ventricular failure (RVF) is a common finding in cardiogenic shock (CS), yet the optimal method of supporting the failing RV remains unclear. This study aimed to describe CS patients receiving percutaneous right ventricular assist devices (pRVADs) using the multicenter Cardiogenic Shock Working Group (CSWG) registry. Among 6,201 patients with CS, 152 (2.4%) received pRVADs, with ProtekDuo and Impella RP being used in 71% and 29% of cases, respectively. The average age of this group was 58.5 years, with a higher proportion of men (66.4%). Heart failure-associated CS (HF-CS) was observed in 48% of patients, while myocardial infarction-associated CS (MI-CS) was seen in 27% (HF-CS versus MI-CS: 52.8% vs. 21.3% for ProtekDuo; 36.4% vs. 40.9% for Impella RP; p = 0.01). The overall in-hospital mortality rate was 54.6%, bleeding complications were more prevalent among ProtekDuo recipients (64.8% vs. 43.2%, p = 0.008), whereas Impella RP recipients had shorter hospital stays (20.4 ± 18.7 vs. 41.9 ± 31.5 days, p < 0.001). ProtekDuo was more commonly used in patients with HF-CS and was associated with higher rates of bleeding and longer hospital stays compared with Impella RP, although overall mortality was similar. Further investigation is required to determine the ideal timing and clinical conditions warranting pRVAD deployment in CS.
急性右心室衰竭（RVF）是心源性休克（CS）的常见表现，但支持衰竭右心室的最佳方法仍不明确。本研究旨在利用多中心心源性休克工作组（CSWG）登记处的数据，描述接受经皮右心室辅助装置（pRVAD）治疗的CS患者。在6201例CS患者中，152例（2.4%）接受了pRVAD治疗，其中71%的病例使用了ProtekDuo，29%的病例使用了Impella RP。该组患者的平均年龄为58.5岁，男性比例较高（66.4%）。48%的患者出现与心力衰竭相关的心源性休克（HF-CS），27%的患者出现与心肌梗死相关的心源性休克（MI-CS）（HF-CS与MI-CS：ProtekDuo分别为52.8%和21.3%；Impella RP分别为36.4%和40.9%；p = 0.01）。总体住院死亡率为54.6%，ProtekDuo接受者出血并发症更为普遍（64.8%对43.2%，p = 0.008），而Impella RP接受者住院时间较短（20.4±18.7天对41.9±31.5天，p < 0.001）。ProtekDuo更常用于HF-CS患者，与Impella RP相比，出血率更高，住院时间更长，尽管总体死亡率相似。需要进一步研究以确定在CS中使用pRVAD的理想时机和临床情况。
