European Heart Journal Advance Access originally published online on July 18, 2009
European Heart Journal 2009 30(17):2102-2108; doi:10.1093/eurheartj/ehp292
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Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials
Department of Cardiology, Erasmus Medical Center, Thoraxcenter, ‘s-Gravendijkswal 230, Room V-017, 3015 CE Rotterdam, the Netherlands
Received 30 January 2009; revised 29 May 2009; accepted 26 June 2009; online publish-ahead-of-print 18 July 2009.
* Corresponding author. Tel: +31 10 70 35019, Fax: +31 10 70 32890, Email: c.denuil{at}erasmusmc.nl
See page 2073 for the editorial comment on this article (doi:10.1093/eurheartj/ehp274)
Aims: Studies have compared safety and efficacy of percutaneous left ventricular assist devices (LVADs) with intra-aortic balloon pump (IABP) counterpulsation in patients with cardiogenic shock. We performed a meta-analysis of controlled trials to evaluate potential benefits of percutaneous LVAD on haemodynamics and 30-day survival.
Methods and results: Two independent investigators searched Medline, Embase, and Cochrane Central Register of Controlled Trials for all controlled trials using percutaneous LVAD in patients with cardiogenic shock, where after data were extracted using standardized forms. Weighted mean differences (MDs) were calculated for cardiac index (CI), mean arterial pressure (MAP), and pulmonary capillary wedge pressure (PCWP). Relative risks (RRs) were calculated for 30-day mortality, leg ischaemia, bleeding, and sepsis. In main analysis, trials were combined using inverse-variance random effects approach. Two trials evaluated the TandemHeart and a recent trial used the Impella device. After device implantation, percutaneous LVAD patients had higher CI (MD 0.35 L/min/m2, 95% CI 0.09–0.61), higher MAP (MD 12.8 mmHg, 95% CI 3.6–22.0), and lower PCWP (MD –5.3 mm Hg, 95% CI –9.4 to –1.2) compared with IABP patients. Similar 30-day mortality (RR 1.06, 95% CI 0.68–1.66) was observed using percutaneous LVAD compared with IABP. No significant difference was observed in incidence of leg ischaemia (RR 2.59, 95% CI 0.75–8.97) in percutaneous LVAD patients compared with IABP patients. Bleeding (RR 2.35, 95% CI 1.40–3.93) was significantly more observed in TandemHeart patients compared with patients treated with IABP.
Conclusion: Although percutaneous LVAD provides superior haemodynamic support in patients with cardiogenic shock compared with IABP, the use of these more powerful devices did not improve early survival. These results do not yet support percutaneous LVAD as first-choice approach in the mechanical management of cardiogenic shock.
Key Words: Cardiogenic shock • Cardiac-assist device • Intra-aortic balloon pump • Outcome • Meta-analysis
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EHJ 2009 30: 2073-2075.[Extract] [Full Text]
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  N. R. Desai and D. L. Bhatt Evaluating percutaneous support for cardiogenic shock: data shock and sticker shock Eur. Heart J., September 1, 2009; 30(17): 2073 - 2075. [Full Text] [PDF]
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