The Impella CP device for acute mechanical circulatory support in refractory cardiac arrest.

INTRODUCTION: Mechanical circulatory support may be considered as a therapeutic option in selected patients with refractory cardiac arrest (rCA). Animal studies suggest a potential role for the Impella® left ventricular assist device in this setting, but so far no human data have been published. METHODS: Eight patients with rCA were treated with the Impella CP® device at our institution from November 2014 to October 2015. The Impella CP® was used at the discretion of the treating physicians in patients with rCA and pulseless electrical activity with presumed primary left ventricular failure. These patients were compared to 12 patients with cardiogenic shock also treated with the Impella device during the same period. RESULTS: All cardiac arrests were witnessed with a no-flow time of 0min, six in-hospital and two out-of-hospital. Low-flow time was 50±52min (SD). The Impella device was successfully inserted in all patients with rCA and circulation was re-established. Survival rate to hospital discharge with good neurological outcome was similar among patients with rCA and cardiogenic shock treated with the Impella device (50% vs. 58%). Major vascular complications after Impella insertion occurred more frequently among patients with rCA compared to patients with cardiogenic shock (50% vs. 0%, P<0.05). CONCLUSION: Mechanical support with the Impella CP® device is a feasible and promising treatment option for selected patients with rCA. Further studies are warranted to determine the full potential and optimal patient selection compared to other modalities of mechanical circulatory support.

[Catheter-based aortic valve substitution. Initial experiences with stent valve implantation]. / Kateterbaseret aortaklapsubstitution. Initiale erfaringer med implantation af stentklap.

INTRODUCTION: Recent years have seen the introduction of catheter-based aortic valve substitution with stent valves to treat aortic valve stenosis in patients who were deemed inoperable via conventional open heart surgery. We here report our initial experience. MATERIAL AND METHODS: Register-based study with prospective registration of prespecified parameters. A total of 26 patients were treated with an aortic stent valve, 12 via transfemoral (TFA-AVI) and 14 via transapical (TAP-AVI) access. In the TFA-AVI group, 75% were women and the average age was 85 4.5 years; in the TAP-AVI group, 71% were women and the average age was 79 8.4 years. RESULTS: In the TFA-AVI group, successful stent valve implantation was performed in 9/12 (75%) and TAP-AVI in 13/14 (93%) patients. Mortality after 30 days was 25% in the TFA-AVI and 7% in the TAP-AVI group. The aortic valve area increased from 0.6 0.13 cm(2) to 1.6 0.39 (2) in the TFA-AVI group and from 0.7 0.2 (2) to 1.6 0.37 (2) in the TAP-AVI group. 91% of patients showed clinical improvement after treatment. CONCLUSION: Transcatheter aortic valve implantation of conventional unresectable patients requires close cooperation between different specialities. The treatment seems to be a realistic alternative to medical treatment for inoperable patients and may even be used in operable high-risk patients.

[Minimally invasive mitral valve surgery]. / Minimalinvasiv mitralklapkirurgi.

INTRODUCTION: We have experienced a growing demand from patients for minimally invasive cardiac surgery. MATERIAL AND METHODS: From March 2006 through November 2007 we performed endoscopic mitral valve surgery in 30 patients (20 mitral valve repairs, eight mitral valve replacements and two extirpations of mitral valve fibroelstoma). Seven patients had concomitant surgery, including cryomaze to eliminate atrial fibrillation and/or closure of an atrial septal defect (ASD). Median preoperative functional class was New York Heart Association (NYHA) II and all patients had severe mitral valve regurgitation. The mean age was 58.0 +/-3 years and 27% of the patients were females. RESULTS: The procedure was performed successfully in all patients with no conversion to sternotomy, while postoperative morbidity was very limited and no mortality was seen. Early echocardiographic follow-up showed fully competent mitral valve repairs. CONCLUSION: Endoscopic mitral valve surgery is an attractive alternative to conventional sternotomy with an attractive cosmetic result. This can be obtained without compromising quality or safety. This paper confirms that endoscopic mitral valve surgery is feasible and it provides the least invasive operative approach. The technique is currently our primary surgical approach for mitral valve disease.