Minerva cardioangiologica
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Minerva cardioangiologica · Aug 2008
ReviewVolatile anesthetics for periprocedural cardiac protection. A review.
All volatile anesthetics have cardiac depressant effects that decrease myocardial oxygen demand and may, therefore, have a beneficial role on the myocardial oxygen balance during ischemia. Recently, experimental evidence has clearly demonstrated that in addition to these indirect protective effects, volatile anesthetic agents also have direct protective properties against ischemic myocardial damage. ⋯ Multicenter, randomized clinical trials had previously demonstrated that the use of desflurane can reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalization, following coronary artery bypass graft surgery, either with and without cardiopulmonary bypass. Evidence in non-coronary surgical settings is contradictory and will be reviewed in this paper together with the mechanism of cardiac protection by volatile agents.
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Minerva cardioangiologica · Aug 2008
Use of Impella Recover 2.5 left ventricular assist device in patients with cardiogenic shock or undergoing high-risk percutaneous coronary intervention procedures: experience of a high-volume center.
Percutaneous coronary interventions are increasingly applied to high-risk patients. The availability of hemodynamic support devices offers a promising option to prevent and treat low-output syndrome in these patients. The aim of this study was to evaluate the feasibility, safety and efficacy of the Impella Recover'' LP 2.5 left ventricular assist device in patients with cardiogenic shock or undergoing high-risk percutaneous coronary interventions. ⋯ These data, although preliminary due to the limited sample size, demonstrated the feasibility, safety and efficacy of the Impella Recover LP 2.5 during high-risk percutaneous procedures, even though the benefits of prophylactic deployment of such a system have to be further investigated. The use of Impella Recover LP 2.5 in patients with cardiogenic shock is feasible and safe, however it maybe insufficient in reversing an advanced cardiogenic shock which, probably, has to be treated with more powerful left ventricular assist devices.