Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials
Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials
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DOI：
10.1093/eurheartj/ehp292
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发表时间：
2009-09-01
影响因子：
39.3
通讯作者：
Serruys, Patrick W.
中科院分区：
文献类型：
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作者：
Cheng, Jin M.;den Uil, Corstiaan A.;Serruys, Patrick W.
研究比较了经皮左心室辅助装置（LVAD）与主动脉内球囊反搏（IABP）反搏在心源性休克患者中的安全性和有效性。我们进行了一项对照试验的荟萃分析，以评估经皮LVAD对血流动力学和30天生存率的潜在益处。两名独立的研究人员检索了Medline、Embase和科克伦对照试验中心，以查找所有使用经皮LVAD治疗心源性休克患者的对照试验，然后使用标准化表格提取数据。计算心脏指数（CI）、平均动脉压（MAP）和肺毛细血管楔压（PCWP）的加权平均差（MD）。计算30天死亡率、腿部缺血、出血和败血症的相对风险（RR）。在主成分分析中，试验采用逆方差随机效应方法合并。两项试验评估了TandemHeart，最近的一项试验使用了Impella器械。器械植入后，与IABP患者相比，经皮LVAD患者的CI更高（MD 0.35 L/min/m2，95% CI 0.09-0.61），MAP更高（MD 12.8 mmHg，95% CI 3.6-22.0），PCWP更低（MD -5.3 mmHg，95% CI -9.4至-1.2）。与IABP相比，经皮LVAD的30天死亡率相似（RR 1.06，95% CI 0.68-1.66）。与IABP患者相比，经皮LVAD患者的腿部缺血发生率无显著差异（RR 2.59，95% CI 0.75-8.97）。TandemHeart患者的出血（RR 2.35，95%CI 1.40-3.93）明显多于IABP治疗的患者。尽管与IABP相比，经皮LVAD为心源性休克患者提供了上级血流动力学支持，但使用这些更强大的设备并没有改善早期生存率。这些结果尚不支持经皮LVAD作为心源性休克机械治疗的首选方法。
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.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/m(2), 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.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.