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Article ; Online: Predictors of Short-term Survival in Cardiogenic Shock Patients Requiring Left Ventricular Support Using the Impella CP or 5.0.

Panoulas, Vasileios / Monteagudo-Vela, María

CJC open

2021 Volume 3, Issue 8, Page(s) 1002–1009

Abstract: Background: Percutaneous ventricular assist devices (pVADs) have been used to support patients who are in cardiogenic shock (CS). There is limited data on 30-day mortality predictors in patients supported by an Impella pVAD.: Methods: All CS patients ...

Abstract	Background: Percutaneous ventricular assist devices (pVADs) have been used to support patients who are in cardiogenic shock (CS). There is limited data on 30-day mortality predictors in patients supported by an Impella pVAD. Methods: All CS patients requiring left-sided Impella implantation in Harefield Hospital (Greater London, United Kingdom) between 2017 and 2020 were included in the current study. Logistic regression analysis was used to identify predictors of 30-day mortality. Results: A total of 92 patients were included. The mean age was 53.8 ± 14.9 years, and 78.3% were male. CS etiology was predominantly acute coronary syndromes (44.6%), followed by decompensated dilated cardiomyopathy (28.3%). Survival at 30 days was 63% (58 of 92). Deceased patients had a lower left ventricular ejection fraction (LVEF) (15.1 ± 9.6 vs 21.8 ± 14.2, Conclusions: In the current retrospective registry of patients requiring Impella pVAD implantation, independent 30-day mortality predictors included serum lactate, baseline LVEF, and prolonged invasive ventilation (> 24 hours). These parameters could highlight patients who would benefit from earlier mechanical circulatory support escalation or neurologic assessment to inform withdrawal decisions.
Language	English
Publishing date	2021-03-16
Publishing country	United States
Document type	Journal Article
ISSN	2589-790X
ISSN (online)	2589-790X
DOI	10.1016/j.cjco.2021.03.008
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Impella in Cardiogenic Shock: Who and When?

Monteagudo Vela, María / Panoulas, Vasileios

Cardiovascular revascularization medicine : including molecular interventions

2020 Volume 21, Issue 5, Page(s) 697

MeSH term(s)	Heart-Assist Devices ; Humans ; Retrospective Studies ; Shock, Cardiogenic
Language	English
Publishing date	2020-02-12
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2212113-4
ISSN	1878-0938 ; 1553-8389
ISSN (online)	1878-0938
ISSN	1553-8389
DOI	10.1016/j.carrev.2020.02.008
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Zs.A 5562: Show issues

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Article: Right ventricular failure: Current strategies and future development.

Monteagudo-Vela, María / Tindale, Alexander / Monguió-Santín, Emilio / Reyes-Copa, Guillermo / Panoulas, Vasileios

Frontiers in cardiovascular medicine

2023 Volume 10, Page(s) 998382

Abstract: Right heart failure can be defined as a clinical syndrome consisting of signs and symptoms of heart failure resulting from right ventricular dysfunction. Function is normally altered due to three mechanisms: (1) pressure overload (2) volume overload, or ( ...

Abstract	Right heart failure can be defined as a clinical syndrome consisting of signs and symptoms of heart failure resulting from right ventricular dysfunction. Function is normally altered due to three mechanisms: (1) pressure overload (2) volume overload, or (3) a decrease in contractility due to ischaemia, cardiomyopathy or arrythmias. Diagnosis is based upon a combination of clinical assessment plus echocardiographic, laboratory and haemodynamic parameters, and clinical risk assessment. Treatment includes medical management, mechanical assist devices and transplantation if recovery is not observed. Distinct attention to special circumstances such as left ventricular assist device implantation should be sought. The future is moving towards new therapies, both pharmacological and device centered. Immediate diagnosis and management of RV failure, including mechanical circulatory support where needed, alongside a protocolized approach to weaning is important in successfully managing right ventricular failure.
Language	English
Publishing date	2023-04-28
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2781496-8
ISSN	2297-055X
ISSN	2297-055X
DOI	10.3389/fcvm.2023.998382
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Article ; Online: Initial experience with Impella RP in a quaternary transplant center.

Monteagudo-Vela, María / Simon, Andre / Panoulas, Vasileios

Artificial organs

2020 Volume 44, Issue 5, Page(s) 473–477

Abstract: Right ventricular failure is one of the most common complications encountered after left ventricular assist device implantation and heart transplantation. It has been reported to have an incidence up to 30%. It increases morbidity and short-term ... ...

Abstract	Right ventricular failure is one of the most common complications encountered after left ventricular assist device implantation and heart transplantation. It has been reported to have an incidence up to 30%. It increases morbidity and short-term mortality. Impella RP is a small pump that can provide up to 4L/min of flow. We analyzed all the patients with right ventricular failure that were treated with Impella RP in our institution. The Impella RP was implanted percutaneously in the catheterization laboratory guided by fluoroscopy. Overall, 7 patients required the implantation of an Impella RP due to right ventricular failure: 2 after long-term LVAD, 3 presented with acute right ventricular failure immediately after LVAD implantation, and 2 needed it after heart transplantation. Regarding complications, we report 2 patients with hemolysis. Hemodynamic parameters as well as end-organ perfusion and inotropic requirements improved after the insertion of the Impella. Overall, 30-day survival is 58%. Median time of support was 9 (5-19) days. RV failure is one of the most challenging complications after LVAD implantation and heart transplantation. The major challenge is the timing of implantation. The minimally invasive nature of the Impella RP facilitates de-escalation of treatment and paves the road to recovery. Impella RP proved useful in facilitating ECMO wean. Used in a prompt manner alongside the ease of implantation and the minimal rate of complications, Impella RP seems to be an appropriate device to tackle RV failure providing enough flow to allow for recovery or escalation decision-making.
MeSH term(s)	Female ; Heart Transplantation ; Heart-Assist Devices ; Humans ; Male ; Middle Aged ; Postoperative Complications/therapy ; Retrospective Studies ; Ventricular Dysfunction, Right/therapy
Language	English
Publishing date	2020-01-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	441812-8
ISSN	1525-1594 ; 0160-564X
ISSN (online)	1525-1594
ISSN	0160-564X
DOI	10.1111/aor.13610
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Article ; Online: Is the quality-of-life improvement after transcatheter aortic valve implantation equivalent to that achieved by surgical aortic valve replacement?

Monteagudo-Vela, Maria / Panoulas, Vasileios / Kourliouros, Antonios / Krasopoulos, George

Interactive cardiovascular and thoracic surgery

2021 Volume 33, Issue 6, Page(s) 866–870

Abstract: A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'is the quality-of-life (QoL) improvement after transcatheter aortic valve implantation (TAVI) equivalent to that achieved by surgical ... ...

Abstract	A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'is the quality-of-life (QoL) improvement after transcatheter aortic valve implantation (TAVI) equivalent to that achieved by surgical aortic valve replacement (sAVR)?' Literature search revealed 189 papers with reference to QoL after TAVI, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. QoL plays a crucial role in the decision-making process for procedures such as TAVI and sAVR. Current evidence included and analysed in this review have shown a clear improvement in QoL after both TAVI and sAVR. TAVI offers a rapid improvement of QoL, evident within the first 30 days. There is no difference in QoL at 2- and 5-year follow-up between TAVI and sAVR. There are currently paucity of data on long-term QoL and the potential impact of structural valve degeneration following TAVI.
MeSH term(s)	Aortic Valve/surgery ; Aortic Valve Stenosis/diagnostic imaging ; Aortic Valve Stenosis/surgery ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation/adverse effects ; Heart Valve Prosthesis Implantation/methods ; Humans ; Quality of Life ; Risk Factors ; Transcatheter Aortic Valve Replacement/adverse effects ; Transcatheter Aortic Valve Replacement/methods ; Treatment Outcome
Language	English
Publishing date	2021-07-01
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivab186
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Zs.A 5730: Show issues

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ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Use of Impella RP for Acute Right Ventricular Failure Post-Pericardiectomy.

Monteagudo-Vela, María / Farmidi, Abu / Panoulas, Vasileios / Bhudia, Sunil K

Cardiovascular revascularization medicine : including molecular interventions

2021 Volume 28S, Page(s) 176–179

Abstract: Surgical pericardiectomy is the accepted treatment for patients with constrictive pericarditis. Right ventricular failure in patients that undergo pericardiectomy is a frequent complication due to sudden volume overload. Impella RP is used to bypass the ... ...

Abstract	Surgical pericardiectomy is the accepted treatment for patients with constrictive pericarditis. Right ventricular failure in patients that undergo pericardiectomy is a frequent complication due to sudden volume overload. Impella RP is used to bypass the right ventricle and tackle the transient right ventricular failure. It is implanted percutaneously and provides enough support to achieve haemodynamical stability and recover end-organ function. We report the case of a patient that developed acute right ventricular failure in the early postoperative period of a pericardiectomy. He underwent the implantation of an Impella RP in the setting of acute right ventricular failure and was successfully explanted after 6 days of support.
MeSH term(s)	Heart Failure/diagnosis ; Heart Failure/etiology ; Heart Failure/surgery ; Humans ; Male ; Pericardiectomy ; Pericarditis, Constrictive/diagnostic imaging ; Pericarditis, Constrictive/etiology
Language	English
Publishing date	2021-02-15
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2212113-4
ISSN	1878-0938 ; 1553-8389
ISSN (online)	1878-0938
ISSN	1553-8389
DOI	10.1016/j.carrev.2021.02.016
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Article ; Online: Impact of third-generation left ventricular assist devices on quality of life: Scoping review and meta-analysis.

Monteagudo-Vela, María / Krasopoulos, George / Athanasiou, Thanos / Tsui, Steven / Kourliouros, Antonios

Artificial organs

2022 Volume 46, Issue 6, Page(s) 1012–1018

Abstract: Objectives: Development in device technology and the scarcity of donor's hearts have increased the number of patients with advanced heart failure receiving durable left ventricular assist devices (LVADs) as a bridge to transplantation and destination ... ...

Abstract	Objectives: Development in device technology and the scarcity of donor's hearts have increased the number of patients with advanced heart failure receiving durable left ventricular assist devices (LVADs) as a bridge to transplantation and destination therapy, with improved prognosis compared with guideline-directed medical therapy. We sought to examine the impact of modern durable LVADs on the quality of life (QoL) of the recipients. Methods: We carried out a systematic review of articles on QoL following the implantation of third-generation LVADs published between January 2010 and February 2021. Included studies were critically analyzed and evidence synthesis was carried out into a meta-analysis. Results: The systematic search yielded 269 articles, 11 of which met the search predefined criteria. Three of them reported results of randomized trials and eight were retrospective and registry studies. Statistically significant QoL improvement from baseline was observed in all published reports. When using the EuroQol 5L questionnaire (scale 0-100) as a QoL tool 6 months post-LVAD implantation, a meta-analysis of four included studies demonstrated a mean difference increase of 28.9 points (95% confidence interval: 26.71-31.14). Conclusions: Third-generation LVADs confer a significant improvement in QoL and their use can be supported not only for prognosis but also for symptom control. Although methodological limitations should be considered, the available QoL outcomes can be a useful tool in patient selection and the decision-making process.
MeSH term(s)	Heart Failure/surgery ; Heart-Assist Devices ; Humans ; Quality of Life ; Registries ; Retrospective Studies
Language	English
Publishing date	2022-02-07
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	441812-8
ISSN	1525-1594 ; 0160-564X
ISSN (online)	1525-1594
ISSN	0160-564X
DOI	10.1111/aor.14186
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Zs.A 1463: Show issues

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Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Pulmonary artery sarcoma with extensive leiomyosarcoma differentiation and heterologous osteosarcomatous elements.

Monteagudo-Vela, María / Rosell Alayza, Alejandra / Monguió Santín, Emilio / Cecconi, Alberto / Reyes Copa, Guillermo

Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology

2022 Volume 60, Page(s) 107436

Abstract: Pulmonary artery sarcomas are exceptionally unusual. Their clinic, diagnosis and treatment play a very important role in the ultimate outcome and long-term survival. We present the case of a 70-year-old gentleman diagnosed with a leiomyosarcoma of the ... ...

Abstract	Pulmonary artery sarcomas are exceptionally unusual. Their clinic, diagnosis and treatment play a very important role in the ultimate outcome and long-term survival. We present the case of a 70-year-old gentleman diagnosed with a leiomyosarcoma of the pulmonary artery with osteosarcoma differentiation that underwent surgical resection and subsequent chemotherapy, with good recovery at 9 months follow-up. Late diagnosis and incomplete surgical resection will worsen the short- and long-term prognosis of these patients.
MeSH term(s)	Aged ; Bone Neoplasms/diagnostic imaging ; Bone Neoplasms/pathology ; Bone Neoplasms/surgery ; Humans ; Leiomyosarcoma/diagnostic imaging ; Leiomyosarcoma/pathology ; Leiomyosarcoma/surgery ; Lung Neoplasms/pathology ; Male ; Osteosarcoma/pathology ; Osteosarcoma/surgery ; Pulmonary Artery/diagnostic imaging ; Pulmonary Artery/pathology ; Pulmonary Artery/surgery ; Sarcoma/pathology ; Sarcoma/surgery
Language	English
Publishing date	2022-05-18
Publishing country	United States
Document type	Case Reports
ZDB-ID	1134600-0
ISSN	1879-1336 ; 1054-8807
ISSN (online)	1879-1336
ISSN	1054-8807
DOI	10.1016/j.carpath.2022.107436
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Zs.A 3572: Show issues

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Article ; Online: Coronary-subclavian steal syndrome: a case report of a rare entity that can become a deadly threat.

Monteagudo-Vela, María / Bastante, Teresa / Monguió-Santín, Emilio / Del Val, David / Panoulas, Vasileios / Reyes-Copa, Guillermo

European heart journal. Case reports

2023 Volume 7, Issue 1, Page(s) ytac490

Abstract: Background: In patients who underwent coronary artery bypass graft (CABG), the coronary-subclavian steal syndrome (CSSS) is characterized by a subclavian artery stenosis proximal to the origin of the internal mammary artery resulting in functional graft ...

Abstract	Background: In patients who underwent coronary artery bypass graft (CABG), the coronary-subclavian steal syndrome (CSSS) is characterized by a subclavian artery stenosis proximal to the origin of the internal mammary artery resulting in functional graft failure. Case summary: A 62-year-old gentleman underwent CABG following a non-ST elevation myocardial infarction and an angiogram showing left main stem and three-vessel disease. Forty-eight hours later he developed cardiogenic shock that improved with inotropic support and intra-aortic balloon pump insertion. However, 7 days later, he deteriorated again and even though the myocardial injury markers and echocardiogram were normal, an angiography was performed showing significant CSSS. Due to the chronic nature of his subclavian stenosis and the severity of the cardiogenic shock, the heart team decided to treated his epicardial disease percutaneously and occlude the left internal mammary artery in its mid-segment with coils. The patient was discharged home 28 days after CABG and has remained since asymptomatic with improvement in his functional class. Discussion: Coronary-subclavian steal syndrome is a rare but fatal complication with increased morbidity and mortality due to reduced awareness amongst medical professionals. Subclavian artery stenosis stenting is the gold standard treatment; herein we present a new approach for complex and very sick patients in whom it is not possible to open the subclavian artery percutaneously. Increased awareness and prompt diagnosis of this pathology in CABG patients are essential for successful outcomes.
Language	English
Publishing date	2023-01-10
Publishing country	England
Document type	Case Reports
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/ytac490
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Article ; Online: Anticoagulation in syncardia total artificial heart recipients: anti-factor Xa or activated partial thromboplastin time?

Monteagudo-Vela, María / Bowles, Christopher / Raj, Binu / Robinson, Derek / Simon, Andre

Interactive cardiovascular and thoracic surgery

2021 Volume 34, Issue 2, Page(s) 322–325

Abstract: Although the activated partial thromboplastin time (aPTT) has historically been the method of choice for anticoagulation monitoring in patients undergoing mechanical circulatory support with intravenous unfractionated heparin, it is being progressively ... ...

Abstract	Although the activated partial thromboplastin time (aPTT) has historically been the method of choice for anticoagulation monitoring in patients undergoing mechanical circulatory support with intravenous unfractionated heparin, it is being progressively superseded by the anti-factor Xa (anti-Xa) method. A retrospective single-arm, single-centre analysis of 20 patients who underwent total artificial heart implantation entailed simultaneous determinations of aPTT and anti-Xa. Agreement between these parameters was assessed using the Bland-Altman method. Despite a positive correlation between aPTT and anti-Xa, normal target ranges were poorly aligned: from 5th to 30th postoperative day, for anti-Xa values of 0.2 and 0.4 U/ml corresponding aPTT values were 52.1 and 65.2 s, 7.9 and 14.8 lower than predicted values, respectively. This was not associated with thromboembolic sequalae. It was not possible to demonstrate a significant relationship between the predictor variables (postoperative day; white blood cell count; C-reactive protein concentration; alanine transaminase and alkaline phosphatase level; bilirubin; haemoglobin; albumin and total protein concentration) and the agreement between aPTT and anti-Xa levels. In summary, when anti-Xa levels were used to guide anticoagulation therapy, corresponding aPTT levels were low with respect to target range. Methodology applied in this study is generalizable to other forms of mechanical circulatory support.
MeSH term(s)	Anticoagulants/adverse effects ; Drug Monitoring/methods ; Factor Xa Inhibitors/adverse effects ; Heart, Artificial ; Heparin/adverse effects ; Humans ; Partial Thromboplastin Time ; Retrospective Studies
Chemical Substances	Anticoagulants ; Factor Xa Inhibitors ; Heparin (9005-49-6)
Language	English
Publishing date	2021-11-19
Publishing country	England
Document type	Journal Article
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivab251
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