Overview
Imported Impella The price is relatively expensive and difficult for ordinary patients to afford. In order to better meet the growing clinical needs in China, Anhui Tongling Bionic Technology Co., Ltd. has developed an interventional left ventricular assist system. The test device was tested in preclinical animals It has shown good effectiveness and safety. Through the implementation of this clinical trial, the interventional left ventricular assist system The safety and effectiveness of the system for hemodynamic support in patients with cardiogenic shock have led to further development of this product in the country.
Description
In recent years, patients with severe heart disease, with coronary heart disease as the main disease spectrum, have been on the rise, and the mortality rate remains high. In routine clinical diagnosis and treatment, inotropic drugs and vasoactive drugs are used to correct shock and maintain blood flow. The cornerstone of mechanical stability, however, there is insufficient evidence that these drugs benefit patients in the long term. Mechanical circulatory support (MCS) is a life support technology that was firstly used clinically in the 1950s. It can replace or partially replace the functions of the heart and/or lungs. And by increasing end-organ and coronary artery perfusion, reducing cardiac volume load, ventricular wall stress and myocardial oxygen consumption, etc. mechanism, quickly and accurately produce a stable hemodynamic effect, ultimately reducing the patient's pulmonary circulation congestion and myocardial ischemia. Reduce blood flow and infarction area and gain valuable time for follow-up treatment, so that patients with severe heart disease can be supported and transitioned to treatment great progress has been made in the treatment of heart diseases, and this technology has been widely used in the field of critical heart disease. 2017 American Heart Association The American Heart Association (AHA) recommends MCS for waiting for recovery of cardiac function or heart transplantation. Interimplantation and definitive treatment of advanced heart failure. Depending on location, MCS is divided into left ventricle Left ventricular assist device (LVAD), right ventricular assist device (Right ventricular assist device (RVAD), biventricular assist device (Biventricular assist device, BVAD) and total artificial heart (TAH). Currently, MCS commonly used in clinical practice mainly includes Intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (Extracorporeal membrane oxygenation (ECMO), Impella, TandemHeart and RVAD. The Impella system is an LVAD, it is divided into 3 models according to the diameter of the instrument: 12F (Impella 2.5), 14F (Impella CP) and 21F (Impella 5.0), the corresponding maximum output flows are 2.5L/min, 3.0~4.0L/min and 5.0L/min. The working principle of the device is to pump the left heart through the built-in micro axial flow pump at the front end of the catheter.
The oxygenated blood in the ventricle is pumped out through the catheter inlet, and then the axial flow pump is pumped directly into the ascending aorta to establish the left ventricular-ascending aorta. Aortic drainage pathway. Can help increase cardiac output (CO), increase aortic pressure and Coronary perfusion pressure, improve mean arterial pressure, coronary blood flow; while reducing left ventricular preload and pulmonary Pulse wedge pressure reduces ventricular wall tension and myocardial oxygen consumption. Acts as an active mechanical pump and partially replaces left ventricular function able. Impella is commonly used in the clinical treatment of cardiogenic shock. The ISAR-SHOCK study enrolled 26 patients with acute cardiac arrest. Comparing the efficacy of IABP and Impella 2.5 in patients with cardiogenic shock after myocardial infarction, the primary endpoint of the study Changes in cardiac index (CI) 30 minutes after MCS insertion. It was found that Impella A more significant increase in CI than after IABP, with 30-day mortality of 46% in both groups, confirms that Impella 2.5 Safety and feasibility in the treatment of cardiogenic shock after acute myocardial infarction. Two other studies also found that Similar conclusion RECOVER I study is a study that included 16 cases of cardiogenic shock or hypocardia after cardiotomy. A prospective, single-arm study of patients with displacement syndrome, the results of which indicate immediate blood loss after implantation of Impella 5.0 Fluid dynamics indicators improved significantly, and 93% of patients had improved cardiac function at discharge, with all patients at 30 days, 3 months, and 1 year. The survival rates were 94%, 81% and 75% respectively, proving the safety of Impella 5.0 for bridging treatment after cardiac surgery and feasibility. Currently, only Impella produced by the American company Abiomed has been approved by the FDA. However, imported Impella The price is relatively expensive and difficult for ordinary patients to afford. In order to better meet the growing clinical needs in China, Anhui Tongling Bionic Technology Co., Ltd. has developed an interventional left ventricular assist system. The test device was tested in preclinical animals It has shown good effectiveness and safety. Through the implementation of this clinical trial, the interventional left ventricular assist system The safety and effectiveness of the system for hemodynamic support in patients with cardiogenic shock have led to further development of this product in the country.
Eligibility
Inclusion Criteria:
- 1) Age 18-75 years old; 2) By Cardiac MDT Expert
Group was judged to have refractory cardiogenic shock;
The criteria for refractory cardiogenic shock are: despite adequate doses of two vasoactive
Sexual medications are used and the underlying cause is treated, but evidence of tissue
hypoperfusion persists;
3) The subjects can understand the purpose of the trial, voluntarily participate and sign
in writing, which will be reviewed and approved by the ethics committee.
Approved informed consent; subject agrees to complete follow-up visits in accordance with
protocol requirements.
Exclusion Criteria:
- 1) Right heart failure that meets any of the following conditions:
1. Central venous pressure-capillary wedge pressure ≥10mmHg;
2. Central venous pressure-pulmonary artery diastolic pressure ≥10mmHg;
3. Cardiac tamponade. 2) Any peripheral vascular disease that prevents placement of
the test device;
3) Thrombus in the left ventricle or right ventricle;
4) Aortic valve regurgitation, echocardiography grade ≥2+;
5) Aortic valve stenosis, valve orifice area ≤1.5cm
2;
6) Aortic valve calcification;
7) Presence of mechanical aortic valve;
8) Hypertrophic or obstructive cardiomyopathy;
9) Untreated ventricular septal or atrial septal defect;
10) Patent foramen ovale;
11) Mechanical complications of acute myocardial infarction;
12) Presence of hereditary spherocytosis, hereditary elliptocytosis, autoimmune
Sexual hemolytic anemia or other diseases causing hemolysis;
13) Intrapulmonary resuscitation lasts for more than 15 minutes 24 hours before
catheter pump implantation;
14) Ventricular tachycardia or ventricular fibrillation is unresponsive to drug
treatment;
15) Renal failure, serum creatinine ≥309.4umol/l or blood urea
nitrogen2≥35.7mmol/l);
16) Liver failure (total bilirubin ≥85.5umol/l);
17) Allergy or intolerance to heparin;
18) Presence of any cardiac assist device;
19) There is active systemic infection;
20) Refusing to sign the informed consent form, or unable to complete the
follow-up as required by the protocol;
21) Pregnant or lactating women with potential fertility but unable or unwilling
to use it during the study
Female subjects using effective contraceptive measures;
22) Subjects who have participated in other clinical trials or are currently
participating in other clinical trials within 3 months;
23) The researcher believes that there are other circumstances that make it
inappropriate to conduct clinical trials