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Onset to Unloading Time in Acute Cardiogenic Shock; Hype or Hope?

      Cardiogenic shock is well-recognized as one of the catastrophic acute heart failure syndromes especially in the setting of an acute myocardial infarction. Even in the era of early prompt coronary reperfusion with a conventional mechanical circulatory support, systemic and myocardial tissue-level mal-perfusion have a critical role in the fatal pathogenesis of a cardiogenic shock complicating acute myocardial infarction. In 2017, the Impella system has been launched in Japan for a variety of acute cardiogenic shocks. Using a miniaturized axial pump aspirating blood from the left ventricle (LV) into the ascending aorta, the Impella system may decrease LV oxygen consumption and synergistically preserve systemic perfusion. Here, I will address an overview of critical issues and then think of the best challenges to provide better clinical outcomes using this system in patients with a cardiogenic shock complicating acute myocardial infarction.
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