{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:08:37Z","timestamp":1789013317566,"version":"build-2803163510"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Optimal unloading strategies for patients with cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation remain uncertain, particularly when comparing Impella and intra\u2010aortic balloon pump (IABP). We aimed to compare outcomes of patients receiving Impella or IABP during venoarterial extracorporeal membrane oxygenation and evaluate cause\u2010specific differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">In this retrospective cohort study using the nationwide JROAD\u2010DPC (Japanese Registry of All Cardiac and Vascular Diseases\u2013Diagnosis Procedure Combination) database from 2012 to 2023, patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation and either Impella or IABP were analyzed. Propensity score\u2013based inverse probability of treatment weighting was applied to adjust baseline differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among 18\u2009906 patients (Impella, n=1688; IABP, n=17\u2009218), overall in\u2010hospital mortality was 57.3% with Impella and 67.2% with IABP. Impella use was associated with lower in\u2010hospital mortality compared with IABP (odds ratio [OR], 0.86 [95% CI, 0.75\u20130.99]). Cause\u2010specific analyses showed significantly lower mortality with Impella in heart failure (OR, 0.66 [95% CI, 0.47\u20130.91]) and arrhythmia (OR, 0.62 [95% CI, 0.42\u20130.91]). Impella use was also associated with longer hospital stay (median, 22 versus 12\u2009days), longer support duration (7 versus 4\u2009days), and higher total costs (56.1 versus 27.3 thousand USD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">In this nationwide cohort, Impella unloading during venoarterial extracorporeal membrane oxygenation was associated with lower in\u2010hospital mortality than IABP in the overall cohort, particularly in selected causes, at the expense of prolonged hospitalization and higher costs. Further studies are needed to define optimal cause\u2010specific unloading strategies in cardiogenic shock.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.047993","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T11:16:55Z","timestamp":1785496615000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Left Ventricular Unloading With Impella Versus Intra\u2010Aortic Balloon Pump in Cardiogenic Shock Requiring Venoarterial Extracorporeal Membrane Oxygenation"],"prefix":"10.1161","volume":"15","author":[{"given":"Ryota","family":"Ito","sequence":"first","affiliation":[{"name":"Nagoya University Graduate School of Medicine","place":["Nagoya, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6853-7574","authenticated-orcid":false,"given":"Toru","family":"Kondo","sequence":"additional","affiliation":[{"name":"Nagoya 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