Mechanical Circulatory Support Cardiogenic Shock Post AMI For Cardiogenic Shock Post AMI Asghar Khaghani Royal Brompton and Harefield NHS Trust

Mechanical Circulatory Support Cardiogenic Shock Post AMI Difficulties: Delayed Referral Cardiac Arrest/ Unknown neurological state Ventilated Pyrexia of unknown origin Failed thrombolysis . Risk of bleeding Coming back to my talk MCs for bridging Short time bridge using temporary dvices .Moriband patients unknown neurological stae …infecton ….end organ failures funding issusses some say go direct vto expensive devices I think these are easy to insert without CPB

Mechanical Circulatory Support Cardiogenic Shock Post AMI Majority have had PCI and on Clopidogrel Not tolerant of Inotropes Have other co-morbidities Have had previous surgical re-vascularisation Multi organ dysfunction Coming back to my talk MCs for bridging Short time bridge using temporary dvices .Moriband patients unknown neurological stae …infecton ….end organ failures funding issusses some say go direct vto expensive devices I think these are easy to insert without CPB

Cardiogenic Shock Post AMI Options: MCS Cardiogenic Shock Post AMI Options: IABP Percutaneous ventricular assist devices ECMO Short term devices ? Upgrades to Long term devices Coming back to my talk MCs for bridging Short time bridge using temporary dvices .Moriband patients unknown neurological stae …infecton ….end organ failures funding issusses some say go direct vto expensive devices I think these are easy to insert without CPB

Cardiogenic Shock Post AMI IABP - can initially stabilise the patient - may not provide enough support - requires a certain level of LV function - may be limited by persistent tachycardia / tachyarrythmias

Impella 2.5 – 9F shaft diameter - 12F pump rotor - 2.5 Litres/min - 5 days 5 – 9F shaft diameter - 21F pump rotor - 5 Litres/min - 10 days

Reitan Catheter pump 10 F -> opens to 14F

TandemHeart pVAD Removes oxygenated blood from LA via transseptal cannula in the femoral vein Returns blood via femoral artery Reduces preload Increases MAP Continuous flow 21 F 14 days

ECMO for Cardiogenic Shock Post AMI Easy and fast to commence Less bleeding Less costly Easy to upgrade to a VAD Moblisation is difficult Pulmonary congestion Inadequat flow

Short term Devices for Cardiogenic Shock Post AMI Easy to insert CPB not required Less bleeding Less costly Gives time for further assessment

CentriMag® MagLev Ventricular Assist System: Pump Motor Console

Levitronix for End Stage Cardiac Failure Left Ventricular Support LVAD cannulation using a 32FR inflow placed at the junction of the right superior pulmonary vein and left atrium. The 22 FR return cannula is placed in a 8 mm graft sutured to the ascending aorta.

Levitronix for End Stage Cardiac Failure Biventricular Support LVAD cannulation using a 32FR inflow placed at the junction of the right superior pulmonary vein and left atrium. The 22 FR return cannula is placed in a 8 mm graft sutured to the ascending aorta.

CentriMag® in action

Short term Devices for Cardiogenic Shock Post AMI Bridge to recovery Bridge to surgery Bridge to a long term VAD Bridge to urgent heart transplantation

Areas of Concern Transfer of Patients to VAD units Ventilated patients Infection Bleeding Type of intervention Multi organ dysfunction Shortage of donor hearts!