1. Preoperative screening for LVAD an TAH implantation
P. Leprince
Institut de cardiologie
Chirurgie Cardiovasculaire
Groupe Hospitalier Pitié-Salpétrière
Paris, France

2. Disclosure St Jude (Abott): Heartmate II Medtronic: HVAD, ECMO
Jarvik 2000
Syncardia

3. Pre operative assessment
Assess Illness severity
Patient selection
Optimize the sickest patients
Define risk factor for surgery
Right ventricle assessment
Other organic and functional considerations
Select appropriate device

4. Illness assessment for operative risk

5. Low: < 1.58
Mid: ,58
High: > 1.58

8. 3 centers 101 patients Intermacs 1 (28) Intermacs 2-3 (49)
AJ Boyle et al. JHLT 2011, 30: 402

9. Intermacs 2016 report

10. BTB: HVAD 2012-2014 La Pitié 38 patients, 33 males 51± 12.5 y
12(31%) bridge to LVAD with peripheral ECMO
29 (76%) implanted on ECMO (vs CPB +valvular surgery)
7 (18%) peripheral ECMO + HVAD
17 (45%) percutaneous ECMO RVAD + HVAD
 63 % RVAD support
71% hospital discharge

11. No ECMO ECMO pre N=26 N=12 No support ECMO Pc RVAD No support ECMO
31%
N=5
19%
N=13
50%
N=6
50%
N=2
16%
N=4
33%
87%
60%
54%
83%
100%
75%

15. Infection screening and control

16. Right ventricular function
Echocardiography
TAPSE
S wave
Strain
Septal function
LV/RV ratio

17. In case of RV dysfunction
Patient optimisation: inotropes, diuresis, CVVHD
Biventricular or TAH support
LVAD with temporary RVAD

18. Percutaneous temporary RVAD

19. Temporary percutaneous ECMO RVAD

20. Percutaneous temporary ECMO RVAD
N = 27
RVAD
Timing (j)
2,1 ± 5,4
Duration (j)
12,9 ± 7,6
Devenir
Death under RVAD
10 (37,0%)
Weaning from RVAD
17 (63,0%)
Transplantation
3 (11,1%)
6 months death
14 (51,8%)
50%
67%
John
n=12
14 d
21%
53%
Bad-O
n=45
21 j
64%
Dang
n=14
13 d

21. Other considerations Pulmonary function
Neurologic function +++Carotide art. assessment
Valvular disease +++ aortic valve
Arrhytmias
Psychologic and psychiatric conditions
Social conditions

22. Which device for which patient?
Center experience with multiple devices
RV Function?
Heart transplant candidate or DT patient?
Body size: output vs space
Surgical technic:
sternotomy vs thoracotomy
redo patient
CPB vs ECMO vs off pump?
Hemorrhagic risk

23. Requirement for biventricular support
Syncardia Carmat Double LVAD LVAD + temporary RVAD
TAH with BiHVAD La Pitié

24. Which device for which patient?
Center experience with multiple devices
RV Function?
Heart transplant candidate or DT patient?
Body size: output vs space
Surgical technic:
sternotomy vs thoracotomy
redo patient
CPB vs ECMO vs off pump?
Hemorrhagic risk

27. Which device for which patient?
Center experience with multiple devices
RV Function?
Heart transplant candidate or DT patient?
Body size: output vs space
Surgical technic:
sternotomy vs thoracotomy
redo patient
CPB vs ECMO vs off pump?
Hemorrhagic risk

29. Biventricular
Destination
BTT
HMIII
LVAD

30. Спасибо Большое