Presentation is loading. Please wait.

Presentation is loading. Please wait.

Assist Devices for the Treatment of Cardiogenic Shock

Published byGeorge Russell Modified over 6 years ago

Similar presentations

Presentation on theme: "Assist Devices for the Treatment of Cardiogenic Shock"— Presentation transcript:

1 Assist Devices for the Treatment of Cardiogenic Shock
Ezequiel J Molina, MD Attending Cardiac Surgeon Advanced Heart Failure and Transplant Program MedStar Heart and Vascular Institute – Washington Hospital Center Washington, DC I have no relevant financial relationships

2 Background Mortality rate of refractory cardiogenic shock is high
Early initiation of MCS may improve outcomes Avoid progression of MSOF and optimize organ function Potential outcomes: Heart recovery Heart transplantation Temporary or durable LVAD Withdrawal of care and death

3 Ideal Support Device Easy and rapid implementation
Provide robust hemodynamic support Biventricular support when needed Allow pulmonary support Cost effective Multidisciplinary team approach

4 Device Selection Patient status and location
Etiology of cardiogenic shock Technology available at your institution Devices: VA ECMO CentriMag LVAD Durable LVAD

5 VA ECMO

6 VA ECMO Abrams et al, J Am Coll Cardiol, 2014

7 ELSO Survival Data

8 ECMO Outcomes AMI Negi et al, J Invasive Cardiol, 2016

9 ECMO Outcomes AMI Negi et al, J Invasive Cardiol, 2016

10 ECMO Advantages Allows for minimally invasive
Rapid bedside application Biventricular support Pulmonary support Low initial cost Transport capabilities

11 ECMO Advantages

12 ECMO Disadvantages Labor intensive High cost with prolonged support
Requires anticoagulation LV distension / thrombosis Historically high complication rates Limited duration of support

13 LV Distension Inotropes Minimize vasoconstriction Central cannulation
LV vent insertion LVAD conversion Impella / Tandem Heart

14 CentriMag LVAD

15 CentriMag LVAD Magnetically levitated centrifugal blood pump
Low shear stress of blood components LVAD, RVAD or BiVAD Allows ECMO (oxygenator) Flows up to 10 L/min Optimal LV decompression Bridge to recovery, transplant or long term device

16 Disadvantages of CentriMag LVAD
More expensive than ECMO Requires sternotomy Thromboembolic complications Anticoagulation / Bleeding May select patients with no exit strategy

17 CentriMag LVAD Takayama et al, J Heart Lung Transplant, 2013

18 Durable LVADs

19 INTERMACS Profiles

20 Durable LVADs Kirklin et al, J Heart Lung Transplant, 2015

21 LVAD Survival Kirklin et al, J Heart Lung Transplant, 2015

22 LVAD Survival Kirklin et al, J Heart Lung Transplant, 2015

23 Conclusions Early and rapid recognition of cardiogenic shock
Robust hemodynamic support may improve outcomes ECMO is our first line of therapy for cardiopulmonary support… before MSOF CentriMag LVADs as bridge to recovery, transplantation or durable LVADs Durable LVADs can be successful in selected INTERMACS 1 patients Teamwork and communication at each stage is critical Management guidelines are needed but difficult to develop

24 Q&A

25 Tandem Heart

26 Tandem Heart Cheng et al, European Heart Journal, 2009

Download ppt "Assist Devices for the Treatment of Cardiogenic Shock"

Similar presentations

Mechanical Support for Acute Cardiogenic Shock

Mechanical Support for Acute Cardiogenic Shock
Extracorporeal Membrane Oxygenation (ECMO): Indications and Management Strategy David Spielvogel, MD Surgical Director, Cardiac Transplant and Mechanical.

Extracorporeal Membrane Oxygenation (ECMO): Indications and Management Strategy David Spielvogel, MD Surgical Director, Cardiac Transplant and Mechanical.
A Randomized Trial of Protocol-Based Care for Early Septic Shock Andrea Caballero, MD January 15, 2015 LSU Journal Club The ProCESS Investigators. N Engl.

A Randomized Trial of Protocol-Based Care for Early Septic Shock Andrea Caballero, MD January 15, 2015 LSU Journal Club The ProCESS Investigators. N Engl.
LABORATORY OF BIOLOGICAL STRUCTURE MECHANICS www.labsmech.polimi.it Technical and biological advances in ECMO New Perspective in ECMO 2012 III International.

LABORATORY OF BIOLOGICAL STRUCTURE MECHANICS Technical and biological advances in ECMO New Perspective in ECMO 2012 III International.
ECMO application: ruled implementation or free diffusion? Milan 2012 Palle Palmér ECMO Centrum Karolinska Karolinska University Hospital, Stockholm Sweden.

ECMO application: ruled implementation or free diffusion? Milan 2012 Palle Palmér ECMO Centrum Karolinska Karolinska University Hospital, Stockholm Sweden.
Innovative Minimally Invasive Circulatory Assist Device.

Innovative Minimally Invasive Circulatory Assist Device.
Equipoise Does Not Exist for REVIVE IT Andrew Boyle, MD Heart and Vascular Center Director, Florida Chairman of Cardiology Medical Director of Heart Failure,

Equipoise Does Not Exist for REVIVE IT Andrew Boyle, MD Heart and Vascular Center Director, Florida Chairman of Cardiology Medical Director of Heart Failure,
Management of Acute Shock and Right Ventricular Failure Nader Moazami, MD Department of Thoracic and Cardiovascular Surgery and Biomedical Engineering,

Management of Acute Shock and Right Ventricular Failure Nader Moazami, MD Department of Thoracic and Cardiovascular Surgery and Biomedical Engineering,
Ventricular Assist Devices Brian Schwartz, CCP February 25, 2003.

Ventricular Assist Devices Brian Schwartz, CCP February 25, 2003.
Rejection Normal response Inflammation 25% of pt. will have acute rejection during the first year post transplant Causes: Previous Rejection Noncompliance.

Rejection Normal response Inflammation 25% of pt. will have acute rejection during the first year post transplant Causes: Previous Rejection Noncompliance.
Advances In LVAD Patient Management

Advances In LVAD Patient Management
A Validated Practical Risk Score to Predict the Need for RVAD after Continuous-flow LVAD SK Singh MD MSc, DK Pujara MBBS, J Anand MD, WE Cohn MD, OH.

A Validated Practical Risk Score to Predict the Need for RVAD after Continuous-flow LVAD SK Singh MD MSc, DK Pujara MBBS, J Anand MD, WE Cohn MD, OH.
Keith Aaronson, Mark Slaughter, Edwin McGee, William Cotts, Michael Acker, Mariell Jessup, Igor Gregoric, Pranav Loyalka, Valluvan Jeevanandam, Allen Anderson,

Keith Aaronson, Mark Slaughter, Edwin McGee, William Cotts, Michael Acker, Mariell Jessup, Igor Gregoric, Pranav Loyalka, Valluvan Jeevanandam, Allen Anderson,
Treatment of Heart Failure: Beyond Medical Therapy

Treatment of Heart Failure: Beyond Medical Therapy
Predicting Patients at Risk for Poor Global Outcomes after DT- MCS Therapy Suzanne V. Arnold, MD, MHA Saint Luke’s Mid America Heart Institute/UMKC May.

Predicting Patients at Risk for Poor Global Outcomes after DT- MCS Therapy Suzanne V. Arnold, MD, MHA Saint Luke’s Mid America Heart Institute/UMKC May.
Predicting Major Outcomes after MCSD Implant 1 Risk Factors for Death, Transplant, and Recovery James Kirklin, MD David Naftel, PhD.

Predicting Major Outcomes after MCSD Implant 1 Risk Factors for Death, Transplant, and Recovery James Kirklin, MD David Naftel, PhD.
MCS in Special Populations: The Use of Mechanical Support in Adults with Congenital Heart Disease 9 th Annual Meeting May 15, 2015 Christina VanderPluym,MD.

MCS in Special Populations: The Use of Mechanical Support in Adults with Congenital Heart Disease 9 th Annual Meeting May 15, 2015 Christina VanderPluym,MD.
Survival following VAD complications: implications for transplant priority. Todd Dardas, MD, MS May 16, 2015.

Survival following VAD complications: implications for transplant priority. Todd Dardas, MD, MS May 16, 2015.
Revascularizaton of Ischemic DCM Percutaneous Revascularization and Hemodynamic Support Matthew R. Wolff, M.D. University of Wisconsin Disclosures: Cordis.

Revascularizaton of Ischemic DCM Percutaneous Revascularization and Hemodynamic Support Matthew R. Wolff, M.D. University of Wisconsin Disclosures: Cordis.
Optimal Therapies for End-Stage Thoracic Organ Failure: The Critical Role of the Surgeon and the Use of ECMO, MCS and Transplantation Decision Making:

Optimal Therapies for End-Stage Thoracic Organ Failure: The Critical Role of the Surgeon and the Use of ECMO, MCS and Transplantation Decision Making:

Similar presentations

Ads by Google