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

2. 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

3. 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

4. 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

5. 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

6. 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

7. Reitan Catheter pump
10 F -> opens to 14F

8. 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

9. 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

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

12. CentriMag® MagLev Ventricular Assist System:
Pump Motor Console

13. 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.

14. 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.

15. CentriMag® in action

16. 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

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