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Cardiac assistance: role of haemodynamics January 14 th, 2016 8h30-10h.

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Presentation on theme: "Cardiac assistance: role of haemodynamics January 14 th, 2016 8h30-10h."— Presentation transcript:

1 Cardiac assistance: role of haemodynamics January 14 th, 2016 8h30-10h

2 What is (are) the correct proposition(s) about LVAD ? A) Long-term LVAD decreases cardiac myocytes hypertrophy B) Decreases SRAA activation at the cellular level C) Favors left ventricle inverse remodeling D) Inverse remodeling with continuous flow is > pulsatile flow E) Despite inverse remodeling at the cellular level, myocardial repair with LVEF normalization is scarce

3 What is (are) the correct proposition(s) about LVAD ? A) Long-term LVAD decreases cardiac myocytes hypertrophy B) Decreases SRAA activation at the cellular level C) Favors left ventricle inverse remodeling D) Inverse remodeling with continuous flow is > pulsatile flow E) Despite inverse remodeling at the cellular level, myocardial repair with LVEF normalization is scarce

4 Kato T et al. Circ Heart Fail 2011; 4: 546 Inverse LV remodeling : comparison between pulsatile (P) and continuous (C) flow LVAD Echocardiographic data evolution(n=61 patients):

5 What are the predictive factors of good prognosis after LVAD leading to withdrawal? A) A younger age B) Non ischemic aetiology (e.g idiopathic DCM) C) A shorter length of LVAD D) A continuous flow LVAD versus pulsatile flow E) Faith

6 What are the predictive factors of good prognosis after LVAD leading to withdrawal? A) A younger age B) Non ischemic aetiology (e.g idiopathic DCM) C) A shorter length of LVAD D) A continuous flow LVAD versus pulsatile flow E) Faith Of note: LVAD withdrawal= 25% after pulsatile flow versus 3.3% after continuous flow Krabatsch T et al. Ann Thor Surg 2011; 91: 1335)

7 Which anticoagulant and antiagregant treatment after HeartMate II or HeartWare? A) AVK (INR 2-3) B) AVK (INR 2,5 à 3,5) C) AVK (INR 2-3) + aspirin D) AVK (INR 2-3) + aspirin + clopidogrel E) Aspirin + clopidogrel

8 Which anticoagulant and antiagregant treatment after HeartMate II or HeartWare? A) AVK (INR 2-3) B) AVK (INR 2,5 à 3,5) C) AVK (INR 2-3) + aspirin D) AVK (INR 2-3) + aspirin + clopidogrel E) Aspirin + clopidogrel

9 INR range after HeartMate II or HeartWare DeviceINR range AbioCor TAH2.5-3.5 HeartMate II2.0-3.0 HeartWare HVAD2.0-3.0 MicroMed DeBakey2.5-3.5 Syncardia TAH2.5-3.5 Thoratec IVAD2.5-3.5 Thoratec PVAD2.5-3.5

10 a) Cournand b) Rickets et Abrams c) Gruentzig d) Campeau e) Igaki-Tamai Match the discovery and their discoverer(s) 1)development of the radial route 2)1 st bioabsorbable coronary stent implantation 3)conception of the 1 st intra-arterial probe 4)1 st coronary balloon angioplasty 5)1 st coronary angiography through percutaneous transfemoral approach C: a3; b5; c4; d1; e2 B: a1; b4; c5; d3; e2 A: a4; b5; c3; d1; e2 D: a5; b2; c4; d1; e3

11 a) Cournand b) Rickets et Abrams c) Gruentzig d) Campeau e) Igaki-Tamai Match the discovery and their discoverer(s) 1)development of the radial route 2)1 st bioabsorbable coronary stent implantation 3)conception of the 1 st intra-arterial probe 4)1 st coronary balloon angioplasty 5)1 st coronary angiography through percutaneous transfemoral approach C: a3; b5; c4; d1; e2 B: a1; b4; c5; d3; e2 A: a4; b5; c3; d1; e2 D: a5; b2; c4; d1; e3

12 1) Gruentzig : 1 st coronary balloon angioplasty 2) Igaki-Tamai : 1 st bioabsorbable coronary stent implantation 3) Cournand : conception of the 1 st intra-arterial probe 4) Campeau : development of the radial route 5) Rickets et Abrams : 1 st coronary angiography through percutaneous transfemoral approach And now classify them by chronologic order! Oldest Newest C: 3; 5; 4; 1; 2 D: 1; 4; 5; 3; 2 A: 1; 2; 3; 4; 5 B: 3; 5; 1; 4; 2

13 1) Gruentzig : 1 st coronary balloon angioplasty 2) Igaki-Tamai : 1 st bioabsorbable coronary stent implantation 3) Cournand : conception of the 1 st intra-arterial probe 4) Campeau : development of the radial route 5) Rickets et Abrams : 1 st coronary angiography through percutaneous transfemoral approach And now classify them by chronologic order! Oldest Newest C: 3; 5; 4; 1; 2 D: 1; 4; 5; 3; 2 A: 1; 2; 3; 4; 5 B: 3; 5; 1; 4; 2

14 Cournand : conception of the 1 st intra-arterial probe Rickets et Abrams : 1 st coronary angiography through percutaneous transfemoral approach Gruentzig : 1 st coronary balloon angioplasty Campeau : development of the radial route Igaki-Tamai : 1 st bioabsorbable coronary stent implantation And now classify them by chronologic order! 1941 1962 1977 1989 1999

15 What is (are) the contra-indication(s) to LVAD implantation? A) Aortic bioprosthesis B) Aortic mechanical prosthesis C) Mitral bioprosthesis D) Mitral mechanical prosthesis E) Patent foramen ovale (PFO)

16 What is (are) the contra-indication(s) to LVAD implantation? A) Aortic bioprosthesis B) Aortic mechanical prosthesis C) Mitral bioprosthesis D) Mitral mechanical prosthesis E) Patent foramen ovale (PFO)

17 Explanations Aortic mechanical prosthesis: risk of thrombosis due to decreased transprothetic flow Patent foramen ovale (PFO): refactory hypoxemia due to a right- left shunt induced by LV discharge

18 Patient with HFpEF Vs HFrEF are more frequently: A) Men B) Obese C) In atrial fibrillation D) With a coronary artery disease E) Anemic

19 Patient with HFpEF Vs HFrEF are more frequently: A) Men B) Obese C) In atrial fibrillation D) With a coronary artery disease E) Anemic

20 CharacteristicsReduced EF (n=2429) Preserved EF (n=2167) P Value Age (yr)71.7±12.174.4±14.4<0.001 Male sex (%)65.444.3<0.001 Obesity (%)35.541.40.007 Hemoglobin on admission (g/dl)12.5±2.011.8±2.1<0.001 Coronary artery disease (%)63.752.9<0.001 Atrial fibrillation (%)28.541.3<0.001 < < < < < Adapted from Owan TE, NEJM 2006;355:251-59 Patient with HFpEF Vs HFrEF are more frequently:

21 Which proposition(s) about fractional flow reserve (FFR) is/are correct? A) FFR= Aortic pressure/ distal coronary pressure B) FFR between 0.6 and 0.8= grey zone, no diagnosis C) FFR < 0.8 = ischemia D) FFR measurement must be done when the valves are closed E) FFR measurement must be done after Risordan injection

22 Which proposition(s) about fractional flow reserve (FFR) is/are correct? A) FFR= Aortic pressure/ distal coronary pressure B) FFR between 0.6 and 0.8= grey zone, no diagnosis C) FFR < 0.8 = ischemia D) FFR measurement must be done when the valves are closed E) FFR measurement must be done after Vasopressin injection

23 FFR in practice

24 Tonino et al JACC 2010 - De Bruyne FAME 2 Nejm 2014 FFR : major role for coronary lesion functional classification

25 In which situations should we decrease the speed of the LVAD pump? A) Digestive Haemorrhage B) Sepsis C) No aortic cusps opening D) Suction phenomenon E) Suspicion of pump thrombosis

26 In which situations should we decrease the speed of the LVAD pump? A) Digestive Haemorrhage B) Sepsis C) No aortic cusps opening D) Suction phenomenon E) Suspicion of pump thrombosis

27 Explanations Digestive Haemorrhage: decrease of shear stress may be responsible for acquired Willebrandt syndrom No aortic cusps opening : risk of cusps fusion with thrombosis Suction phenomenon: favoured by hypovolemia in case of too high speed of pump

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