Predicting Major Outcomes after MCSD Implant. Risk Factors for Death, Transplant, and Recovery. James Kirklin, MD David Naftel, PhD
|
|
|
- Lindsey Randall
- 6 years ago
- Views:
Transcription
1 Predicting Major Outcomes after MCSD Implant Risk Factors for Death, Transplant, and Recovery James Kirklin, MD David Naftel, PhD 1
2 I have no financial disclosures (I am the Principle Investigator for the NIH contract for INTERMACS) James K Kirklin
3 Predicting Major Outcomes after MCSD Implant Risk Factors for Death, Transplant, and Recovery What do we have so far? 3
4 Continuous Flow LVAD/BiVAD Implants: , n=9359 Event: Death (censored at transplantation or recovery) n=9359, Deaths=2280 % Survival Months % Survival 1 95% 12 80% 24 69% 36 59% 48 47% Hazard (early + late) Deaths/months n at risk: Months post implant 4
5 Continuous Flow LVAD/BiVAD Implants: , n=9359 Event: Death (censored at transplantation or recovery) n=9359, Deaths=2280 % Survival Months % Survival 1 95% 12 80% 24 69% 36 59% 48 47% Hazard (early + late) Deaths/months n at risk: Months post implant 5
6 Figure 10 Implants: June 2006 December 2013, n=10542 LVAD: Continuous n=9112, Deaths=2154 TAH: Pulsatile n=239, Deaths=59 % Survival at Pump 1 yr post implant CF LVAD 81% CF Bi-VAD 57% PF LVAD 65% PF Bi-VAD 45% TAH 59% % Survival BiVAD: Pulsatile n=319, Deaths=123 BiVAD: Continuous n=260, Deaths=118 LVAD: Pulsatile n=612, Deaths=230 overall p <.0001 Event: Death (censored at transplant and recovery) Months post implant 6
7 Implants: June 2006 December 2013, n=10542 LVAD: Continuous n=9112, Deaths=2154 TAH: Pulsatile n=239, Deaths=59 % Survival at Pump 1 yr post implant CF LVAD 81% CF Bi-VAD 57% PF LVAD 65% PF Bi-VAD 45% TAH 59% % Survival BiVAD: Pulsatile n=319, Deaths=123 BiVAD: Continuous n=260, Deaths=118 LVAD: Pulsatile n=612, Deaths=230 overall p <.0001 Event: Death (censored at transplant and recovery) Months post implant 7
8 Adult Primary Continuous Flow LVADs and BiVADs Implants: June 2006 December 2013, n=9372 Risk Factors for Death Demographics Early hazard Late hazard Hazard Ratio p-value Hazard Ratio p-value Age (older) 1.36 <.0001 Female BMI (higher) 1.13 <.0001 Clinical Status History of Stroke INTERMACS Level <.0001 INTERMACS Level <.0001 Destination Therapy Non-Cardiac Systems Albumin (lower) Creatinine (higher) Dialysis 2.37 <.0001 BUN (higher) 1.06 < Right Heart Dysfunction Right Atrial Pressure (higher) RVAD in same operation 2.45 <.0001 Bilirubin (higher) 1.21 <.0001 Ascites Surgical Complexities History of cardiac surgery 1.43 <.0001 Concommitant Cardiac Surgery
9 Adult Primary Continuous Flow LVADs and BiVADs Implants: June 2006 December 2013, n=9372 Early hazard Late hazard Risk Factors for Death Hazard Ratio p-value Hazard Ratio p-value Demographics Age (older) 1.36 <.0001 Female BMI (higher) 1.13 <.0001 Clinical Status History of Stroke INTERMACS Level <.0001 INTERMACS Level <.0001 Destination Therapy Non-Cardiac Systems Albumin (lower) Creatinine (higher) Dialysis 2.37 <.0001 BUN (higher) 1.06 < Right Heart Dysfunction Right Atrial Pressure (higher) RVAD in same operation 2.45 <.0001 Bilirubin (higher) 1.21 <.0001 Ascites Surgical Complexities History of cardiac surgery 1.43 <.0001 Concommitant Cardiac Surgery
10 Continuous Flow LVAD/BiVAD Implants: , n=9372 Age < 50 yrs n=2403, deaths=446 % Survival Age > 70 yrs, n=1301 deaths=451 Overall P <.0001 Age yrs n=4184 Deaths= 942 Age yrs n=1484, deaths=433 Event: Death (censored at transplant and recovery) Months post implant 10
11 June 2006 December 2012 AGE GROUP (yr) Unspecified TOTAL IMPLANT DATE PERIOD < n % n % n % % % % % % % % % % Age Category % % % % % % % % % 11
12 Adult Primary Continuous Flow LVADs and BiVADs Implants: June 2006 December 2013, n=9372 Early hazard Late hazard Risk Factors for Death Hazard Ratio p-value Hazard Ratio p-value Demographics Age (older) 1.36 <.0001 Female BMI (higher) 1.13 <.0001 Clinical Status History of Stroke INTERMACS Level <.0001 INTERMACS Level <.0001 Destination Therapy Non-Cardiac Systems Albumin (lower) Creatinine (higher) Dialysis 2.37 <.0001 BUN (higher) 1.06 < Right Heart Dysfunction Right Atrial Pressure (higher) RVAD in same operation 2.45 <.0001 Bilirubin (higher) 1.21 <.0001 Ascites Surgical Complexities History of cardiac surgery 1.43 <.0001 Concommitant Cardiac Surgery
13 Continuous Flow LVAD/BiVAD Implants: , n=9372 Levels 4-7, n=1789 Deaths=405 Level 1: n=1391 Deaths=381 % Survival Level 3: n=2591 Deaths=544 Level 2: n=3601 Deaths=942 P <.0001 Event: Death (censored at transplant and recovery) Months post implant 13
14 Patient Profile at time of implant Continuous Flow Devices CF-LVAD/BiVAD Implants: January 2008 December 2013, n=9372 Implant Date Era TOTAL N % N % N % 1 Critical Cardiogenic Shock % % % 2 Progressive Decline % % % 3 Stable but Inotrope Dependent % % % 4 Resting Symptoms % % % 5 Exertion Intolerant % % % 6 Exertion Limited % % % 7 Advanced NYHA Class % % % TOTAL % % % 14
15 Patient Profile at time of implant Continuous Flow Devices CF-LVAD/BiVAD Implants: January 2008 December 2013, n=9372 Implant Date Era TOTAL N % N % N % 1 Critical Cardiogenic Shock % % % 2 Progressive Decline % % % 3 Stable but Inotrope Dependent % % % 4 Resting Symptoms % % % 5 Exertion Intolerant % % % 6 Exertion Limited % % % 7 Advanced NYHA Class % % % TOTAL % % % 15
16 Table 6 Adult Primary Continuous Flow LVADs and BiVADs Implants: June 2006 December 2013, n=9372 Early hazard Late hazard Risk Factors for Death Hazard Ratio p-value Hazard Ratio p-value Demographics Age (older) 1.36 <.0001 Female BMI (higher) 1.13 <.0001 Clinical Status History of Stroke INTERMACS Level <.0001 INTERMACS Level <.0001 Destination Therapy Non-Cardiac Systems Albumin (lower) Creatinine (higher) Dialysis 2.37 <.0001 BUN (higher) 1.06 < Right Heart Dysfunction Right Atrial Pressure (higher) RVAD in same operation 2.45 <.0001 Bilirubin (higher) 1.21 <.0001 Ascites Surgical Complexities History of cardiac surgery 1.43 <.0001 Concommitant Cardiac Surgery LVAD, left ventricular assist device; BiVAD, biventricular assist device; DT, destination therapy; BTT, bridge to transplant; BMI, body mass index; BUN, blood urea nitrogen; RVAD, right ventricular assist device. 16
17 Continuous Flow LVAD/BiVAD Implants: , n=9372 BTR, n= 46 Deaths= 4 BTT (including BTC), n= 5886 Deaths= 1218 % Survival Rescue Therapy, n= 27 Deaths= 11 DT, n= 3373 Deaths= 1027 p <.0001 Other, n= 40 Deaths= 12 Event: Death (censored at transplant and recovery) Months post implant 17
18 Continuous Flow Devices CF-LVAD/BiVAD Implants: June 2006 December 2013, n=9372 Device Strategy at time of implant Implant Date Era TOTAL N % N % N % BTT Listed % % % BTT Likely % % % BTT Moderate % % % BTT Unlikely % 218 ¾% % Destination Therapy % % % BTR % % % Rescue Therapy % % % Other % % % TOTAL % % % 18
19 Table 6 Adult Primary Continuous Flow LVADs and BiVADs Implants: June 2006 December 2013, n=9372 Early hazard Late hazard Risk Factors for Death Hazard Ratio p-value Hazard Ratio p-value Demographics Age (older) 1.36 <.0001 Female BMI (higher) 1.13 <.0001 Clinical Status History of Stroke INTERMACS Level <.0001 INTERMACS Level <.0001 Destination Therapy Non-Cardiac Systems Albumin (lower) Creatinine (higher) Dialysis 2.37 <.0001 BUN (higher) 1.06 < Right Heart Dysfunction Right Atrial Pressure (higher) RVAD in same operation 2.45 <.0001 Bilirubin (higher) 1.21 <.0001 Ascites Surgical Complexities History of cardiac surgery 1.43 <.0001 Concommitant Cardiac Surgery LVAD, left ventricular assist device; BiVAD, biventricular assist device; DT, destination therapy; BTT, bridge to transplant; BMI, body 19 mass index; BUN, blood urea nitrogen; RVAD, right ventricular assist device.
20 Figure 14 Continuous Flow LVAD/BiVAD Implants: , n=9372 Survival by Renal Risk Factors Low n=8237, deaths=1862 % Survival Severe (dialysis) n=142, deaths=71 Moderate (creat > 2 or BUN > 60) n=993, deaths=339 Overall P <.0001 Event: Death (censored at transplant and recovery) Months post implant 20
21 Figure 14 Continuous Flow LVAD/BiVAD Implants: , n=9372 Survival by Renal Risk Factors Low n=8237, deaths=1862 % Survival Severe (dialysis) n=142, deaths=71 Moderate (creat > 2 or BUN > 60) n=993, deaths=339 Overall P <.0001 Event: Death (censored at transplant and recovery) Months post implant 21
22 Adult Primary Continuous Flow LVADs & BIVADs, DT and BTT, n=4917 Implants: June 2006 March 2012: Creatinine Time course of Creatinine according to pre-implant Renal Dysfunction Creatinine (mg/dl) Severe (n=282) Moderate (n=1475) Mild/None (n=3160) ** ** ** ** ** ** ** ** ** ** ** ** ** ** * ** ** ** ** * p <.05 ** p <.001 Paired comparisons to pre-implant Follow-up Time Period 22
23 Adult Primary Continuous Flow LVADs and BiVADs Implants: June 2006 December 2013, n=9372 Early hazard Late hazard Risk Factors for Death Hazard Ratio p-value Hazard Ratio p-value Demographics Age (older) 1.36 <.0001 Female BMI (higher) 1.13 <.0001 Clinical Status History of Stroke INTERMACS Level <.0001 INTERMACS Level <.0001 Destination Therapy Non-Cardiac Systems Albumin (lower) Creatinine (higher) Dialysis 2.37 <.0001 BUN (higher) 1.06 < Right Heart Dysfunction Right Atrial Pressure (higher) RVAD in same operation 2.45 <.0001 Bilirubin (higher) 1.21 <.0001 Ascites Surgical Complexities History of cardiac surgery 1.43 <.0001 Concommitant Cardiac Surgery
24 Continuous Flow LVAD/BiVAD Implants: , n=9372 Survival by Right Heart Failure Risk Factors Low n=6596, deaths=1481 % Survival Severe (BiVAD) n=260, deaths=120 Moderate (ascites or RAP >= 18 or Bilirubin >= 2) n=2516, deaths=690 Overall P <.0001 Event: Death (censored at transplant and recovery) Months post implant 24
25 Adult Primary Continuous Flow LVADs and BiVADs Implants: June 2006 December 2013, n=9372 Early hazard Late hazard Risk Factors for Death Hazard Ratio p-value Hazard Ratio p-value Demographics Age (older) 1.36 <.0001 Female BMI (higher) 1.13 <.0001 Clinical Status History of Stroke INTERMACS Level <.0001 INTERMACS Level <.0001 Destination Therapy Non-Cardiac Systems Albumin (lower) Creatinine (higher) Dialysis 2.37 <.0001 BUN (higher) 1.06 < Right Heart Dysfunction Right Atrial Pressure (higher) RVAD in same operation 2.45 <.0001 Bilirubin (higher) 1.21 <.0001 Ascites Surgical Complexities History of cardiac surgery 1.43 <.0001 Concommitant Cardiac Surgery
26 Tricuspid Repair Following VAD Implantation in INTERMACS 04/04/2014 Howard Song, MD, PhD Co-authors James Mudd, MD; Jill Gelow, MD, MPH; Christopher Chien, MD; Fred Tibayan, MD; Kathryn Hollifield, BSN, RN; David Naftel, PhD; and James Kirklin, MD "This project has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract No. HHSN C" 26
27 INTERMACS: June 2006 March 2013: TVR Adult Destination Therapy CF primary LVAD/BiVAD, n=2527 Phase of Hazard Early Constant Risk Factors for Death Hazard ratio p-value Hazard ratio p-value Age (years) 1.58 <.0001 BMI (higher) Not Married Hx of CABG BUN (higher) Total Bilirubin (higher) Creatinine (higher) Ventilator INTERMACS Level INTERMACS Level Bi-VAD 5.05 <.0001 Tricuspid Regurgitation 1.35*.009 * Represents the increased risk for 1 level increase in TV Regurgitation 27
28 So, is the real risk factor the procedure or the condition? 28
29 INTERMACS: June 2006 March 2013: TVR Adult Destination Therapy CF primary LVAD/BiVAD, n=2527 Tricuspid Regurg Echo at pre-implant: Moderate/Severe, n=989 Concomitant Tricuspid Surgery n deaths None Repair % Survival Overall p =.83 Event: Death with a device in place (censored at transplant and recovery Months post implant 29
30 % Moderate/Severe Tricuspid Regurgitation 100% INTERMACS: June 2006 March 2013: TVR Moderate/Severe Tricuspid Regurgitation over time by TV Repair vs. No TVR Procedure, n=989 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 100% 100% n=215 n=757 42% n=136 21% n=21 30% n=50 25% 26% n=8 39% 39% n=88 n=17 Pre-implant 1 week 1 month 3 month 6 month 12 month 18 month 24 month TV Repair No TV Procedure Note: N s represent the number of Moderate/Severe Tricuspid Regurg n=75 29% n=17 No TV Procedure, n=757 TV Repair, n= % n=46 23% n=9 40% n=31 19% n=3 n=12 33% 30% n=3
31 Continuous Flow LVAD Implants: , n=9111 Era 1: n=2800, Events=273 Pump Thrombosis % Freedom from Exchange Era 2: N=6311, events=522 p <.0001 Event: Time to 1 st Exchange Months post implant 31
32 Figure 20 Continuous Flow LVAD/BiVAD Implants: , n=9372 Operation 1: N=8565, deaths=2039 p <.0001 % Survival Operation 2: n=734, Deaths=242 Operation 3: n=73, Deaths=29 Event: Death (censored at transplant and recovery) Months post implant 32
33 Education War Era Cardiac Surgery These stratified actuarial depictions are very useful, but They have limited value for predicting outcomes for an individual patient. The stratified actuarial method forces conditions like.. assuming he/she does not receive a heart transplant, or.. assuming there is not explant for recovery Ideally, INTERMACS could provide software or website applications that allow the physician to provide the patient with the most useful predictions of the chances of various outcomes occurring to him/her. 33
34 Education War Era Cardiac Surgery Predictive modeling for outcome events based on initial implant strategy The goal is useful predictions of the likelihood (probability) of a specific patient (with his/her individual risk profile) experiencing a given outcome depending on the initial implant strategy. The basic methodology utilizes multivariable hazard function analyses on the competing outcomes platform. The basic strategies are BTT, BTC, DT, and BTR. The outcome event of interest are Transplant, Alive on device, Explant for recovery, and death. David Naftel will review our initial steps in this process. 34
35 Continuous Flow LVAD/BiVAD Implants: , n=9372 BTT: Listed CFLVAD implants , n=1309 Proportion of Patients Outcome % at 1 year Alive (device in place) 50% Transplanted 37% Dead 12% Recovery 1% Figure 6 Months after Implant 35
36 Continuous Flow LVAD/BiVAD Implants: , n=9372 BTC CFLVAD implants , n=2205 Proportion of Patients Outcome % at 1 year Alive (device in place) 64% Transplanted 20% Dead 15% Recovery 1% Figure 7 Months after Implant 36
Fifth INTERMACS annual report: Risk factor analysis from more than 6,000 mechanical circulatory support patients
http://www.jhltonline.org SPECIAL FEATURE Fifth INTERMACS annual report: Risk factor analysis from more than 6, mechanical circulatory support patients James K. Kirklin, MD, a David C. Naftel, PhD, a Robert
What has INTERMACS Taught Us about Patient Outcomes with Durable MCS? James K. Kirklin, MD
What has INTERMACS Taught Us about Patient Outcomes with Durable MCS? James K. Kirklin, MD Disclosure: I am Director of the Data Coordinating Center for the INTERMACS project and receive support through
Concomitant Aortic Valve Procedures in Patients Undergoing Implantation of Continuous-Flow LVADs: An INTERMACS Database Analysis
Concomitant Aortic Valve Procedures in Patients Undergoing Implantation of Continuous-Flow LVADs: An INTERMACS Database Analysis April 11, 2014 Jason O. Robertson, M.D., M.S.; David C. Naftel, Ph.D., Sunil
Seventh INTERMACS annual report: 15,000 patients and counting
http://www.jhltonline.org INTERMACS ANNUAL REPORT Seventh INTERMACS annual report: 15,000 patients and counting James K. Kirklin, MD, a David C. Naftel, PhD, a Francis D. Pagani, MD, PhD, b Robert L. Kormos,
Sixth INTERMACS annual report: A 10,000-patient database
http://www.jhltonline.org INTERMACS ANNUAL FEATURE Sixth INTERMACS annu report: A 10,000-patient database James K. Kirklin, MD, a David C. Naftel, PhD, a Francis D. Pagani, MD, PhD, b Robert L. Kormos,
Moderate TR Should be Repaired at the Time of LVAD Con. James Kirklin MD
Moderate TR Should be Repaired at the Time of LVAD Con James Kirklin MD Disclosure: I am Director of the Data Coordinating Center for the INTERMACS project and receive support through an Institutional
Regional Differences in Utilization and Outcomes of Left Ventricular Assist Devices: Insights from the INTERMACS Registry
Regional Differences in Utilization and Outcomes of Left Ventricular Assist Devices: Insights from the INTERMACS Registry Selim Krim, MD 1 ; Rey Vivo, MD 2 ; Patrick Campbell, MD 1 ; Jerry Estep, MD 3
How do Readmissions Impact Survival among Patients with Continuous-Flow Left Ventricular Assist Devices? Findings from INTERMACS
How do Readmissions Impact Survival among Patients with Continuous-Flow Left Ventricular Assist Devices? Findings from INTERMACS Rey P. Vivo, MD 1 ; Selim R. Krim, MD 2 ; Jerry D. Estep, MD 3 ; Wissam
Bridge to Heart Transplantation
Bridge to Heart Transplantation Ulf Kjellman MD, PhD Senior Consultant Surgeon Heart Centre KFSH&RC 1 Disclosure Appointed for Proctorship by Thoratec/St.Jude/Abbott 2 To run a full overall covering transplant
Update on Mechanical Circulatory Support. AATS May 5, 2010 Toronto, ON Canada
Update on Mechanical Circulatory Support AATS May 5, 2010 Toronto, ON Canada Disclosures NONE Emergency Circulatory Support ECMO Tandem Heart Impella Assessment Cardiac Function Pulmonary function Valvular
How to mend a broken heart: transplantation or LVAD?
SCDU DI CARDIOCHIRURGIA Università degli Studi di Torino Ospedale S. Giovanni Battista Direttore: Prof. Mauro Rinaldi How to mend a broken heart: transplantation or LVAD? Massimo Boffini Mauro Rinaldi
Ventricular Assist Devices for Permanent Therapy: Current Status and Future
Ventricular Assist Devices for Permanent Therapy: Current Status and Future Prospects Francis D. Pagani MD PhD Professor of Cardiac Surgery University of Michigan April 28 th, 2012 Disclosures NHLBI and
Novel Devices for End-Stage Heart Failure
Novel Devices for End-Stage Heart Failure Lynne Warner Stevenson No conflicts of interest Off-label assist devices and expanded indications will be discussed Devices for End-Stage Heart Failure New definitions
A Validated Practical Risk Score to Predict the Need for RVAD after Continuous-flow LVAD
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 Frazier MD, HR Mallidi MD Division of Transplant & Assist
Right Ventricular Failure: Prediction, Prevention and Treatment
Right Ventricular Failure: Prediction, Prevention and Treatment 3 rd European Training Symposium for Heart Failure Cardiologists and Cardiac Surgeons University Hospital Bern June 24-25, 2016 Disclosures:
: 2014 INTERMACS 4.0 Launches June 2, 2014
: 2014 INTERMACS 4.0 Launches June 2, 2014 David C. Naftel, PhD 1 June 2006 March 2014 UAB: DCC UNOS: WBDE 2 : 2006 What patients are receiving MCSDs? Do DT patients ever receive a transplant? What are
Mechanical assist patient selection, device selection, and outcomes
Mechanical assist patient selection, device selection, and outcomes Josef Stehlik, MD, MPH Associate Professor of Medicine Medical Director, Heart Transplant Program University of Utah School of Medicine
Translating Device and Mechanical Support Guidelines to ACHD Research. Timothy M. Maul, CCP, PhD Perfusionist Sr. Research Scientist
Translating Device and Mechanical Support Guidelines to ACHD Research Timothy M. Maul, CCP, PhD Perfusionist Sr. Research Scientist Disclosures No financial disclosures May discuss off-label or investigational
Andrew Civitello MD, FACC
Timing the Transition from Short Term to Long Term Mechanical Circulatory Support Andrew Civitello MD, FACC Medical Director, Heart Transplant Program Director, Fellowship Co-Director, Baylor St. Luke's
LVAD Complications, Recovery
LVAD Complications, Recovery Abbas Ardehali, M.D., F.A.C.S. Professor of Surgery and Medicine, Division of Cardiac Surgery William E. Connor Chair in Cardiothoracic Transplantation Director, UCLA Heart,
Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 (MOMENTUM 3) Long Term Outcomes
Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with (MOMENTUM 3) Long Term Outcomes Mandeep R. Mehra, MD, Daniel J. Goldstein, MD, Nir Uriel, MD, Joseph
Ventricular Assist Device in Acute Myocardial Infarction
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY VOL. 67, NO. 16, 2016 ª 2016 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 0735-1097/$36.00 PUBLISHED BY ELSEVIER http://dx.doi.org/1016/j.jacc.2016.02.025
Surgical Options for Advanced Heart Failure
Surgical Options for Advanced Heart Failure Benjamin Medalion, MD Director, Transplantation and Heart Failure Surgery Department of Cardiothoracic Surgery Rabin Medical Center, Beilinson Hospital Heart
Risk Factors for Adverse Outcome after HeartMate II Jennifer Cowger, MD, MS St. Vincent Heart Center of Indiana
Risk Factors for Adverse Outcome after HeartMate II Jennifer Cowger, MD, MS St. Vincent Heart Center of Indiana Advanced Heart Failure, Transplant, & Mechanical Circulatory Support Relevant Financial Relationship
End Stage Heart Failure - Time to Bring the Hammer Down
End Stage Heart Failure - Time to Bring the Hammer Down Eric R. Skipper, MD, FACS Chief, Adult Cardiovascular Surgery Surgical Director of Cardiac Transplantation and Mechanical Circulatory Support 2 3
Right Heart Failure in LVAD patients: Prevention and Management.
Christian Bermudez MD. Associate Professor Director Thoracic Transplantation Division Cardiac Surgery Department of Surgery University of Pennsylvania Right Heart Failure in LVAD patients: Prevention and
Lessons learned from ENDURANCE, ROADMAP, MedaMACS, and how to go forward?
Lessons learned from ENDURANCE, ROADMAP, MedaMACS, and how to go forward? Mark S. Slaughter, MD Professor and Chair Department of Cardiovascular and Thoracic Surgery University of Louisville What could
Challenges to MCS Use in the Middle East
Challenges to MCS Use in the Middle East Feras Khaliel, MD, Ph.D Consultant Cardiac Surgeon Associate Professor of Surgery, Alfaisal Univerisity King Faisal Specialist Hospital & Research Center Dr. Michael
Mechanical Circulatory Support in the Management of Heart Failure
Mechanical Circulatory Support in the Management of Heart Failure Feras Bader, MD, MS, FACC Associate Professor of Medicine Director, Heart Failure and Transplant Cleveland Clinic Abu Dhabi Chairman, Heart
A Fully Magnetically Levitated Left Ventricular Assist Device. Final Report of the MOMENTUM 3 Trial
A Fully Magnetically Levitated Left Ventricular Assist Device Final Report of the MOMENTUM 3 Trial Mandeep R. Mehra, MD, Nir Uriel, MD, Joseph C. Cleveland, Jr., MD, Daniel J. Goldstein, MD, National Principal
Predicting Outcomes in LVAD Recipients
Predicting Outcomes in LVAD Recipients Sean P. Pinney, MD Director, Advanced Heart Failure & Cardiac Transplantation Professor of Medicine, Cardiology Icahn School of Medicine at Mount Sinai New York,
When to implant VAD in patients with heart transplantation indication. Aldo Cannata Dept of Cardiac Surgery Niguarda Ca Granda Hospital Milano
When to implant VAD in patients with heart transplantation indication Aldo Cannata Dept of Cardiac Surgery Niguarda Ca Granda Hospital Milano LVAD strategies In waiting list? Goal Bridge to transplant
How to Develop a Comprehensive Ventricular Assist Device Program
How to Develop a Comprehensive Ventricular Assist Device Program Rodrigo V. González, MD, MS Sección de Cirugía Cardiovascular División de Cirugía Facultad de Medicina Pontificia Universidad Católica de
ECMO as a Bridge to Heart Transplant in the Era of LVAD s.
Christian Bermudez MD. Associate Professor Director Thoracic Transplantation Division Cardiac Surgery Department of Surgery University of Pennsylvania ECMO as a Bridge to Heart Transplant in the Era of
Artificial Heart Program
Artificial Heart Program Provider Review: General VAD Overview Indications for VAD Bridge to transplant (BTT) historically most common (~80%) allow rehab from severe CHF while awaiting donor Bridge to
Acute Circulatory Support Should We or Shouldn t We?
Acute Circulatory Support Should We or Shouldn t We? Navin K. Kapur, MD, FACC, FSCAI Assistant Professor, Division of Cardiology Director, Acute Circulatory Support Program Director, Interventional Research
Predicting Survival in Patients Receiving Continuous Flow Left Ventricular Assist Devices
Journal of the American College of Cardiology Vol. 61, No. 3, 2013 2013 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2012.09.055
INTERMACS Ninth Annual Meeting Program
INTERMACS Ninth Annual Meeting Program MCSDs in 2015: Evolution, Expansion, and Evaluation Friday, May 15 2015 and Saturday, May 16 2015 Research Data Workshop Space limited Contact Grant Studdard at gkst@uab.edu
1 Week Followup - Intermacs
version date: 9/27/2017 1 Week Followup - Intermacs Followup Status (1 Week Followup (+/- 3 days)) Select one of the following Inpatient Outpatient Other Facility Unable to obtain follow-up information
Analysis of Pump Thrombosis in the Intermacs Database
Analysis of Pump Thrombosis in the Intermacs Database Michael Acker William Measey Professor of Surgery Chief of Division of Cardiovascular Surgery Director of Heart and Vascular Center University of Pennsylvania
ISHLT ACADEMY MASTER CLASS IN MECHANICAL CIRCULATORY SUPPORT (MCS)
ISHLT ACADEMY MASTER CLASS IN MECHANICAL CIRCULATORY SUPPORT (MCS) Saturday, April 30, 2016 1:45 PM 6:30 PM Marriott Wardman Park Hotel, Washington, DC, USA WASHINGTON BALLROOMS 1 & 2 ISHLT ACADEMY MASTER
ORIGINAL ARTICLE. Alexander M. Bernhardt a, *, Theo M.M.H. De By b, Hermann Reichenspurner a and Tobias Deuse a. Abstract INTRODUCTION
European Journal of Cardio-Thoracic Surgery 48 (2015) 158 162 doi:10.1093/ejcts/ezu406 Advance Access publication 29 October 2014 ORIGINAL ARTICLE Cite this article as: Bernhardt AM, De By TMMH, Reichenspurner
Status of Implantable VADs
Status of Implantable VADs John V. Conte, MD, Professor of Surgery Johns Hopkins University School of Medicine Division of Cardiac Surgery The Johns Hopkins Medical Institutions Conflict of Interest Statement
Candidate Selection for Long Term VAD
6th Saudi Heart Failure Symposium Riyadh - December 9, 2017 Candidate Selection for Long Term VAD AMMAR CHAUDHARY, MBCHB, FRCPC Consultant Cardiologist Advanced Heart Failure Department of Cardiology King
What are the indications for Tricuspid valve repair during LVAD Implant RANJIT JOHN, MD UNIVERSITY OF MINNESOTA
What are the indications for Tricuspid valve repair during LVAD Implant RANJIT JOHN, MD UNIVERSITY OF MINNESOTA Contraindications for LVAD Lack of social support system Nonreversible end organ failure
HeartWare ADVANCE Bridge to Transplant Trial and Continued Access Protocol Update
HeartWare ADVANCE Bridge to Transplant Trial and Continued Access Protocol Update Mark S. Slaughter, MD University of Louisville, KY, USA HeartWare Users Meeting 29 October 2012 Barcelona, Spain HEARTWARE,
Heart Failure Medical and Surgical Treatment
Heart Failure Medical and Surgical Treatment Daniel S. Yip, M.D. Medical Director, Heart Failure and Transplantation Mayo Clinic Second Annual Lakeland Regional Health Cardiovascular Symposium February
Why Children Are Not Small Adults? Treatment of Pediatric Patients Needing Mechanical Circulatory Support
Why Children Are Not Small Adults? Treatment of Pediatric Patients Needing Mechanical Circulatory Support Utpal S Bhalala, MD, FAAP Assistant Professor and Director of Research Pediatric Critical Care
Complications of VAD therapy - RV failure
Complications of VAD therapy - RV failure Nana Afari-Armah, MD Advanced heart failure and transplant cardiology Temple University Hospital 3/24/18 Goals Understand the role of the right ventricle in LVAD
Ramani GV et al. Mayo Clin Proc 2010;85:180-95
THERAPIES FOR ADVANCED HEART FAILURE: WHEN TO REFER Navin Rajagopalan, MD Assistant Professor of Medicine University of Kentucky Director, Congestive Heart Failure Medical Director of Cardiac Transplantation
Ventricular Assisting Devices in the Cathlab. Unrestricted
Ventricular Assisting Devices in the Cathlab Unrestricted What is a VAD? A single system device that is surgically attached to the left ventricle of the heart and to the aorta for left ventricular support
Heart Transplantation & MCS in 2017 Advances & Challenges
Heart Transplantation & MCS in 2017 Advances & Challenges Steven Tsui Papworth Hospital, Cambridge, UK Papworth Hospital Heart Transplantation ADVANCES AND CHALLENGES Heart Transplants 100 75 Adult Heart
เอกราช อร ยะช ยพาณ ชย
30 July 2016 เอกราช อร ยะช ยพาณ ชย Heart Failure and Transplant Cardiology aekarach.a@chula.ac.th Disclosure Speaker, CME service: Merck, Otsuka, Servier Consultant, non-cme service: Novartis, Menarini
Evaluation of the Right Ventricle in Candidates for Right Ventricular Assist Device Implantation.
Evaluation of the Right Ventricle in Candidates for Right Ventricular Assist Device Implantation. Evaluation of RVAD Function. Ioannis A Paraskevaidis Attikon University Hospital Historical Perspective
EMS: Care of the VAD Patient. Brittany Butzler BSN RN VAD Coordinator Froedtert and the Medical College of WI
EMS: Care of the VAD Patient Brittany Butzler BSN RN VAD Coordinator Froedtert and the Medical College of WI Disclosure No relevant financial relationships by planners or presenters Left Ventricular Assist
Implantable Ventricular Assist Devices and Total Artificial Hearts. Policy Specific Section: June 13, 1997 March 29, 2013
Medical Policy Implantable Ventricular Assist Devices and Total Artificial Hearts Type: Medical Necessity and Investigational / Experimental Policy Specific Section: Surgery Original Policy Date: Effective
Complications of Left Ventricular Assist Device Chronic Support. Dr. Tal Hasin RMC, Beilinson, Petach-Tiqva, Israel
Complications of Left Ventricular Assist Device Chronic Support. Dr. Tal Hasin RMC, Beilinson, Petach-Tiqva, Israel No disclosures Probability of survival Survival (%) Survival with LVAD Destination Bridge
Intermacs. Quarterly Statistical Report. Interagency Registry for Mechanically Assisted Circulatory Support
1 Alfred M 14 69 112.5 Intermacs Interagency Registry for Mechanically Assisted Circulatory Support Quarterly Statistical Report 2016 Q2 Implant and event dates: June 23, 2006 to June 30, 2016 09/26/2016
Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices: the EUROMACS-RHF Risk Score Osama I.I. Soliman, MD, PhD, FACC,
STATE OF OKLAHOMA 2014 EMERGENCY MEDICAL SERVICES PROTOCOLS
5M VENTRICULAR ASSIST DEVICE (VAD) MANAGEMENT ADULT EMERGENCY MEDICAL DISPATCHER EMERGENCY MEDICAL RESPONDER EMT EMT-INTERMEDIATE 85 ADVANCED EMT PARAMEDIC A Ventricular Assist Device, or VAD, is a mechanical
Recent Trials With Durable LVADs: Is There a Superior Device?
Recent Trials With Durable LVADs: Is There a Superior Device? Francis D. Pagani MD PhD Otto Gago MD Endowed Professor of Cardiac Surgery Michigan Medicine Current Device Landscape 2018 HeartMate 3 HeartMate
Followup Status (1 Week Followup (+/- 3 days))
1 Week Followup - Status version date: 09/27/2018 Intermacs 1 Week Followup Followup Status (1 Week Followup (+/- 3 days)) Select one of the following Inpatient Outpatient Other Facility Unable to obtain
VAD Mechanical Circulatory Support in ACHD as a Bridge to Recovery/Transplant or Destination Therapy
VAD Mechanical Circulatory Support in ACHD as a Bridge to Recovery/Transplant or Destination Therapy David N. Campbell MD Professor of Surgery, UC, Denver and the Children s Hospital Colorado Surgical
1 Week Followup 5/27/2014. Nursing Home/Assisted Care Hospice Another hospital Rehabilitation Facility Unknown
1 Week Followup t Started Please answer all questions considering all time since the previous visit and current follow-up date. Print this Form Followup Status t Started Select one of the following Inpatient
Age and Preoperative Total Bilirubin Level Can Stratify Prognosis After Extracorporeal Pulsatile Left Ventricular Assist Device Implantation
Circulation Journal Official Journal of the Japanese Circulation Society http://www.j-circ.or.jp ORIGINAL ARTICLE Cardiovascular Surgery Age and Preoperative Total Bilirubin Level Can Stratify Prognosis
Pediatric Mechanical Circulatory Support (MCS)
Pediatric Mechanical Circulatory Support (MCS) Ivan Wilmot, MD Heart Failure, Transplant, MCS Assistant Professor The Heart Institute Cincinnati Children s Hospital Medical Center The University of Cincinnati
Understanding the Pediatric Ventricular Assist Device
Understanding the Pediatric Ventricular Assist Device W. James Parks, MSc., MD Pediatric Cardiologist Assistant Professor of Pediatrics and Radiology Children s Healthcare of Atlanta Sibley Heart Center
Disclosures. No disclosures to report
Disclosures No disclosures to report Update on MOMENTUM 3 Trial: The Final Word? Francis D. Pagani MD PhD Otto Gago MD Professor of Cardiac Surgery University of Michigan Ann Arbor, Michigan, USA LVAD
Alfred M Pediatric Registry for Mechanically Assisted Circulatory Support
1 #HHSN268201100025C Alfred M 14 69 112.5 Pedimacs Pediatric Registry for Mechanically Assisted Circulatory Support Quarterly Statistical Report 2017 3rd Quarter Implant and event dates: September 19,
Pedimacs. Quarterly Statistical Report. Pediatric Registry for Mechanically Assisted Circulatory Support
1 #HHSN268201100025C Alfred M 14 69 112.5 Pedimacs Pediatric Registry for Mechanically Assisted Circulatory Support Quarterly Statistical Report 2017 2nd Quarter Implant and event dates: September 19,
Interagency Registry for Mechanically Assisted Circulatory Support. Quarterly Statistical Report
1 #HHSN268201100025C Intermacs Interagency Registry for Mechanically Assisted Circulatory Support Quarterly Statistical Report 2017 Q3 Implant and event dates: June 23, 2006 to September 30, 2017 12/18/2017
Ventricular Assist Device: Are Early Interventions Superior? Hamang Patel, MD Section of Cardiomyopathy & Heart Transplantation
Ventricular Assist Device: Are Early Interventions Superior? Hamang Patel, MD Section of Cardiomyopathy & Heart Transplantation Objectives Current rationale behind use of MCS Patient Selection Earlier?
Heart Transplantation is Dead
Heart Transplantation is Dead Alternatives to Transplantation in Heart Failure Sagar Damle, MD University of Colorado Health Sciences Center Grand Rounds September 8, 2008 Outline Why is there a debate?
Do we really need an Artificial Heart? No!! John V. Conte, MD, Professor of Surgery Johns Hopkins University School of Medicine
Do we really need an Artificial Heart? No!! John V. Conte, MD, Professor of Surgery Johns Hopkins University School of Medicine Division of Cardiac Surgery The Johns Hopkins Medical Institutions Conflict
Case - Advanced HF and Shock (INTERMACS 1)
Case - Advanced HF and Shock (INTERMACS 1) Navin K. Kapur, MD, FACC, FSCAI, FAHA Associate Professor, Department of Medicine Interventional Cardiology & Advanced Heart Failure Programs Executive Director,
Heart Transplant vs Left Ventricular Assist Device in Heart Transplant-Eligible Patients
Heart Transplant vs Left Ventricular Assist Device in Heart Transplant-Eligible Patients Matthew L. Williams, MD, Jaimin R. Trivedi, MD, MPH, Kelly C. McCants, MD, Sumanth D. Prabhu, MD, Emma J. Birks,
Destination Therapy SO MUCH DATA IN SUCH A SMALL DEVICE. HeartWare HVAD System The ONLY intrapericardial VAD approved for DT.
DT Destination Therapy SO MUCH DATA IN SUCH A SMALL DEVICE. HeartWare HVAD System The ONLY intrapericardial VAD approved for DT. ONLY WE HAVE THIS BREADTH OF CLINICAL EVIDENCE TO SUPPORT DESTINATION THERAPY.
Mechanical Circulatory Support (MCS) in 2017: What is New and Different?
Mechanical Circulatory Support (MCS) in 2017: What is New and Different? Rick Thompson, MD Photo Courtesy of St. Jude, Inc Disclosures Together+Clinic Co-Founder CR Bard Consultant MedlaunchSolutions Co-Founder
Mechanical Circulatory Support for Unstable Heart Failure
Mechanical Circulatory Support for Unstable Heart Failure Michael A. Acker, MD William Measey Professor of Surgery Chief of Cardiovascular Surgery University of Pennsylvania Health System O.H. Frazier,
Significance of Postoperative Acute Renal Failure After Continuous-Flow Left Ventricular Assist Device Implantation
Significance of Postoperative Acute Renal Failure After Continuous-Flow Left Ventricular Assist Device Implantation Jamil Borgi, MD, Athanasios Tsiouris, MD, Arielle Hodari, MD, Chad M. Cogan, MS, Gaetano
Acute heart failure: ECMO Cardiology & Vascular Medicine 2012
Acute heart failure: ECMO Cardiology & Vascular Medicine 2012 Lucia Jewbali cardiologist-intensivist 14 beds/8 ICU beds Acute coronary syndromes Heart failure/ Cardiogenic shock Post cardiotomy Heart
Ventricular Assist Device. Lauren Bartlett 10/5/16 BME 281, section 1
Ventricular Assist Device Lauren Bartlett 10/5/16 BME 281, section 1 What is a Ventricular Assist Device (VAD)? Electromechanical device for assisting cardiac circulation Used to partially or completely
ECMO and VAD implantation
1 Udine ECMO Workshop ECMO and VAD implantation Prof. Tomaso Bottio Division of Cardiac Surgery (Director Prof. Gino gerosa) ECMO Extracorporeal membrane oxygena1on (ECMO) is a rescue therapy to support
INTERMACS Interagency Registry for Mechanically Assisted Circulatory Support
INTERMACS Interagency Registry for Mechanically Assisted Circulatory Support Quarterly Statistical Report 2012 4th Quarter Implant and event dates: June 23, 2006 to December 31, 2012 Prepared by: The Data
INTERMACS Interagency Registry for Mechanically Assisted Circulatory Support
INTERMACS Interagency Registry for Mechanically Assisted Circulatory Support Quarterly Statistical Report Centers for Medicare & Medicaid Services 2013 1st Quarter Implant and event dates: June 23, 2006
Mechanical Cardiac Support in Acute Heart Failure. Michael Felker, MD, MHS Associate Professor of Medicine Director of Heart Failure Research
Mechanical Cardiac Support in Acute Heart Failure Michael Felker, MD, MHS Associate Professor of Medicine Director of Heart Failure Research Disclosures Research Support and/or Consulting NHLBI Amgen Cytokinetics
The FORMA Early Feasibility Study: 30-Day Outcomes of Transcatheter Tricuspid Valve Therapy in Patients with Severe Secondary Tricuspid Regurgitation
The FORMA Early Feasibility Study: 30-Day Outcomes of Transcatheter Tricuspid Valve Therapy in Patients with Severe Secondary Tricuspid Regurgitation Susheel Kodali, MD Director, Structural Heart & Valve
Outpatient Treatment of MCS Patient. F. Bennett Pearce, MD Professor of Pediatrics Med Director Heart Transplant COA
Outpatient Treatment of MCS Patient F. Bennett Pearce, MD Professor of Pediatrics Med Director Heart Transplant COA Disclosure Statement I DO NOT HAVE ANY RELEVANT FINANCIAL RELATIONSHIPS WITH ANY COMMERCIAL
Further devices to treat heart failure
Postgraduate Course Heart Failure Further devices to treat heart failure Pr. Matthias Kirsch Department of Cardiac Surgery Centre Hospitalo-Universitaire Vaudois Université de Lausanne e-mail: matthias.kirsch@chuv.ch
EACTS Adult Cardiac Database
EACTS Adult Cardiac Database Quality Improvement Programme List of changes to Version 2.0, 13 th Dec 2018, compared to version 1.0, 1 st May 2014. INTRODUCTORY NOTES This document s purpose is to list
Readmissions: an unavoidable nemesis
Readmissions: an unavoidable nemesis This presentation was presented at the Thoratec Corporation Economic Summit held on September 30-October 2 in La Jolla, CA. Please note that this presentation and content
Left Ventricular Assist Devices (LVADs): Overview and Future Directions
Left Ventricular Assist Devices (LVADs): Overview and Future Directions FATIMA KARAKI, M.D. PGY-3, DEPARTMENT OF MEDICINE WASHINGTON UNIVERSITY IN ST. LOUIS ST. LOUIS, MISSOURI, USA St. Louis, Missouri,
Adham Elmously 1, Andreas R. de Biasi 1, Donald A. Risucci 2,3, Berhane Worku 1, Evelyn M. Horn 4, Arash Salemi 1.
Original Article Systemic blood pressure trends and antihypertensive utilization following continuous-flow left ventricular assist device implantation: an analysis of the interagency registry for mechanically
Extra Corporeal Life Support for Acute Heart failure
Extra Corporeal Life Support for Acute Heart failure Benjamin Medalion, MD Director Heart and Lung Transplantation Department of Cardiothoracic Surgery Rabin Medical Center, Beilinson Campus, Israel Mechanical
Ventricular Assist Device Implant in the Elderly Is Associated With Increased, but Respectable Risk: A Multi-Institutional Study
Ventricular Assist Device Implant in the Elderly Is Associated With Increased, but Respectable Risk: A Multi-Institutional Study Pavan Atluri, MD, Andrew B. Goldstone, MD, Dale M. Kobrin, BA, Jeffrey E.
Modern Left Ventricular Assist Devices (LVAD) : An Intro, Complications, and Emergencies
Modern Left Ventricular Assist Devices (LVAD) : An Intro, Complications, and Emergencies ERIC T. ROME D.O. HEART FAILURE, MECHANICAL ASSISTANCE AND TRANSPLANTATION CVI Left Ventricular Assist Device An
Pediatric Mechanical Circulatory Support - What to Use
Pediatric Mechanical Circulatory Support - What to Use Ronald K. Woods, MD, PhD Associate Professor Medical College of Wisconsin Pediatric Cardiothoracic Surgery Children s Hospital of Wisconsin Disclosure
WHEN TO REFER FOR ADVANCED HEART FAILURE THERAPIES
WHEN TO REFER FOR ADVANCED HEART FAILURE THERAPIES Mrudula R Munagala, M.D., FACC CO- Director Heart Failure & Circulatory Support Program OklahomaHeart.com Heart Failure Prevalence Heart Failure affects
Ventricular Assist Devices for Chronic Heart Failure
Ventricular Assist Devices for Chronic Heart Failure Σ.Γ.Δράκος, Επικ. Καθ/τής Medical Director, Cardiac Mechanical Support Program Investigator, Molecular Medicine Program University of Utah Heart Failure: