Bridging With Percutaneous Devices: Tandem Heart and Impella
|
|
- Lorin Todd
- 5 years ago
- Views:
Transcription
1 Bridging With Percutaneous Devices: Tandem Heart and Impella DAVID A. BARAN, MD, FACC, FSCAI SYSTEM DIRECTOR, ADVANCED HEART FAILURE, TX AND MCS SENTARA HEART HOSPITAL NORFOLK, VA PROFESSOR OF MEDICINE (CARDIOLOGY) EASTERN VIRGINIA MEDICAL SCHOOL
2 Disclosures Research funding Astellas, Abbott Consulting TandemLife, Maquet, Luitpold Lectures Otsuka, Novartis
3 Outline Cardiogenic shock Tools IAB Impella 2.5 CP 5.0 Tandem Heart Conclusions
4 Cardiogenic Shock: SHOCK trial definition Trial of AMI shock. Question of emergency revascularization vs initial medical stabilization End organ hypoperfusion due to cardiac failure Cool extremities Poor urine output or poor mental status SBP < 90 for at least 30 min Cardiac Index 2.2 with support LVEDP 15 Hochman J et al. NEJM 1999; 341:
5 Shock Pathophysiology Reynolds and Hochman. Circulation 2008; 117:
6 Is Cardiogenic Shock Just a Pump Problem? Starts with the pump Hypoperfusion is associated with a cascade of events Vasoconstrictors utilized to raise blood pressure which worsens afterload, further reduces capillary perfusion due to drugassociated spasm Interrupting the vicious circle should help
7 Tools to Address the Pump Problem Intra-aortic balloon pump LV- Aorta pump Left Atrium to Aorta / Femoral Artery pump Extracorporeal membrane oxygenation (VA ECMO) Right Sided Pumps
8 Intra-Aortic Balloon Pump Different sizes depending on height of patient Inflates during diastole leading to diastolic augmentation and systolic unloading (lower afterload) Increased coronary perfusion Most common mechanical circulatory assist? Increases cardiac output 0.5 L
9 ACC AHA 2013 Guidelines I IIa IIb III I IIa IIb III The use of intra-aortic balloon pump counterpulsation can be useful for patients with cardiogenic shock after STEMI who do not quickly stabilize with pharmacological therapy. Alternative LV assist devices for circulatory support may be considered in patients with refractory cardiogenic shock.
10 ESC 2016 Acute HF Guidelines
11 SHOCK-2 IAB Trial
12 SHOCK-2, 1 Year Results Thiele H, et al. Lancet 2013; 382:
13 IAB Pro / Con SHOCK-2 only addressed STEMI and only those randomized Excluding the sickest patients where equipoise doesn t exist 40 cc Balloon pumps (newer technology available) IAB is cheap (<$ ) and readily usable without cath lab environment if needed Tolerant of minimal anticoagulation The expensive pumps are not superior!
14 IAB
15 Survival
16 16
17 Follow-Up Study 76 of the 150 patients had PA catheter monitoring prior and after the IAB Responder defined as 0.01 L/Min increase in cardiac output 60 / 76 (79%) responders 37 patients (49 % of the responders) had care escalated 27 VAD s (temporary or durable) 10 direct to transplant 17
18 Responders to IAB 5 Delta Cardiac Output: Responders vs. Non-Responders ± 1.1 L/min Non- Responder Responder Baran, et al. Cathet Card Diagnosis 18
19
20 Escalation of Care Successful wean 3 21 Unable to wean (no escalation) 3 12 Escalated to VAD 6 21 Bridge to OHT 4 6 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Non-Responder Responder 20
21 Impella Family
22 USPELLA REGISTRY 154 patients undergoing PCI with CS All Impella 2.5 CHF shock excluded O Neill et al. J Interven Cardiol 2014; 27:1-11
23 USPELLA 2.5 Results
24 USPELLA- Real World Registry Results, Impella 2.5 No percutaneous MCS device is benign 9.5% vascular complication with surgical repair 10.3 % hemolysis 1.9 % CVA
25 Impella 25
26 IMPRESS- IAB vs Impella CP for Shock Multicenter, open label, randomized, N= 48 IAB vs Impella CP, 1:1 randomization STEMI with immediate PCI CS as defined by SBP < 90 for 30 minutes or requirement for inotropes / pressors to maintain SBP > 90 ALL Pts were VENTILATOR dependent to be enrolled! Informed consent WAIVED!
27 BASELINE Systolic BP mm Hg % had cardiac arrest Time to ROSC minutes mean Lactate mean ph % had LVEF < % had therapeutic hypothermia
28 IMPRESS- IAB vs Impella CP for Shock Zeymer and Thiele. JACC Jan p
29 Impella With ECMO Pappalardo et al. European J HF 2017; 19:
30 Outcomes
31 Gaudard et al. Critical Care 2015; 19:363
32 N= 40 (Impella 5.0 device)
33 Tandem Heart: Left Atrium to Femoral Artery Bypass
34 TandemHeart vs IAB Burkhoff et al, Am Heart Journal 2006; 152:469 e1-e8
35 Tandem LA-FA Bypass Support vs IAB Prospective, randomized 12 site trial 42 patients but if a site had not placed Tandem they could rollin a patient directly to Tandem Cardiogenic shock criteria: CI 2.2, PCWP 15 and hypoperfusion Could have IAB as long as still in CG shock
36 Outcomes: 33 Randomized Patients TH: 32 % death on support, 6/19 patients No significant difference in Plasma Free HgB (hemolysis)
37 Single Center Experience 117 pts Severe Refractory Cardiogenic Shock SBP < 90, CI < 2.0 Above hemodynamics ON IABP and pressors 48 % of the patients were UNDERGOING CPR during insertion of TH Of these, 43 % (of the 48 %) survived 30 days
38 Outcomes
39 Next Generation?
40 Possible Link Johannson et al. Critical Care 2017; 21:25
41 Why Does This Mechanism Exist? Cardiogenic shock is a hypercoagulable state Endothelial injury releases heparin and other molecules from the endothelial cells This anticoagulant effect balances the hypercoagulability of shock
42 Shock Team Multidisciplinary team is essential in shock Team that works together can handle extreme stress of crashing patients Support early and aim to reverse hypoperfusion Vigilant monitoring and be prepared to escalate therapy
43 Conclusions Complex spiral from insult to multiorgan dysfunction No one tool will suffice for all patients Risk / benefit profile of each device is unique and is weighed by the team when choosing a support device Regardless of device, the mortality is high and relatively unchanged Future advances will involve understanding the process of progression of shock to design inhibitors along with better pumps
44 Thank You
45 Which Device Do I Pick? Confidence- Spider Sense that device will provide sufficient support Competence Ability to rapidly place Changeability Ability to change to another device if needed Capability Inherent capability / flow / characteristics of the device
Introduction to Acute Mechanical Circulatory Support
Introduction to Acute Mechanical Circulatory Support Navin K. Kapur, MD, FACC, FSCAI, FAHA Associate Professor, Department of Medicine Interventional Cardiology & Advanced Heart Failure Programs Executive
More informationMechanical 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
More informationCirculatory Support: From IABP to LVAD
Circulatory Support: From IABP to LVAD Howard A Cohen, MD, FACC, FSCAI Director Division of Cardiovascular Intervention Co Director Cardiovascular Interventional ti Laboratories Lenox Hill Heart & Vascular
More informationAcute Myocardial Infarction Complicated by Cardiogenic Shock
Acute Myocardial Infarction Complicated by Cardiogenic Shock Navin K. Kapur, MD, FACC, FSCAI Assistant Professor, Division of Cardiology Director, Acute Circulatory Support Program Director, Interventional
More informationRationale for Prophylactic Support During Percutaneous Coronary Intervention
Rationale for Prophylactic Support During Percutaneous Coronary Intervention Navin K. Kapur, MD, FACC, FSCAI Assistant Director, Interventional Cardiology Director, Interventional Research Laboratories
More informationCath Lab Essentials : LV Assist Devices for Hemodynamic Support (IABP, Impella, Tandem Heart, ECMO)
Cath Lab Essentials : LV Assist Devices for Hemodynamic Support (IABP, Impella, Tandem Heart, ECMO) Michael A. Gibson, MD Assistant Professor of Medicine University of California, Irvine Division of Cardiology
More informationManagement of Cardiogenic Shock. Dr Stephen Pettit, Consultant Cardiologist
Dr Stephen Pettit, Consultant Cardiologist Cardiogenic shock Management of Cardiogenic Shock Outline Definition, INTERMACS classification Medical management of cardiogenic shock PA catheters and haemodynamic
More informationDECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST Cardiogenic Shock Mechanical Support Eulàlia Roig FESC Heart Failure and HT Unit Hospital Sant Pau - UAB Barcelona. Spain No conflics of interest Mechanical Circulatory
More informationControversies in Cardiogenic Shock. Timothy D. Henry, MD Cedars-Sinai Heart Institute
Controversies in Cardiogenic Shock Timothy D. Henry, MD Cedars-Sinai Heart Institute Key Issues Cardiac Arrest-Cardiogenic shock interaction New SCAI Classification Refractory Shock Shock with Multivessel
More informationAssist Devices in STEMI- Intra-aortic Balloon Pump
Assist Devices in STEMI- Intra-aortic Balloon Pump Ioannis Iakovou, MD, PhD Onassis Cardiac Surgery Center Athens, Greece Cardiogenic shock 5-10% of pts after a heart attack 60000-70000 pts in Europe/year
More informationIntraaortic Balloon Counterpulsation- Supportive Data for a Role in Cardiogenic Shock ( Be Still My Friend )
Intraaortic Balloon Counterpulsation- Supportive Data for a Role in Cardiogenic Shock ( Be Still My Friend ) Stephen G. Ellis, MD Section Head, Interventional Cardiology Professor of Medicine Cleveland
More informationMechanics of Cath Lab Support Devices
Mechanics of Cath Lab Support Devices Issam D. Moussa, MD Professor of Medicine Mayo Clinic College of Medicine Chair, Division of Cardiovascular Diseases Mayo Clinic Jacksonville, Florida DISCLOSURE Presenter:
More informationMechanics of Cath Lab Support Devices
Mechanics of Cath Lab Support Devices Issam D. Moussa, MD Chief Medical Officer First Coast Cardiovascular Institute, Jacksonville, FL Professor of Medicine, UCF, Orlando, FL None DISCLOSURE Percutaneous
More informationTed Feldman, M.D., MSCAI FACC FESC
Support Technologies and High Risk Intervention Patient Selection: When Not to Use Them Ted Feldman, M.D., MSCAI FACC FESC Evanston Hospital SCAI Fall Fellows Course Las Vegas December 7-10 th, 2014 Ted
More informationMechanical circulatory support in cardiogenic shock The Cardiologist s view ACCA Masterclass 2017
Mechanical circulatory support in cardiogenic shock The Cardiologist s view ACCA Masterclass 2017 Pascal Vranckx MD, PhD. Medical director Cardiac Critical Care Services Hartcentrum Hasselt Belgium Disclosure
More informationThe Pathophysiology of Cardiogenic Shock Knowledge Gaps & Opportunities
The Pathophysiology of Cardiogenic Shock Knowledge Gaps & Opportunities Navin K. Kapur, MD, FACC, FSCAI, FAHA Associate Professor, Department of Medicine Interventional Cardiology & Advanced Heart Failure
More informationAllinaHealthSystem 1
: Definition End-organ hypoperfusion secondary to cardiac failure Venoarterial ECMO: Patient Selection Michael A. Samara, MD FACC Advanced Heart Failure, Cardiac Transplant & Mechanical Circulatory Support
More informationCardiogenic Shock and Initiatives to Reduce Mortality
Cardiogenic Shock and Initiatives to Reduce Mortality Tanveer Rab, MD, FACC William O Neill, MD, FACC Perwaiz Meraj, MD, FACC Alex Truesdell, MD, FACC The Golden Hours? 50% dead within 10 hours Overall
More informationRationale for Left Ventricular Support During Percutaneous Coronary Intervention
Rationale for Left Ventricular Support During Percutaneous Coronary Intervention Navin K. Kapur, MD, FACC, FSCAI Associate Professor, Division of Cardiology Director, Acute Circulatory Support Program
More informationCardiogenic Shock. Dr. JPS Henriques. Academic Medical Center University of Amsterdam The Netherlands
Cardiogenic Shock Dr. JPS Henriques Academic Medical Center University of Amsterdam The Netherlands Conflict of interest disclosure Research grant Abbott Vascular Research grant Abiomed Inc. Global Impella
More informationThe Role of Mechanical Circulatory Support in Cardiogenic Shock: When to Utilize
The Role of Mechanical Circulatory Support in Cardiogenic Shock: Presented by Nancy Scroggins ACNP, CNS-CC CV Surgery ACNP Bayshore Medical Center The Role of Mechanical Circulatory Support in Cardiogenic
More informationRhondalyn C. McLean. 2 ND YEAR RESEARCH ELECTIVE RESIDENT S JOURNAL Volume VII, A. Study Purpose and Rationale
A Randomized Clinical Study To Compare The Intra-Aortic Balloon Pump To A Percutaneous Left Atrial-To-Femoral Arterial Bypass Device For Treatment Of Cardiogenic Shock Following Acute Myocardial Infarction.
More informationCase - 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,
More informationPercutaneous Mechanical Circulatory Support for Cardiogenic Shock. 24 th Annual San Diego Heart Failure Symposium Ryan R Reeves, MD FSCAI
Percutaneous Mechanical Circulatory Support for Cardiogenic Shock 24 th Annual San Diego Heart Failure Symposium Ryan R Reeves, MD FSCAI The Need for Circulatory Support Basic Pathophysiologic Problems:
More informationThe majority of patients with cardiomyopathy
Selection of Hemodynamic Support: An Approach for Coronary Interventions in Shock and High-Risk PCI The role of hemodynamic support devices in emergent cardiogenic shock and elective high-risk percutaneous
More informationPercutaneous Mechanical Circulatory Support Devices
Percutaneous Mechanical Circulatory Support Devices Daniel Vazquez RN, RCIS Miami Cardiac & Vascular Institute FINANCIAL DISCLOSURES none CASE STUDY CASE STUDY 52 year old gentlemen Complaining of dyspnea
More informationManagement of Acute Shock and Right Ventricular Failure
Management of Acute Shock and Right Ventricular Failure Nader Moazami, MD Department of Thoracic and Cardiovascular Surgery and Biomedical Engineering, Cleveland Clinic NONE Disclosures CARDIOGENIC SHOCK
More informationCardiogenic Shock in Acute MI
Cardiogenic Shock in Acute MI Mark Sheldon, MD UNMH Interventional Cardiology Objectives Overview Treatment Definition Shock profiles Causes Medical Mechanical Illustrative case Questions? Revascularization
More informationMatching Patient and Pump in the New Era of Percutaneous Mechanical Circulatory Support
Matching Patient and Pump in the New Era of Percutaneous Mechanical Circulatory Support Navin K. Kapur, MD, FACC, FSCAI, FAHA Associate Professor, Department of Medicine Interventional Cardiology & Advanced
More informationCounterpulsation. John N. Nanas, MD, PhD. Professor and Head, 3 rd Cardiology Dept, University of Athens, Athens, Greece
John N. Nanas, MD, PhD Professor and Head, 3 rd Cardiology Dept, University of Athens, Athens, Greece History of counterpulsation 1952 Augmentation of CBF Adrian and Arthur Kantrowitz, Surgery 1952;14:678-87
More informationLow cardiac output & Mechanical Support นายแพทย อรรถภ ม ส ศ ภอรรถ ศ ลยศาสตร ห วใจและทรวงอก โรงพยาบาล ราชว ถ
Low cardiac output & Mechanical Support นายแพทย อรรถภ ม ส ศ ภอรรถ ศ ลยศาสตร ห วใจและทรวงอก โรงพยาบาล ราชว ถ Low cardiac output/cardiogenic Shock State of end-organ hypoperfusion due to cardiac failure.
More informationMANAGEMENT OF CARDIOGENIC SHOCK
MANAGEMENT OF CARDIOGENIC SHOCK CASE PRESENTATION 37 year old Dutch female No known coronary artery disease risk factors 1 week post partum at time of presentation (G3P3) after an uncomplicated normal
More informationManagement of Cardiogenic shock. Prof. Christian JM Vrints
Management of Cardiogenic shock Prof. Christian JM Vrints none conflicts Management of Cardiogenic Shock Incidence and trends Importance of early revascularization Multivessel disease Left main disease
More informationMechanical Circulatory Support (MCS): What Every Pharmacist Needs to Know!
Mechanical Circulatory Support (MCS): What Every Pharmacist Needs to Know! Matthew A. Wanat, PharmD, BCPS, BCCCP, FCCM Clinical Assistant Professor University of Houston College of Pharmacy Clinical Pharmacy
More informationHow to do Primary Angioplasty. - Patients with Cardiogenic Shock
How to do Primary Angioplasty - Patients with Cardiogenic Shock Advanced Cardiovascular Intervention 2011 Dan Blackman Leeds General Infirmary MY CONFLICTS OF INTEREST ARE: Research Grants Medicines Company
More informationEcho assessment of patients with an ECMO device
Echo assessment of patients with an ECMO device Evangelos Leontiadis Cardiologist 1st Cardiology Dept. Onassis Cardiac Surgery Center Athens, Greece Gibbon HLM 1953 Goldstein DJ et al, NEJM 1998; 339:1522
More informationCardiogenic Shock Protocol
Cardiogenic Shock Protocol Impella Devices Best Practices in AMI Cardiogenic Shock Identify 1-3 SBP < 90 mmhg or on inotropes /pressors Cold, clammy, tachycardia Lactate elevated > 2 mmoi /L Stabilize
More informationCardiogenic Shock. Carlos Cafri,, MD
Cardiogenic Shock Carlos Cafri,, MD SHOCK= Inadequate Tissue Mechanisms: Perfusion Inadequate oxygen delivery Release of inflammatory mediators Further microvascular changes, compromised blood flow and
More informationAndrew 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
More informationSurgical Options for Temporary MCS
Surgical Options for Temporary MCS Michael A. Acker, MD Julian Johnson Professor of Surgery Chief of Cardiovascular Surgery Director of Heart and Vascular Center University of Pennsylvania Health System
More informationExtra 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
More informationECMO as a bridge to durable LVAD therapy. Jonathan Haft, MD Department of Cardiac Surgery University of Michigan
ECMO as a bridge to durable LVAD therapy Jonathan Haft, MD Department of Cardiac Surgery University of Michigan Systolic Heart Failure Prevalence 4.8 million U.S. 287,000 deaths per year $39 billion spent
More informationAcute Mechanical Circulatory Support Right Ventricular Support Devices
Acute Mechanical Circulatory Support Right Ventricular Support Devices Navin K. Kapur, MD, FACC, FSCAI, FAHA Associate Professor, Department of Medicine Interventional Cardiology & Advanced Heart Failure
More informationWho is the high risk patient?
Who is the high risk patient? High risk of periprocedural death or other major complications (hemodynamic compromise, MI, stroke, dialysis) Contributors of Risk Lesion/Procedure Governed by 1. Patient
More informationNew Horizons in Cardiogenic Shock. Timothy D. Henry, MD Director of Cardiology Cedars-Sinai Heart Institute
New Horizons in Cardiogenic Shock Timothy D. Henry, MD Director of Cardiology Cedars-Sinai Heart Institute AMI Shock Mortality Unchanged in > 20 years 74355 US AMI/CGS cases per year 1,2 78954 78500 79823
More informationST-Elevation Myocardial Infarction & Cardiogenic Shock. - What Should We Do?
ST-Elevation Myocardial Infarction & Cardiogenic Shock - What Should We Do? Advanced Angioplasty 2008 Dan Blackman Leeds General Infirmary Conflicts of interest Advisory Boards Cordis Boston Scientific
More informationเอกราช 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
More informationAcute 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
More informationDefinition. Low-cardiac-output state resulting in life threatening end-organ hypoperfusion. Criteria: MAP 30 mm Hg lower than baseline)
Definition Low-cardiac-output state resulting in life threatening end-organ hypoperfusion Criteria: 1. Persistent hypotension (SBP
More informationUpdate 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
More informationA Future for the IABP in Cardiogenic Shock? Holger Thiele Medical Clinic II (Cardiology/Angiology/Intensive Care) University of Lübeck, Germany
A Future for the in Cardiogenic Shock? Holger Thiele Medical Clinic II (Cardiology/Angiology/Intensive Care) University of Lübeck, Germany Disclosures Funding: German Research Foundation German Heart Research
More informationΟξύ στεφανιαίο σύνδρομο και καρδιογενής καταπληξία. Επεμβατική προσέγγιση. Σωτήριος Πατσιλινάκος Κωνσταντοπούλειο Γ.Ν. Ν. Ιωνίας
Οξύ στεφανιαίο σύνδρομο και καρδιογενής καταπληξία. Επεμβατική προσέγγιση Σωτήριος Πατσιλινάκος Κωνσταντοπούλειο Γ.Ν. Ν. Ιωνίας ACUTE HEART FAILURE AND CAD: ACS / LV ischaemic dysfunction Mechanical complications
More informationImpella Ins & Outs. CarVasz November :45 12:15
Impella Ins & Outs CarVasz November 21 2014 10:45 12:15 Nicolas M. Van Mieghem, MD, PhD, FESC Clinical Director of Interventional Cardiology Thoraxcenter, Erasmus MC Rotterdam Background IABP is widely
More informationA National Cardiogenic Shock Initiative (CSI):
A National Cardiogenic Shock Initiative (CSI): Insights from the Impella Quality (IQ) Program, cvad Registry and the Detroit CSI Experience William O Neill, MD, FACC Medical Director Structural Heart Disease
More informationPercutaneous mechanical circulatory support for treatment and prevention of hemodynamic instability Engström, A.E.
UvA-DARE (Digital Academic Repository) Percutaneous mechanical circulatory support for treatment and prevention of hemodynamic instability Engström, A.E. Link to publication Citation for published version
More information3/1/2017. Heart Failure is a major driver of morbidity and mortality in the US 1-7
Approaches to Cardiogenic Shock Margarita Camacho MD, FACS Surgical Director Cardiac Transplant and Mechanical Assist Device Program RWJ/Barnabas Health Heart Centers at Newark Beth Israel Medical Center
More informationPUMP FAILURE COMPLICATING AMI: ISCHAEMIC VSR
PUMP FAILURE COMPLICATING AMI: ISCHAEMIC VSR Dr Susanna Price MD PhD MRCP ESICM FFICM FESC Consultant Cardiologist & Intensivist Royal Brompton & Harefield NHS Foundation Trust DECLARATIONS Educational
More informationDECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST Multivessel disease and cardiogenic shock: CABG is the optimal revascularization therapy. Contra Prof. Christian JM Vrints Cardiogenic Shock Spiral Acute Myocardial
More informationTREATMENT OPTIONS IN CARDIOGENIC SHOCK WITH INTRA-AORTIC BALLOON COUNTERPULSATION
TREATMENT OPTIONS IN CARDIOGENIC SHOCK WITH INTRA-AORTIC BALLOON COUNTERPULSATION *Markus W. Ferrari Clinic of Internal Medicine I, HELIOS Dr-Horst-Schmidt-Clinic, Wiesbaden, Germany *Correspondence to
More informationECMELLA. Associate Prof. Dirk Westermann, MD, PhD. Department of General and Interventional Cardiology Hamburg, Germany. Department of Medicine
ACS in Women ECMELLA Combined Impella and ECMO in Cardiogenic Shock Prof. Peter Clemmensen, MD, DMSc, FESC, FSCAI Associate Prof. Dirk Westermann, MD, PhD University Heart Center Hamburg-Eppendorf Department
More information8th Emirates Cardiac Society Congress in collaboration with ACC Middle East Conference Dubai: October Acute Coronary Syndromes
8th Emirates Cardiac Society Congress in collaboration with ACC Middle East Conference 2017 OSPEDALE Dubai: 19-21 October 2017 Acute Coronary Syndromes Antonio Colombo Centro Cuore Columbus and S. Raffaele
More informationA case of post myocardial infarction ventricular septal rupture CHRISTOFOROS KOBOROZOS, MD
A case of post myocardial infarction ventricular septal rupture CHRISTOFOROS KOBOROZOS, MD NAVAL HOSPITAL OF ATHENS case presentation Female, 81yo Hx: diabetes mellitus, hypertension, chronic anaemia presented
More informationThe Robert TV Kung Interventional Heart Failure Fellowship Program Bringing Hope to the Hopeless at Tufts
The Robert TV Kung Interventional Heart Failure Fellowship Program Bringing Hope to the Hopeless at Tufts Navin K. Kapur, MD, FACC, FSCAI, FAHA Associate Professor, Department of Medicine Interventional
More informationTREATMENT OF HIGHER RISK PATIENTS INTRODUCTION TO PROTECTED PCI WITH IMPELLA. IMP v4
1 TREATMENT OF HIGHER RISK PATIENTS INTRODUCTION TO PROTECTED PCI WITH IMPELLA FDA APPROVES IMPELLA FOR HIGH-RISK PCI 2 Impella is the only hemodynamic support device proven safe and effective in elective
More informationLV Assist in High Risk PCI and Cardiogenic Shock: Is it Worth the Effort?
LV Assist in High Risk PCI and Cardiogenic Shock: Is it Worth the Effort? Vincent J. Pompili, MD, FACC, FSCAI Professor of Internal Medicine Director of Interventional Cardiovascular Medicine and Cardiac
More informationIABP SHOCK II trial:
IABP SHOCK II trial: Randomized comparison of intraaortic balloon counterpulsation versus optimal medical therapy in addition to early revascularization in acute myocardial infarction complicated by cardiogenic
More informationMCS for Acute Heart Failure Eric Adler MD Associate Professor of Medicine Medical Director Cardiac Transplant
MCS for Acute Heart Failure 2016 Eric Adler MD Associate Professor of Medicine Medical Director Cardiac Transplant Why do we decompensate? Which Heart Failure Patients Should Get Palliative Care and Who
More informationAcute 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
More informationWhy we need a consensus document on cardiogenic shock? ACCA Masterclass 2017
Why we need a consensus document on cardiogenic shock? ACCA Masterclass 2017 Holger Thiele Cardiogenic Shock STEMI Guidelines Steg et al. Eur Heart J.2012;33:2569-2619 Cardiogenic Shock CHF Guidelines
More informationCardiogenic shock: Current management
Cardiogenic shock: Current management Janine Pöss Universitätsklinikum des Saarlandes Klinik für Innere Medizin III Kardiologie, Angiologie und internistische Intensivmedizin Homburg/Saar I have nothing
More informationLong-Term Management: Preventing Progression. Daniel Burkhoff Cardiovascular Research Foundation and Columbia University
Long-Term Management: Preventing Progression Daniel Burkhoff Cardiovascular Research Foundation and Columbia University Disclosure Unrestricted institutional (CRF) educational grant from Abiomed Left Ventricular
More informationThe Case for Multivessel Revascularization in Shock
The Case for Multivessel Revascularization in Shock Emmanouil S. Brilakis, MD, PhD Minneapolis Heart Institute 9.37 9.49 am Disclosures Consulting/speaker honoraria: Abbott Vascular, American Heart Association
More informationImpella Versus Intra-Aortic Balloon Pump For Treatment Of Cardiogenic Shock: A Meta-Analysis of Randomized Controlled Trials
Accepted Manuscript Impella Versus Intra-Aortic Balloon Pump For Treatment Of Cardiogenic Shock: A Meta-Analysis of Randomized Controlled Trials Dagmar M. Ouweneel, MSc, Erlend Eriksen, MD, Melchior Seyfarth,
More informationIABP to prevent pulmonary edema under VA-ECMO
IABP to prevent pulmonary edema under VA-ECMO Alain Combes Service de Réanimation ican, Institute of Cardiometabolism and Nutrition Hôpital Pitié-Salpêtrière, AP-HP, Paris Université Pierre et Marie Curie,
More informationPHARMACOLOGICAL MANAGEMENT OF CARDIOGENIC SHOCK
PHARMACOLOGICAL MANAGEMENT OF CARDIOGENIC SHOCK Doron Zahger, MD Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva,
More informationUnderstanding 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
More informationThe development of cardiogenic shock portends an extremely poor prognosis. Cardiogenic Shock: A Lethal Complication of Acute Myocardial Infarction
TREATMENT UPDATE Cardiogenic Shock: A Lethal Complication of Acute Myocardial Infarction David R. Holmes, Jr, MD Mayo Graduate School of Medicine, Mayo Clinic, Rochester, MN Cardiogenic shock is a serious
More informationGuideline compliance, utilization trends
Guideline compliance, utilization trends and device selection Tilmann Schwab Cardiology / Intensive care Cardiac support IABP LVAD Transluminal l LVAD Cardiac support Emergency cardiac life support (ECLS)
More informationLV Distension and ECLS Lungs
LV Distension and ECLS Lungs Kevin W. Hatton, MD, FCCM Interim Vice-Chair for Anesthesiology Research Division Chief, Anesthesiology Critical Care Medicine Program Director, Anesthesiology Critical Care
More information206 Recent Developments in Intensive
C H A P T E R 206 Recent Developments in Intensive Cardiac Care for Acute Cardiac Disorders Suraj Kumar Arora, Abhishek Goyal, Gurpreet S Wander Intensive cardiac care includes a wide range of cardiac
More informationCHF ICU to community. Disclosure slide CHF. Diagnosis. Diagnosis. Diagnostic modalties Therapeutic modalities. Talks. Advisory boards.
CHF ICU to community CHF Diagnostic modalties Therapeutic modalities ICU Pacer/ ICD Medication CHF clinic ASV - Nejm. Sept. 17,2015. Advanced care directives Disclosure slide Talks most companies Advisory
More informationAccepted Manuscript. Improving Survival in Cardiogenic shock: Is Impella the Answer?,, James J Glazier MD, Amir Kaki MD S (18)
Accepted Manuscript Improving Survival in Cardiogenic shock: Is Impella the Answer?,, James J Glazier MD, Amir Kaki MD PII: S0002-9343(18)30496-0 DOI: 10.1016/j.amjmed.2018.04.045 Reference: AJM 14684
More informationEpidemiology of Heart Failure in Adults
Cardiac Critical Care : Focused on IABP & PCPS Epidemiology of Heart Failure in Adults Prevalence Incidence Mortality 2004 Hospital Cost 2007 2004 Age 20+ (New Cases) All Ages Discharges Age 35+ 2004 All
More informationRay Matthews MD Professor of Clinical Medicine Chief of Cardiology University of Southern California
High Risk PCI Making Possible the Impossible Ray Matthews MD Professor of Clinical Medicine Chief of Cardiology University of Southern California Disclosures Abiomed Research Support Consulting Agreement
More informationRamani 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
More informationIntravenous Inotropic Support an Overview
Intravenous Inotropic Support an Overview Shaul Atar, MD Western Galilee Medical Center, Nahariya Affiliated with the Faculty of Medicine of the Galilee, Safed, Israel INOTROPES in Acute HF (not vasopressors)
More informationHemodynamic Monitoring and Circulatory Assist Devices
Hemodynamic Monitoring and Circulatory Assist Devices Speaker: Jana Ogden Learning Unit 2: Hemodynamic Monitoring and Circulatory Assist Devices Hemodynamic monitoring refers to the measurement of pressure,
More informationHOW TO PERFORM LEFT VENTRICULAR ASSISTANCE IN THE CATHLAB. Andreas Baumbach, MD FESC FRCP Bristol Heart Institute University Hospitals Bristol UK
HOW TO PERFORM LEFT VENTRICULAR ASSISTANCE IN THE CATHLAB Andreas Baumbach, MD FESC FRCP Bristol Heart Institute University Hospitals Bristol UK Disclosure I have no conflicts of interest regarding this
More information1/5/2017. The Next Frontier: Advanced Cardiogenic Shock U MICHIGAN EPERIENCE
% SURVIVAL 1/5/2017 The Next Frontier: Advanced Cardiogenic Shock William W. O Neill, MD Henry Ford Health System Medical Director Center for Structural Heart Disease Detroit, MI U MICHIGAN EPERIENCE 1983-1985
More information27th Annual ELSO Conference San Diego, CA
27th Annual ELSO Conference San Diego, CA VA ECMO in the cath lab best timing? Impella or ECMO? Michael R. Mooney, MD, FACC, FSCAI, FAHA Director, Coronary Therapeutics Minneapolis Heart Institute at Abbott
More informationCHRONIC HEART FAILURE : WHAT ELSE COULD WE OFFER TO OUR PATIENTS? Cardiac Rehabilitation Society of Thailand
CHRONIC HEART FAILURE : WHAT ELSE COULD WE OFFER TO OUR PATIENTS? Cardiac Rehabilitation Society of Thailand ENHANCED EXTERNAL COUNTER PULSATION Piyanuj Ruckpanich, MD. Cardiac Rehabilitation Center Perfect
More informationRecovering Hearts. Saving Lives.
Recovering Hearts. Saving Lives ṬM The Door to Unload (DTU) STEMI Safety & Feasibility Pilot Trial November 218 Recovering Hearts. Saving Lives. LEGAL DISCLAIMERS This presentation includes select slides
More informationRecognizing the Need to Support A Failing Right Ventricular Role of Mechanical Support
Recognizing the Need to Support A Failing Right Ventricular Role of Mechanical Support Mahir Elder, MD, FACC,SCAI Medical Direct of PERT program Medical Director of Endovascular medicine Clinical Professor
More informationWhich mechanical assistance for cardiogenic shock?
Which mechanical assistance for cardiogenic shock? Alain Combes, MD, PhD, Hôpital Pitié-Salpêtrière, AP-HP Inserm UMRS 1166, ican, Institute of Cardiometabolism and Nutrition Pierre et Marie Curie Sorbonne
More informationTo ECMO Or Not To ECMO Challenges of venous arterial ECMO. Dr Emily Granger St Vincent s Hospital Darlinghurst NSW
To ECMO Or Not To ECMO Challenges of venous arterial ECMO Dr Emily Granger St Vincent s Hospital Darlinghurst NSW The Start: 1972 St Vincent s Hospital The Turning Point ECMO program restarted in 2004
More informationVentricular 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
More informationDisclosures. Extra-Corporeal Membrane Oxygenation During Cardio- Pulmonary Resuscitation ECPR April 22, 2016 ECG. Case. Case. Case Summary 4/22/2016
Extra-Corporeal Membrane Oxygenation During Cardio- Pulmonary Resuscitation ECPR April 22, 2016 Nothing to disclose. Disclosures Ivan J Chavez MD Case ECG History 60 y/o male No prior history of CAD In
More informationCULPRIT-SHOCK: A Randomized Trial of Multivessel PCI in Cardiogenic Shock. Holger Thiele, MD on behalf of the CULPRIT-SHOCK Investigators
CULPRIT-SHOCK: A Randomized Trial of Multivessel PCI in Cardiogenic Shock Holger Thiele, MD on behalf of the CULPRIT-SHOCK Investigators Disclosure Statement of Financial Interest Within the past 12 months,
More informationPlanned, Short-Term RVAD During Durable LVAD Implant: Indications and Management
Planned, Short-Term RVAD During Durable LVAD Implant: Indications and Management Yoshifumi Naka, MD, PhD Columbia University Medical Center New York, NY Disclosure Abbott/St. Jude Med./Thoratec Consultant
More informationDisclosures. Objectives 10/11/17. Short Term Mechanical Circulatory Support for Advanced Cardiogenic Shock. I have no disclosures to report
Short Term Mechanical Circulatory Support for Advanced Cardiogenic Shock Christopher K. Gordon MSN, ACNP-BC Disclosures I have no disclosures to report 1. Pathophysiology 2. Epidemiology 3. Assessment
More information