Hardware in the Chest - From VADs to Valves

Transcription

1 Hardware in the Chest - From VADs to Valves Cristina Fuss, MD Purpose Recognize the device Indication and function Cristina Fuss, MD Department of Diagnostic Radiology FROM VADS TO VALVES Implanting technique Typical location Common peri-/post procedural complications List of devices Ventricular assist devices Temporary Permanent ( Destination therapy ) Left Right Valves Surgical Percutaneous/minimal invasive Closure devices Left ventricular assist devices LVAD HeartMate TM Axial flow, rotary blood pump-no pulse Left ventricular outflow cannula Pump Radiolucent pumpaorta graft Driveline

2 Left ventricular assist devices LVAD HeartWare TM Left ventricular assist devices Impella TM Delivers forward-flow from the left ventricle to the aorta Reduces myocardial workload and O2 consumption Increases cardiac output, coronary and end-organ perfusion. TandemHeart Percutaneous Ventricular Assist Device (pvad) Inserted either in the OR or cath lab. Postcardiotomy cardiogenic shock patients Bridge to a definitive therapy. Short-term support from a few hours up to 14 days

3 Right ventricular assist device Single cannula for both venous drainage and reinfusion of blood via internal jugular vein approach during extracorporeal life support. Surgical valves Mechanical Caged ball Tilting disk Bi-leaflet Bio-prosthetic Mechanical valves Mechanical valves: Caged ball Starr Edwards Starr Edwards Smeloff-Cutter Valve Mechanical valves: Bi-leaflet St Jude valve Bi-leaflet Endless lifetime (equivalent of over 50,000 years in accelerated valve wear tester) Requires anticoagulation

4 What valve is it? Bio-prosthetic valves Bio-prosthetic valve Tips point in the direction of flow Advantage bio-prosthetic vs. mechanical: No anticoagulation Disadvantage: Shorter lifetime Medtronic Mosaic valve Bio-prosthetic porcine valve Can be used in younger patients (<65yo) Both AVR and MVR Does not require anticoagulation

5 Transcatheter valves Transcatheter valves Melody valve Pulmonary valve Melody transcatheter pulmonary valve Aortic: Balloon expandable- Edwards SAPIEN XT Self-expandable - CoreValve Mitral MitraClip Melody valve Pediatric and adult patients with regurgitant or stenotic Right Ventricular Outflow Tract (RVOT) conduit History of ToF Transcatheter valves Transcatheter Aortic Valve Replacement-TAVR Transcatheter valves Edwards SAPIEN XT Edwards SAPIEN XT Transcatheter Heart Valve Bio-prosthetic valve mounted on balloon expandable stent Treatment for aortic valve stenosis Inoperable patients or patients with high surgical risk Three approaches: Transfemoral Transapical Transaortic

6 Transcatheter valves CoreValve Mitral clip Mitral clip placement MitraClip TM Designed to reduce mitral regurgitation Percutaneous trans-septal approach Am Heart J Jul;160(1):23-9

7 AMPLATZER Septal Occluder CardioSEAL Septal Occluder