Circulatory Support: From IABP to LVAD d h Howar d A Cohen, MD, FACC, FSCAI Director Division of Cardiovascular Intervention C Di t C di l It ti lL b t i Co‐Director Car diovascular InterventionalLaboratories Lenox Hill Heart & Vascular Institute Lenox Hill Heart and Vascular Institute of New York Lenox Hill Heart and Vascular Institute of New York
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Circulatory Support: From IABP to LVAD
d hHoward A Cohen, MD, FACC, FSCAIDirector Division of Cardiovascular Intervention
C Di t C di l I t ti l L b t iCo‐Director Cardiovascular Interventional LaboratoriesLenox Hill Heart & Vascular Institute
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
DISCLOSURESDISCLOSURES• CardiacAssist Inc
– Medical Director– Stock Options– Grant supportGrant support
• Medtronic Inc– Grant Support
• Abbott Vascular– Grant Support
• Boston Scientific Corporation• Boston Scientific Corporation– Grant Support
• St. Jude, IncSt. Jude, Inc– Grant Support
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
• Non CAD patients – acute and chronic severeNon CAD patients acute and chronic severe LV dysfunction, acute and chronic valvulardi RV d f ti VT bl tidisease, RV dysfunction, VT ablation
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
Hemodynamic Support in the Cardiac Cath LabHemodynamic Support in the Cardiac Cath Lab
What Constitutes High Risk PCI
• High Risk Patient Severe LV/VALVE Dysfunction• High Risk Patient Severe LV/VALVE Dysfunction– Hemodynamically compromised
Last remaining vessel– Last remaining vessel
– Large amount of myocardium at risk
• High Risk Lesion• High Risk Lesion – LMCA ‐complex
C l l i ith ith t th b (B2 C)– Complex lesion with or without thrombus (B2,C)
• Combination High Risk Patient/High Risk Lesion
LV ASSIST DEVICELV ASSIST DEVICELenox Hill Heart and Vascular
Institute of New YorkLenox Hill Heart and Vascular
Institute of New York
LV ASSIST DEVICELV ASSIST DEVICE
HIGH RISK PCIHEMODYNAMIC SUPPORT
LV FUNCTION SIMPLE PCI COMPLEX PCI
NORMAL LV NONE IABPNORMAL LV NONE IABP
POOR LV IABP LVAD
RIHAL, AICT, BANGKOK 2008
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
Mechanical Circulatory SupportMechanical Circulatory Support
Ideal Percutaneous Left Ventricular AssistIdeal Percutaneous Left Ventricular AssistSafety and efficacy
Freedom from thrombosis, bleeding, infection, hemolysis vascular compromisehemolysis, vascular compromiseFlow rate – complete supportImprove systemic and myocardial perfusionp y y pImprove SurvivalBridge to next therapy
Ease of insertion weaning and removalEase of insertion, weaning and removalCostAvailabilityAvailability
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
PERCUTANEOUS LEFT VENTRICULAR ASSISTPERCUTANEOUS LEFT VENTRICULAR ASSIST