1 VENTRICULAR ASSIST DEVICES VENTRICULAR ASSIST DEVICES Arthur Hill, M.D. Arthur Hill, M.D. Department of Surgery Department of Surgery Division of Cardiothoracic Surgery Division of Cardiothoracic Surgery University of California, San Francisco University of California, San Francisco
52
Embed
VENTRICULAR ASSIST DEVICES - Continuing Medical · PDF file · 2009-01-161 VENTRICULAR ASSIST DEVICES Arthur Hill, M.D. Department of Surgery Division of Cardiothoracic Surgery...
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
►► Device Design and Categorization of Assist DevicesDevice Design and Categorization of Assist Devices
►► Established Indications for Use of Ventricular Established Indications for Use of Ventricular Assist DevicesAssist Devices�� Acute Circulatory SupportAcute Circulatory Support
►► PercutaneousPercutaneous Circulatory Support in the Catheterization LabCirculatory Support in the Catheterization Lab
�� BridgeBridge--toto--TransplantTransplant
�� BridgeBridge--toto--RecoveryRecovery
�� DestinationDestination
►► Patient SelectionPatient Selection
►► FutureFuture
4
VENTICULAR ASSIST DEVICEVENTICULAR ASSIST DEVICE
Definition:Definition:
►► Mechanical Device which is Mechanical Device which is used to replace or reproduce used to replace or reproduce the pump function of the left the pump function of the left and/or right ventricle.and/or right ventricle.
►► Device Design and Categorization of Assist DevicesDevice Design and Categorization of Assist Devices
►► Established Established IndicationsIndications for Use of Ventricular Assist for Use of Ventricular Assist DevicesDevices�� Acute Circulatory SupportAcute Circulatory Support
�� BridgeBridge--toto--TransplantTransplant
�� BridgeBridge--toto--RecoveryRecovery
�� DestinationDestination►► REMATCHREMATCH
►► INTrEPIDINTrEPID
►► HeartMateHeartMate IIII
► Patient Selection
►► FutureFuture
31
Mechanical Circulatory SupportMechanical Circulatory Support
►►Established Indications for Use of Established Indications for Use of
�� Improved Survival with Rapid Culprit RevascularizationImproved Survival with Rapid Culprit Revascularization5,65,6
�� 5050--70% Mortality70% Mortality44--77
►► PercutaneousPercutaneous Ventricular AssistVentricular Assist�� IABP IABP –– NO IMPROVEMENT IN SURVIVALNO IMPROVEMENT IN SURVIVAL44--77
�� pVADpVAD►► TandemHeartTandemHeart
►► ImpellaImpella
1. Goldberg RJ, Samad NA, Yarzebski J, et al. Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Engl J Med 1999;340:1162–1168.2. Rogers WJ, Canto JG, Lambrew CT, et al. Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990through 1999: the National Registry of Myocardial Infarction 1, 2 and 3. J Am Coll Cardiol 2000; 36:2056–2063.3. Holmes DR Jr, Berger PB, Hochman JS, et al. Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation.Circulation 1999; 100:2067–2073.4. Hasdai D, Harrington RA, Hochman JS, et al. Platelet glycoprotein IIb/IIIa blockade and outcome of cardiogenic shock complicating acute coronarysyndromes without persistent ST-segment elevation. J Am Coll Cardiol 2000; 36:685–692.5. Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators.Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock [see comments]. N Engl J Med 1999; 341:625–634.6. Hochman JS, Sleeper LA, White HD, et al. One-year survival following early revascularization for cardiogenic shock. Jama 2001; 285:190–192.7. Hochman JS, Buller CE, Sleeper LA, et al. Cardiogenic shock complicating acute myocardial infarction–etiologies, management and outcome: a reportfrom the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? J Am Coll Cardiol 2000; 36:1063–1070.