Assisted Circulation in the Treatment of Heart Failure

1. Assisted Circulation in the Treatment of Heart Failure

2. Assisted Circulation • MEDICAL • Drugs • EECP • MECHANICAL • IABP ( Introaortic balloon pump) • VAD (Ventricular assist device)

3. Inclusion criteria ofMechanical Circulatory Support • Cardiogenic shock criteria • Maximal inotropic support • IABP

4. Exclusion criteria of Mechanical Circulatory Support • BUN > 100 mg/dl • Cr > 5 mg/dl • Chronic lung disease • Chronic liver disease • Metastatic cancer • Sepsis • Neurological deficit • Post cardiotomy cardiogenic shock • Age > 65 yr ( if bridge to transplant )

5. Definition of cardiogenic shock • Cardiac output index < 2 lit/min/m2 • Systolic blood pressure < 90 mmHg • Left or right atrial pressure > 20 mmHg • Urine output < 20 cc/hr • Systemic vascular resistance > 2100 dynes-sec.cm-5

6. Indication of IABP • Cardiogenic shock • Postcardiotomy • Associated with acute myocardial infarction • Mechanical complications of myocardial infarction • Mitral regurgitation • Ventricular septal defect • In association with coronary artery bypass surgery • Preoperative insertion • Patients with severe left ventricular dysfunction • Patients with intractable ischemic arrhythmias • Postoperative insertion • postcardiotomycardiogenic shock

7. Indication of IABP (continue) • In association with nonsurgical revascularization • Hemodynamically unstable infarct patients • High-risk coronary angioplasty • Patients with severe left ventricular dysfunction • Complex coronary artery disease • Stabilization of cardiac transplant recipient before insertion of ventricular assist device • Postinfarction angina • Ventricular arrhythmias related to ischemia

8. Contraindication of the use of IABP • Absolute: • Aortic valve insufficiency • Aortic dissection • Relative: • Femoral arterial insertion • Abdominal aortic aneurysm • Severe calcificaortoilliac or femoral arterial disease • Percutaneous insertion • Recent ipsilateral groin inceision • Morbid obesity

9. Complication of IABP • Minor • Bleeding at the insertion site • Superficial wound infection • Lymphocele • Peritoneal perforation • Major • Limb ischemia requiring thrombectomy, revascularization, or • amputation • Aortic dissection • Aortoiliac laceration • Femoral artery pseudoaneurysm • Retroperitoneal hemorrhage • Renal ischemia from mal position • Myocardial ischemia from poor timing of balloon augmentation • Deep wound infection requiring operative debridement

10. Medication of VAD

11. Comparison between different VADs

12. LVAD Screening score

13. Hemodynamic status during mechanical of ventricular assistance

14. Device selection depends on: • Availability • Physicians experiences

15. FDA approved several VADs • Abiomed biventricular system (BVS) 5000i for postcardiotomy and post MI cardiogenic shock • The thoraticporacorporeal device, Novacor and HeartMate for bridge to transplantation. • The HeartMate for destination therapy • Implantable device as LionHeart, Jarvik, HeartMate II, DeBakey and Cor-Aide.

16. Short term devices • Extracorporeal centrifugal pump • Extracorporeal membrane oxygenation (ECMO) • ABIOMED BVS 5000i

17. The Dbiomed biventricular system (BVS) 5000i

18. Long term device • Pulsatile devices • HeartMate LVAD (Implantable) • Novacor (Implantable) • Thoratic • Total artificial heart • Cardiowest • Abiocor • Axial flow pumps • Micromeddebakey VAD • HeartMate II • Jarvik 2000 • Totally implantable pulsatile devices • LionHeart LVD 200 • Novacor II

19. HeartMate

20. Novacor

21. Thoratecparacorporeal VAD

22. Abiocor

23. MicroMedDeBakey

24. Jarvik 2000

25. LionHeart

26. Major Complication

27. Complications during mechanical circulatory support