Device Therapy:the future is now.

Mariell Jessup MD FAHA, FACC, FESCProfessor of Medicine

University of PennsylvaniaPhiladelphia, Pennsylvania, USA

Disclosure: Mariell Jessup MD

• Speakers Bureau:• Advisory Board:• Honorarium:

University of Pennsylvania

NONE

Devicedɪˈvʌɪsnouna thing made or adapted for a particular purpose, especially a piece of mechanical or electronic equipment.

synonyms: implement, gadget, utensil, tool, appliance, piece of equipment, apparatus, piece of apparatus, piece of hardware, instrument, machine, mechanism, contrivance, contraption, invention, convenience, amenity.

Heart Failure Device Therapy

• Implanted electrical devices: ICD, CRT• Mechanical circulatory support devices

– Short term versus durable devices• Valvular closure or replacement devices• Monitoring devices• Stimulation HF devices• Personal wearable devices.

Heart Failure Device Therapy

• Implanted electrical devices: ICD, CRT• Mechanical circulatory support devices

– Short term versus durable devices• Valvular closure or replacement devices• Monitoring devices• Stimulation HF devices• Personal wearable devices.

Secondary Prevention

2008 ACC/AHA/HRS Guidelines for Device-Based Therapy

Primary Prevention

2008 ACC/AHA/HRS Guidelines for Device-Based Therapy

Camm and Nisam Europace (2010) 12, 1063–1069

Masoudi et al. J Am Coll Cardiol 2013;62:1931–47

Camm and Nisam Europace (2010) 12, 1063–1069

17% reduction in mortality.

ACC/AHA guidelines, 2012

Heart Failure Device Therapy

• Implanted electrical devices: ICD, CRT• Mechanical circulatory support devices

– Short term versus durable devices• Valvular closure or replacement devices• Monitoring devices• Stimulation HF devices• Personal wearable devices.

the OPTIONS

Sick patient

Temporary supportChronic support

Unclear situation

1. Support circulation2. Oxygenate patient

Choice dictated by clinical status:temporary supportECMO

Durable VADs pulsatile non-pulsatile

~ ½ of the patients who need an MCSD for shock survive, and ~ ½ of these survivors require an

implantable VAD. Ongoing CPR is predictive of in- hospital

mortality.

VADs are getting better, but heart transplant is still the gold standard.

Heart Failure Device Therapy

• Implanted electrical devices: ICD, CRT• Mechanical circulatory support devices

– Short term versus durable devices• Valvular closure or replacement devices• Monitoring devices• Stimulation HF devices• Personal wearable devices.

Mitral Clip

“we conclude the non-inferiority of the MitraClip as a treatment for severe, symptomatic MR, in comparison to conventional valvular surgery. Despite a higher risk profile in the MitraClip patients, the

clinical outcomes were comparable although surgery was more effective in reducing MR in the early post procedure period. “

TAVR

Heart Failure Device Therapy

• Implanted electrical devices: ICD, CRT• Mechanical circulatory support devices

– Short term versus durable devices• Valvular closure or replacement devices• Monitoring devices• Stimulation HF devices• Personal wearable devices.

Heart Failure Device Therapy

• Implanted electrical devices: ICD, CRT• Mechanical circulatory support devices

– Short term versus durable devices• Valvular closure or replacement devices• Monitoring devices• Stimulation HF devices• Personal wearable devices.

Heart Failure Device Therapy

• Implanted electrical devices: ICD, CRT• Mechanical circulatory support devices

– Short term versus durable devices• Valvular closure or replacement devices• Monitoring devices• Stimulation HF devices• Personal wearable devices.

Further understanding of information shared by the public in this forum could suggest new approaches for improving resuscitation related education.

Thank You