Device therapy: the future is now....Device therapy: the future is now. Author European Society of...
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Device Therapy: the future is now. Mariell Jessup MD FAHA, FACC, FESC Professor of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA
Transcript of Device therapy: the future is now....Device therapy: the future is now. Author European Society of...
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
