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Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust Mechanical Circulatory Support For Cardiogenic Shock Post AMI Asghar Khaghani Royal Brompton and Harefield NHS Trust Slide 2 Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust Mechanical Circulatory Support Cardiogenic Shock Post AMI Delayed Referral Cardiac Arrest/ Unknown neurological state Ventilated Pyrexia of unknown origin Failed thrombolysis. Risk of bleeding Difficulties: Slide 3 Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust Mechanical Circulatory Support Cardiogenic Shock Post AMI Majority have had PCI and on Clopidogrel Not tolerant of Inotropes Have other co-morbidities Have had previous surgical re-vascularisation Multi organ dysfunction Slide 4 Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust IABP Percutaneous ventricular assist devices ECMO Short term devices ? Upgrades to Long term devices MCS Cardiogenic Shock Post AMI Options: Slide 5 Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust - can initially stabilise the patient - may not provide enough support - requires a certain level of LV function - may be limited by persistent tachycardia / tachyarrythmias Cardiogenic Shock Post AMI IABP Slide 6 Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust Impella 2.5 9F shaft diameter - 12F pump rotor - 2.5 Litres/min - 5 days 5 9F shaft diameter - 21F pump rotor - 5 Litres/min - 10 days Slide 7 Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust Reitan Catheter pump 10 F -> opens to 14F Slide 8 Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust TandemHeart pVAD Removes oxygenated blood from LA via transseptal cannula in the femoral veinRemoves oxygenated blood from LA via transseptal cannula in the femoral vein Returns blood via femoral arteryReturns blood via femoral artery Reduces preloadReduces preload Increases MAPIncreases MAP Continuous flowContinuous flow 21 F21 F 14 days14 days Slide 9 Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust Easy and fast to commence Less bleeding Less costly Easy to upgrade to a VAD Moblisation is difficult Pulmonary congestion Inadequat flow ECMO for Cardiogenic Shock Post AMI Slide 10 Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust Slide 11 Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust Easy to insert CPB not required Less bleeding Less costly Gives time for further assessment Short term Devices for Cardiogenic Shock Post AMI Slide 12 Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust CentriMag MagLev Ventricular Assist System: Pump Motor Console Pump Motor Console Slide 13 Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust Levitronix for End Stage Cardiac Failure Left Ventricular Support Slide 14 Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust Levitronix for End Stage Cardiac Failure Biventricular Support Slide 15 Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust CentriMag in action Slide 16 Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust Bridge to recovery Bridge to surgery Bridge to a long term VAD Bridge to urgent heart transplantation Short term Devices for Cardiogenic Shock Post AMI Slide 17 Imperial College OF SCIENCE TECHNOLOGY AND MEDICINE Harefield Hospital Royal Brompton & Harefield NHS Trust Transfer of Patients to VAD units Ventilated patients Infection Bleeding Type of intervention Multi organ dysfunction Shortage of donor hearts! Areas of Concern