HeartMate II Percutaneous LVAS Tethered Configuration

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HeartMate II Percutaneous LVAS Tethered
Configuration
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?????? ???? ??? ?? HeartMate III

• ???????? ??? ??? ???? ??? ?? 10 ?? 15 ???
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• ????? ???? ????? ? ????? ????? ?? ??? ?????
  ?????????? ????? ???? ?? ???????? ????? ??? ?? ???

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HeartMate XVE LVAS

• Internally implanted, electric pulsatile pump
• left heart support only
• up to 10 lpm flow
• Medium- to long-term therapy (months to years)
• bridge to transplant
• destination therapy (only FDA-approved DT device)

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?????? ???? ???? Heartmate XVE LVAS

• ??? ?????????
• ??? ??? 1150 ???
• ?????? ????? ??? 83 ?????????
• ????? 120 ??? ?????
• ???? ????? ??? ?? 10 ???? ?? ?????
• ????? ???? ?????? ?? ??????? ????? ?????? ?????
  ?????
• ??????? ??? mm25 ??? ?? ???????? ?? ??? ??????
• ???????? ???????????
• ??? ??????? ???? ??????? ???? ???? ????? ????????
  ??????? ?? ???????? ????? ? ??????? ?? ????? ?
  ???????? ???

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THORATEC STABILIZATION BELT
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?????????? ???? ???? ????? ???

• ?????????? ? ????????? ????
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• ?????? ???? ????
• ?? ??? ?????? ???? ???? ??? ?? ?? ???????? ?????
  ???? ??? ??
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  ????
• ?????? ????
• ?????????? ???????? ????
• ?????? ??? ??????? ??? ?? ?? ??????? ?????
• ??????? ???? ABIOMED BVS-5000
• ?????? ???? AB 5000TM
• ?????? ???? TandemHeart
• ?????? ???? Levitronix CentriMag

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??????? ???? ABIOMED BVS-5000
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TandemHeart
Levitronix CentriMag

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?????????? ???? ??? ???? ????? FDA
??? ????? ??? ???? ????? ???
DeBakey VAD MicroMed Technology, Inc. 25/2/2004
NOVACOR LVAS WORLD HEART, INC 29/9/1998
THORATEC(R) THORATEC LABORATORIES CORP. 20/12/1995
HEARTMATE THERMO CARDIOSYSTEMS, INC 30/9/1994
ABIOMED BVS(R) ABIOMED CARDIOVASCULAR, INC 20/11/1992
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Centrifugal pumps

• Acute hemodynamic support
• Continuous flow
• Extracorporeal
• LV, RV or biventricular support
• Wide availability
• Ease of use
• Relatively low cost
• Limited duration of support
• Bridge to recovery
• Bridge to decision

Hoy et al. Ann Thorac Surg 2000 701259-63
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• 3- ???????? ??????? ??? ???? ?? ?????? ???? ????
  ???? ???
• ????? ??????? ???? ??????? ???? ?? ????? ?? ????
  ?????? ????? ?? ???? ???? ????? ????
• ????? ????? ?????? ?? ??????? ?? ???? ??????
  ????? ???? ???????? ?? ?? ????? ?????? ??? ?????

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Tandem hearts

• Acute hemodynamic support
• Centrifugal pump
• Percutaneous placement
• LV support via transseptal cannula
• Used in high risk cardiac catheterization
  procedures
• Risk of vascular injuries due to cannula size

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Levitronix Centrimag

• Newer generation
• Centifugal pump
• Continuous flow
• Extracorporeal
• Impellar within the pump rotates in contact-free
  manner
• Increased durability
• Minimal thrombus formation and hemolysis of RBCs

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  ????? ????
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• ???? ???? ?? ???? ????? ???????? ??? ??? ????
  ????? ???????

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Impella

• Axial flow pumps
• Acute hemodynamic support
• Miniaturized impellar pump in catheter
• Helical catheter tip placed across aortic valve
  and left ventricle
• Percutaneous or direct placement
• Flow 4.5L/min
• Bridge to recovery

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????? ??? ?????????????? ?????

• 1- ???? ???? ????? ???????? ?? ????? ???? ?? ???
  ???????? ? ??? ?? ?????? ??????
• 2- ???? ???????? ??????????? ?? ?? ???? ??????? ?
  ?? ????? ??? ??? ?? ????? ?? ??????
• 3- ?????? ??????????? ?? ??? ???? ?????? ????? ?
  ???? ???

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Abiomed 5000

• Extracorporeal
• Pneumatic pulsatile pumps
• Uni- or biventricular support
• Bridge to transplant
• Easy to insert and operate so used in community
  hospitals
• Flows 6L/min

Circulation. 2005112438-448.
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Thoratec

• Pneumatic pulsatile pump
• LVAD, RVAD or biventricular support
• Durable
• Can be used in smaller patients
• Flows 7L/min
• Short- to medium-term use (up to 1-2 years)
• Bridge to recovery
• Bridge to transplant

Circulation. 2005112438-448.
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THORATEC
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Thoratec pVAD
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Problems/Complications

• Major VAD Complications
• Bleeding
• Thrombosis
• Infection
• sepsis is leading cause of death in long-term VAD
  support
• RV dysfunction/failure
• Suckdown (low preload causes a nonpulsatle VAD to
  collapse the ventricle)
• Device failure/malfunction (highly variable by
  device type)
• Hemolysis (the VAD destroys blood cells)

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Problems/Complications

• Bleeding Thrombosis
• Careful control of anticoagulation is imperative
• Patients are often on both anticoagulants and
  platelet inhibitors
• Device thrombosis
• rare in pulsatile devices
• typically revealed by increased power and signs
  and symptoms of hemolysis

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Problems/Complications

• Infection
• The leading cause of mortality in VAD patients
• Higher incidence in pulsatile VADs
• The driveline provides direct access into the
  body and into the blood stream
• Often recurrent and difficult to treat

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Problems/Complications

• Preventing Infection
• Always observe clean/ sterile technique
  when able
• Make sure driveline exit site is covered
  with a clean, dry gauze dressing

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Problems/Complications

• Hemolysis
• Blood cells are destroyed as they travel through
  the VAD
• More common in non pulsatile devices

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Problems/Complications

• Treating Hemolysis
• Initiate a peripheral IV and slowly give volume
• If able and instructed by the VAD Coordinator,
  reduce the speed of the VAD
• If thrombus is suspected to be causing hemolysis,
  administer lytics and anticoagulants as able/
  ordered

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Alarms

• All VAD devices typically have two distingue
  alarms to indicate a problem and its severity
• Advisory Alarms
• Critical/ Hazardous Alarms

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Problems/Complications

• Device Failure
• This is a true emergency requiring immediate
  transport to the implanting VAD center
• Most common in pulsatile devices
• Patients caregivers are trained to identify
  signs and symptoms of device failure
• May require the VAD to be replaced

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Next generation of VADs

• Miniaturized
• Improved durability
• Bearing-less technology
• Blood compatible surfaces
• Nonthrombogenic
• Transcutaneous
• Drive line
• Power sources

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Indicators of poor clinical outcome

• Diabetes mellitus
• 4-fold increased risk of early death
• Associated with end organ failure
• Renal failure
• Increased allograft vasculopathy after transplant
• Type I DM is contraindication to transplant
• Low preoperative serum albumin
• Surrogate measure of nutritional status
• Increased infections and impaired wound healing
• For every 1 mg/dL increase in albumin, had 19.2
  times increased likelihood for bridge to
  transplant

JCTS 20051305 1302-1311
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