Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (17)
Similar to LVAD in India, LVAD Implantation in India, LVAD II Final Output 20/10/2015
Similar to LVAD in India, LVAD Implantation in India, LVAD II Final Output 20/10/2015 (20)
Recently uploaded
Recently uploaded (20)
LVAD in India, LVAD Implantation in India, LVAD II Final Output 20/10/2015
- 1. Ventricular Assist Devices Dr. Kewal Krishan MBBS MS MCh DNB MNAMS FIACS (CTVS) Advanced Fellow, Mayo Clinic & Mount Sinai, USA Program Head, Heart Transplant & Ventricular Assist Devices Senior Consultant Cardiac Surgeon Max Superspeciality Hospital, Saket, NewDelhi 1
- 2. Advanced Heart Failure - Definition Patients have significant cardiac dysfunction and marked symptoms: dyspnea, fatigue end-organ hypoperfusion at rest or with minimal exertion despite maximal medical therapy AHA Stage D Refractory symptoms requiring specialized interventions to manage symptoms or prolong life Goodlin et al, Journal of Cardiac Failure Vol. 10 No. 3 2004 Hunt SA et al JACC 2001;38:2101–13.
- 3. INTERMACS Profiles 1-3 Interagency Registry for Mechanical Circulatory Support ‘Frequent Flyer’ Stevenson, JHLTX; 09:535
- 4. INTERMACS Profiles 4-7 Stevenson, JHLTX; 09:535 ‘Housebound’ ‘Class IIIb’
- 5. DegreeofCirculatorySupport IABP PARTIAL SUPPORT CI* ↑15% CI ↑30-60% ECMO + FULL SUPPORT CI ↑100% Levitronix CentriMag Abiomed BVS 5000 Abiomed AB 5000 Abiomed Impella 5.0 LP Abiomed Impella 5.0 LD TandemHeart pVAD Abiomed Impella 2.5 LP Short-term MCS Devices *CI – cardiac index
- 6. VAD Components Inflow cannula Outflow Graft Percutaneous drive line Pump
- 7. HEART WARE • Weigh 145 gms • Pumps 4-5 liter/min • No pocket required • Under clinical trial
- 8. Peripherals
- 9. Circulite
- 10. HeartMate II® Left Ventricular Assist System
- 11. 11
- 12. 12
- 13. CASE 1 Mr. SDC a 38 yr old man Kn case of Dilated CMP with AICD x 2yrs Admitted to another hospital, He was put on ventilator due to pul.edema and was in multiorgan failure. He was told he would die in next few hrs. I received call if emegernt extracorporeal LVAD can be considered Transferred the patient to our hospital IV infusions( inotropes/Swan/ IABP was inserted to optimise him as he had fever(39.5) 13
- 14. CASE 1 Lab at admission were TLC 24000, Cr.7.8 Urea 272, SGOT/PT 8700/5660 Neurological status was unknown. CRRT started for high Cr. – Remained for 4 days and Cr. Came down to 2.2 After 2 days he woke up On esmolol infusion for VT Started recovering and 2 options were discussed with family Heart Transplant and LVAD Becoz of Puacity of organ donation LVAD looked more appropriate 14
- 15. 15
- 16. CASE 1 Inotopes weaned to minimal/ Esmolol stopped/ With the anticipation of putting LVAD IABP was removed to avoid intravascular lines. 3 hrs after removal of IABP – Crashed - Reintubated—IABP reinserted LVAD was implanted after few days on Feb 16. IABP was removed - All inotropes weaned off – Moved to Room Had post op AF –settled with pharmacotherapy Discharged home after 3 wks of surgery. 16
- 17. 17
- 18. 18
- 19. 19CT AORTOGRAM
- 20. 20 CT AORTOGRAM
- 21. 21
- 22. 22
- 23. Case 2 36 yrs old young man Kn cae of dilated cardiomayopathy since Aug 2013. CRT was not offerred becoz of narrow QRS complex Had 2 episodes of acute heart failure with abnormal labs. Airlifted few days ago to another hospital for pulm.edema Labs showed raised LFT and RFT and low perfusion state. 23
- 24. Case 2 Advised LVAD – shifted to our hospital IV inotropes /Swan /diretics – Medical optimization Cardiac index at time of insertion was 0.75 Got better – LVAD implanted on March 12, 2015 Extubated next morning – Recovered uneventfully. Off inotropes/ Swan removed in 4 days Discharged home on POD 11 24
- 25. 25
- 26. 26
- 27. 27
- 28. 28
- 29. 29
- 32. 32
- 33. Per operative View Intracorporeal Ventricular assist device ( Heart Ware)
- 40. Short-Term Extracorporeal Assist DeviceDevi Levitronix CentriMag Magnetically-levitated centrifugal pump Continuous-flow rotary pump Electrical actuation– magnetic coupling of the motor and impellor Capable of 6 ~ 9 L/min at 5500 RPM Left, Right, or Biventricular support Operative placement requiring sternotomy Bridge to recovery Courtesy of Levitronix, Inc.
- 41. Extra Corporeal Membrane Oxygenation ( ECMO)
- 43. Thank you
Editor's Notes
- In fact, all major organized religions support an individual’s decision to be an organ donor. I personally consider donation to be a profoundly spiritual act that honors the sanctity of life.