Lvad vijayanand
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This document discusses left ventricular assist devices (LVADs) including: - Types of LVAD support including bridge to transplantation, destination therapy, and devices like the HeartMate II. - Contraindications and patient criteria for LVAD support. - Components and functions of the LVAD including the external controller. - Monitoring of pump parameters on the controller. - Potential complications of LVAD support. - Clinical trial results demonstrating improved survival and quality of life with LVADs.
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The document discusses left ventricular assist devices (LVADs), which are mechanical pumps that help the failing left ventricle pump blood to the body. It provides background on the history and development of LVAD technology, describing early models and milestones as well as current FDA-approved devices like the HeartMate II. The document also outlines how LVADs work, their uses as either a bridge to transplant or for destination therapy, and outcomes data from clinical trials.
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The document discusses left ventricular assist devices (LVADs), which are mechanical pumps that help the failing left ventricle pump blood to the body. It provides background on the history and development of LVAD technology, describing early models and milestones as well as current FDA-approved devices like the HeartMate II. The document also outlines how LVADs work, their uses as either a bridge to transplant or for destination therapy, and outcomes data from clinical trials.
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CORONARY ENGAGEMENT.pdf
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- Using multiple catheters (Judkins, Amplatz) or single catheter (Tiger, Jacky)
- Requirements of an optimal catheter engagement: no pressure dampening, coaxial orientation, 2-3 mm engagement depth
- Pressure waveform monitor is of the utmost importance. Failure to recognize pressure damping/ventricularization followed by contrast injection can cause catastrophic complications.
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“Never take your eyes off the monitor and the pressure curve!”
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1. Guide catheters provide support for advancing devices into coronary arteries and injecting contrast for visualization. Their selection depends on factors like coronary anatomy, aortic root size, and desired level of support.
2. Common guide catheters include the Judkins, Amplatz, and extra-backup guides. The Judkins provides balanced support while the Amplatz offers firm passive support. Long tip catheters provide coaxial support and manipulation.
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LEFT VENTRICULAR ASSIST DEVICE- DESTINATION THERAPY
Left ventricular assist devices (LVADs) can provide long-term support for patients with end-stage heart failure who are not candidates for transplant. Continuous-flow LVADs have high 1- and 2-year survival rates of 80% and 70% respectively. While LVADs improve survival and quality of life, patients face risks of complications like bleeding, infection, stroke, and device malfunction. Ongoing management requires careful monitoring and optimization of patient hemodynamics and medical therapies.
Lvad
A ventricular assist device (VAD) is a mechanical pump that helps the ventricles pump blood through the body. VADs are used to treat heart failure and cardiogenic shock. They can partially or completely replace the function of a failing heart. VADs are designed to assist the right ventricle, left ventricle, or both ventricles. Common uses of VADs include bridging patients to transplant, bridging to recovery or decision, and destination therapy for patients who are not eligible for transplant. Complications of VAD therapy include bleeding, infection, thromboembolism, device malfunction, and right heart failure.
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The document discusses left ventricular pressure tracings and their components during systole and diastole. It also discusses simultaneous pressure tracings from the left ventricle and aorta in a patient with aortic stenosis that show a fixed aortic obstruction. Finally, it examines left ventricular and left brachial artery pressure tracings in a patient with hypertrophic cardiomyopathy that show an increased gradient and spike-and-dome configuration in the arterial pressure waveform following an extrasystolic beat.
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TEE VIEWS
This document provides an overview of standard transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) views. It describes the imaging windows, planes, and positions for obtaining basic and modified TTE views such as parasternal, apical, and subcostal views. It also outlines TEE imaging levels and how to manipulate the probe to obtain standard midesophageal and transgastric views, including 4-chamber, 2-chamber, aortic valve, and left ventricular views. The document aims to guide practitioners in performing comprehensive TTE and TEE exams through appropriate patient positioning and transducer manipulation.
IFR - Instantenous wave free ratio
A novel parameter to quantify the hemodynamic severity of coronary artery stenosis without adenosine infusion.
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I am going to describe in this ppt how to assess severityy of AR by echo, its advantage and limitation.
Tavi,Transcatheter Aortic Valve Replacement, TAVI,TAVR,
Transcatheter aortic valve implantation (TAVI) has been developed as an alternative to surgical aortic valve replacement for high-risk patients. TAVI involves threading a collapsible valve through blood vessels and implanting it to replace the diseased valve. Over 30,000 high-risk patients with severe aortic stenosis have undergone TAVI, based on evidence from studies showing it is safer than surgery for this group. TAVI indications may expand as longer-term data on outcomes becomes available and the procedure requires a multidisciplinary team approach and dedicated training.
Asd device closure
Atrial septal defect (ASD) closure can be performed surgically or percutaneously. Percutaneous closure is preferred for secundum ASDs that meet criteria such as defect size less than 38mm and adequate rim tissue. Echocardiography guides device placement and confirms closure. Complications include device embolization, arrhythmias, and erosion. Most studies report high success rates with percutaneous closure and shorter hospital stays than surgery. Surgical closure is preferred for sinus venosus, primum, or coronary sinus defects.
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2) Landmark trials like CARE-HF, MADIT-CRT and REVERSE showed that CRT reduces mortality and hospitalization in patients with heart failure symptoms.
3) Later trials also found benefits of CRT in mildly symptomatic patients with reduced left ventricular function and wide QRS duration, including decreased heart failure events and increased left ventricular ejection fraction, though effects on quality of life and exercise capacity were less clear.
CORONARY ENGAGEMENT.pdf
CORONARY ENGAGEMENT
- Engaging the coronary artery ostia is one of the most essential steps of diagnostic angiography and PCI
- Using multiple catheters (Judkins, Amplatz) or single catheter (Tiger, Jacky)
- Requirements of an optimal catheter engagement: no pressure dampening, coaxial orientation, 2-3 mm engagement depth
- Pressure waveform monitor is of the utmost importance. Failure to recognize pressure damping/ventricularization followed by contrast injection can cause catastrophic complications.
FINAL MESSAGE
“Never take your eyes off the monitor and the pressure curve!”
“Serious complications in the cath lab often happen not out of ignorance or lack of expertise, but because of ignoring some basic principles and lack of cath lab discipline.”
Echo assessment of RV function
The document provides an overview of right ventricular assessment using echocardiography. It discusses normal RV anatomy, segmental nomenclature, and coronary supply. Key metrics for evaluating RV size, wall thickness, function, and pressures are outlined. Normal values and technical aspects of measuring RV dimensions, area/fractional area change, tricuspid annular plane systolic excursion, myocardial velocity, and diastolic function are summarized. Hemodynamic assessment of pulmonary pressures is also reviewed.
VAD
Ventricular assist devices (VADs) are mechanical pumps that are used to partially or completely replace the function of the failing left ventricle (LVAD), right ventricle (RVAD), or both ventricles (BiVAD). Short-term VADs such as the Impella, TandemHeart, and ECMO are used for days to weeks to provide urgent hemodynamic support, while long-term VADs like the HeartMate II and III are implanted surgically to support patients for months to years as either a bridge to transplant or destination therapy. VADs carry risks of complications involving the inflow and outflow cannulas, pumps, batteries, drive lines, and may
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This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.
Advanced Heart Failure Therapies: Cardiac Transplantation and Mechanical Circ...
By Michael A. Samara, MD. A discussion about the growing population of patients with heart failure, advances in heart failure therapies, and the role of ECMO and LVAD implants in improving outcomes. "ECMO is an older therapy that is undergoing a renaissance. We've learned that poorer outcomes were a consequence of resorting to ECMO too late after multiple system failure. Now we're starting ECMO in the cath lab, even during active CPR."
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Guiding catheter in coronary intervention
1. Guide catheters provide support for advancing devices into coronary arteries and injecting contrast for visualization. Their selection depends on factors like coronary anatomy, aortic root size, and desired level of support.
2. Common guide catheters include the Judkins, Amplatz, and extra-backup guides. The Judkins provides balanced support while the Amplatz offers firm passive support. Long tip catheters provide coaxial support and manipulation.
3. Achieving proper coaxial alignment and maintaining backup support are important for device delivery and preventing complications. Catheter size, curves, and deep seating techniques impact the level of passive versus active support provided.
Imaging for Predicting and Assessing Patient Prosthesis Mismatch after AVR
This document discusses patient-prosthesis mismatch (PPM) after aortic valve replacement (AVR). PPM occurs when the effective orifice area (EOA) of the implanted prosthetic valve is too small relative to the patient's body size, leading to higher-than-expected gradients. PPM is associated with worse outcomes including reduced exercise capacity, less regression of left ventricular hypertrophy, and reduced long-term survival. The document outlines methods for assessing and differentiating PPM from valve stenosis using echocardiography parameters. It also discusses strategies for preventing PPM including proper valve sizing and the potential role of transcatheter valve-in-valve procedures for treating PPM in failed biopro
Coronary artery perforation
Coronary artery perforation during percutaneous coronary intervention (PCI) can be classified based on its anatomical location and severity. Proximal or midvessel perforations carry a greater risk of complications while distal perforations often have a benign course. Treatment depends on the perforation type and severity, with supportive measures, prolonged balloon inflation, covered stents, or vessel occlusion techniques used for more severe cases. Emergency surgery may be needed for large perforations not responding to other treatments, though surgical outcomes in emergency settings are often disappointing.
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This document summarizes guidelines for the treatment of heart failure. It describes the New York Heart Association classification system for heart failure severity. It lists drug and device therapy recommendations for heart failure, including levels of evidence. Device therapies discussed include implantable cardioverter-defibrillators, cardiac resynchronization therapy, ventricular assist devices, and the total artificial heart. Contraindications and outcomes for long-term and short-term ventricular assist device support are outlined.
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Survival in patients with advanced heart failure (AHF) has improved over the last 2 decades. An increasing number of patients however, are dying with progressive heart failure over the same duration. Optimal utilization of medical therapies and devices like implantable defibrillators and biventricular pacemakers are the likely reasons patients are surviving longer albeit with progressive HF.
Evolution in mechanical circulatory support (MCS) devices has occurred over the same period, such that they can now be rapidly instituted providing support for pump failure, often percutaneously, with timely restitution of physiologic and metabolic derangements with fewer complications.
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Mechanical Circulatory Support.pptx
Mechanical circulatory support devices such as left ventricular assist devices (LVADs) are increasingly being used as an alternative to cardiac transplantation for patients with advanced heart failure. LVADs are mechanical pumps that are implanted to support the left ventricle and improve cardiac output. They can be used as a bridge to transplantation, destination therapy for those ineligible for transplant, or potentially as a bridge to recovery in some cases. Common LVAD devices are continuous flow pumps that are more pulsatile than earlier generation pulsatile pumps. LVADs have been shown to improve symptoms, quality of life and survival for advanced heart failure patients.
CONGESTIVE HEART FAILURE.pptx
Congestive cardiac failure (CHF) refers to systemic and pulmonary congestion resulting from the heart's inability to pump enough blood for the body's needs. It has multiple causes in infants and children, including structural heart defects, arrhythmias, infections, and cardiomyopathies. Presentation depends on the degree of cardiac reserve but includes symptoms like tachypnea, tachycardia, poor feeding, and hepatomegaly. Diagnosis involves history, physical exam, chest x-ray, ECG, echocardiogram and other tests. Treatment focuses on correcting underlying causes, managing precipitants, and controlling heart failure through diuretics, inotropic drugs, afterload reducers, and other
Renal function with LVADs
This document discusses the relationship between kidney function and left ventricular assist devices (LVADs). It begins with an overview of the problem of heart failure and renal impairment. It then describes the different types of LVADs and how pre-implantation renal function affects outcomes. Continuous flow LVADs can impact renal function through changes in hemodynamics. The document discusses acute kidney injury following LVAD implantation as well as potential improvements in renal function post-implantation. It also reviews renal replacement therapy modalities and considerations for LVAD patients, such as vascular access, blood pressure monitoring, and the effects of pump speed and flow on kidney function.
Heart tyransplantation
The document discusses heart transplantation, including:
- The normal function of the human heart and what happens when it is not able to supply blood properly.
- That heart transplantation involves replacing a damaged heart with a healthy donor heart through surgery.
- Some details about the first successful heart transplant performed in India in 1994 and hospitals approved to perform the procedure.
- Criteria for determining donor heart suitability and matching it to a recipient, including blood type and body size compatibility.
- Indications and contraindications for receiving a heart transplant.
- Surgical techniques for transplantation, including the biatrial technique which is the standard orthotopic heart transplant procedure.
From LVAD to Transplant: State of the Art of Advanced Heart Failure Management
Jeffrey Keenan, MD
Duke University
Rounds January 2015
syncope in kids,healthy living [exercise], pauses, thumps,call in EKG,need for EKGs, Cases with ETCO@ low and high,Afib, aortic dissection talk,
Renal replacement therapy
- Renal replacement therapies are important in critical care for managing complications of renal failure such as fluid, electrolyte and acid-base imbalances. There are many questions around optimal therapy including timing, dose and modality.
- Acute kidney injury is common in the ICU and associated with worse outcomes. Continuous renal replacement therapies may provide more stable volume and chemistry control compared to intermittent therapies.
- High volume hemofiltration shows promise for removing inflammatory mediators in sepsis but optimal dose is still unclear. Renal replacement therapies have an important role beyond renal support as blood purification techniques.
44 de martino renal-failure
The document discusses renal (kidney) failure, including anatomy, functions of the kidneys, causes and symptoms of both acute and chronic renal failure, and treatment options like dialysis. It addresses dialysis access sites, complications, and considerations for EMS. Hemodialysis and peritoneal dialysis are described as common dialysis methods used to treat chronic renal failure. Kidney injury from hypotension, toxins, obstruction or other causes can potentially lead to acute or chronic renal failure if not resolved.
Continuous renal replacement therapy crrt
CRRT is a continuous renal replacement therapy that provides a gentler form of dialysis for critically ill patients. It works through slow, continuous removal of waste and fluid over multiple days rather than the typical 4 hour sessions of hemodialysis. This puts less stress on the heart. CRRT can be delivered through various modes including continuous venovenous hemofiltration, hemodialysis, or hemodiafiltration that utilize diffusion, convection, or both to clean the blood. Anticoagulation is required to prevent clotting of the dialysis circuit and can include regional citrate or low-dose heparin.
Blood pressure changes during
1. Hemodialysis involves removing fluid and solutes from the body through diffusion and convection to achieve "dry weight." Careful fluid removal is needed to minimize hypotension risks.
2. Blood pressure fluctuates significantly during hemodialysis due to changes in vascular volume, cardiac output, and systemic vascular resistance. Both hypotension and hypertension are common complications.
3. Preventing intradialytic blood pressure issues involves accurate dry weight determination and gradual, steady ultrafiltration. Treatment of issues focuses on fluid balance, vasoactive medications, and optimizing dialysis prescription elements like sodium and temperature.
CRT
Cardiac resynchronization therapy (CRT) involves implanting electrodes in the left and right ventricles of the heart to coordinate their contractions and improve heart function in patients with heart failure. CRT works by delivering electrical pulses that resynchronize the timing of the ventricles' contractions. Studies show CRT can improve symptoms, exercise capacity, quality of life and reduce mortality and hospitalizations in heart failure patients. CRT devices include a pacemaker or defibrillator and leads placed in the heart to deliver electrical pulses. Doctors program the devices to optimize timing between the ventricles. CRT is effective for treating ventricular dyssynchrony seen in conditions like left bundle branch block.
Dialytic support for aki
1) The document discusses different modalities for providing dialytic support for acute kidney injury (AKI) patients, including intermittent and continuous renal replacement therapies.
2) It compares the pros and cons of different modalities and notes there is no clear evidence of differences in mortality or renal recovery between intermittent and continuous therapies.
3) Guidelines recommend considering patient hemodynamic stability and using continuous renal replacement therapy for unstable patients or those with brain injury, and emphasize starting renal replacement therapy based on clinical criteria rather than a single laboratory value.
Crrt in aki
* Pt weight: 60 kg
* Required dose: 35 ml/kg/hr
* Pt weight in kg: 60 kg
* Dose per kg: 35 ml/kg/hr
* Dose for pt: 60 kg x 35 ml/kg/hr = 2100 ml/hr
* Fluid removal: 100 ml/hr
* So required dialysate flow: 2100 - 100 = 2000 ml/hr
Therefore, the required dialysate flow is 2000 ml/hr.
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Aki in cardiac patients dr.vijayanand
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- It can affect both native and prosthetic heart valves. Staphylococcus aureus is now the most common cause.
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Christiaan Neethling Barnard was a South African cardiac surgeon who performed the world's first human-to-human heart transplant in 1967. After graduating from medical school and completing further studies, Barnard returned to Cape Town in 1958 as a cardiothoracic surgeon. To prepare for the landmark transplant, Barnard and his brother Marius practiced transplant techniques on dogs. On December 3, 1967 in Cape Town, Barnard's team successfully transplanted the heart of Denise Darvall into Louis Washkansky, who lived 18 days after the transplant. Barnard went on to perform more transplants and made advances in organ storage techniques, but retired in 1983 due to arthritis. He authored several books and used
Et co2
Capnography is superior to capnometry as it provides a graphical display of expired carbon dioxide (CO2) levels over time, allowing analysis of the capnographic waveform. Measuring end-tidal CO2 (ETCO2) using capnography is the best non-invasive method to verify correct endotracheal tube placement and provides valuable information about ventilation, cardiac output, and metabolism. ETCO2 levels normally approximate arterial CO2 (PaCO2) but the correlation decreases with abnormalities that increase the ventilation-perfusion mismatch. Key features of the capnographic waveform include the baseline, rise and contour of the CO2 curve which can provide diagnostic clues about various clinical conditions.
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- 1. LEFT VENTRICULAR ASSIST DEVICE BY DR . VIJAYANAND PALANISAMY
- 3. 10.5% 9.7% 8.2% 6.4% 11.9% 53.3% Hospitalization $20.9 Lost Productivity/ Mortality* $4.1 Home Healthcare $3.8 Drugs/Other Medical Durables $3.2 Physicians/Other Professionals $2.5 Nursing Home $4.7 Total Cost $39.2 billion Heart Disease and Stroke Statistics— 2010 Update: A Report From the AHA Circulation, Feb 2010; 121: e46 - e215
- 4. • Non-ischemic cardiomyopathy• Ischemic cardiomyopathy
- 10. Decreased end organ perfusion • Renal function • Liver function • Pulmonary function We need more support!
- 11.
- 12.
- 14. ANY • Are there any contraindications toVAD support? • End-stage lung, liver, or renal disease • Metastatic disease • Medical non-adherence or active drug addiction • Active infectious disease • Inability to tolerate systemic anticoagulation (recent CVA, GI bleed, etc.,) • Moderate to severe RV dysfunction for some LVADs • What are our other issues in this particular patient? • What are the patient’s goals? What are our goals? • What happens if we don’t meet our goals?
- 15. Long-term placement DestinationTherapy (DT) • Not a heart transplant candidate • NYHA IV • LVEF <25% • Maximized medical therapy >45 of 60 days; IABP for 7 days; OR 14 days • Functional limitation with a peak oxygen consumption of less than or equal to 14 ml/kg/min • Life expectancy < 2 years Bridge toTransplantation (BTT) • Patient is approved and currently listed for transplant • NYHA IV • Failed maximized medical therapy http://www.cms.gov/medicare- coverage-database
- 16. Bridge toTransplantation (BTT) DestinationTherapy (DT) HeartMate II (Thoratec)
- 22. Is EXTERNAL and it operates the pump and has lights, messages, and/or alarms if the power is low or if it is not functioning properly. It can be worn around the waist or over the shoulder. Look at the color of the tag on the controller so you can refer to the EMS guide on how to treat your pt with that specificVAD.
- 23. DC adaptor
- 27. Pump Speed (RPM) – How quickly the pump rotates Pump Power (Watts) – Measure of motor voltage and current Pump Flow (L/min) - Estimated value of the volume running through the pump Pulsitility Index –The measure of the left ventricular pressure during systole
- 28. VS
- 30. Inflow cannula (poor position, obstruction) Pump/rotor dysfunction (thrombus) Battery dysfunction Outflow graft (kink , leak) Drive line infection / fracture Controller malfunction
- 33. Rose, EA; et al NEJM 2001; 345:1435-1443 • 129 patients assigned to LVAD vs optimal medical therapy • Survival 52 vs 25% at 1 yr; 23 vs 8% at 2 yr = 48% reduction in mortality • Significantly improved quality of life at one year
- 34. Kirkland, JK, et. al JHLT 2013; 32:141-156
- 35. Kirkland, JK, et. al JHLT 2013; 32:141-156
- 36. • ShockTeam Evaluation for mechanical circulatory support (MCS) • Try to avoid the bridge to decision or the bridge to nowhere
- 38. • Utilized for LV support only; not appropriate to use with RV failure • Impella 2.5 can be inserted through the femoral artery during a standard catheterization procedure; provides up to 2.5 L of flow • Impella 5.0 inserted via femoral or axillary artery cut down; provides up to 5L of flow • The catheter is advanced through the ascending aorta into the left ventricle • Pulls blood from an inlet near the tip of the catheter and expels blood into the ascending aorta • FDA approved for support of up to 6 hours
- 39. • Used for LV support; not appropriate in RV failure • Cannulas are inserted percutaneously through the femoral vein and advanced across the intraatrial septum into the left atrium • The pump withdraws oxygenated blood from the left atrium and returns it to the femoral arteries via arterial cannulas • Provides up to 5L/min of flow • Can be used for up to 14 days
- 40. • Can be used for LV and/or RV support • Cannula are typically inserted via a midline sternotomy • Capable of delivering flows up to 9.9 L/min • Can be used for up to 30 days
- 41. • Used for patients with a combination of acute cardiac and respiratory failure • A cannula takes deoxygenated blood from a central vein or the right atrium, pumps it past the oxygenator, and then returns the oxygenated blood, under pressure, to the arterial side of the circulation • Can be used for days to weeks