mcs and heart transplant in acute mi cardiogenic shock · etiology of suspected cardiogenic shock...
TRANSCRIPT
MCS and Heart Transplant in Acute MI Cardiogenic Shock Howard T Massey MD Surgical Director Cardiac Transplantation and Mechanical Circulatory Support Thomas Jefferson University Hospital
2
CARDIOGENIC SHOCK
bull Acute Myocardial Infarction Cardiogenic Shock bull Points
bull It remains a problem bull Timing is everything bull Save the organism not the organ bull Unloading is good and offers a substantial platform to improve
current results
3
Acute MI complicated by Cardiogenic Shock bull The SHOCK ( Should we emergently revascularize Occluded Coronaries for cardiogenic shocK )
bull Randomized controlled clinical study that evaluated efficacy of revascularization ( PCI or CABG ) versus conventional
medical therapy bull No reduction in 30 day mortality significant survival benefit at 6 months and 1 year bull 6 month 497 and 1 year 467
bull Survivors NHYA I or II
Hochman J S et al JAMA 20062952511-2515
PCI of the Infarct Related Artery is the mainstay of Therapy Decreasing time to intervention has not increased yield AMICS mortalities remain unacceptably high
Kaplan-Meier curve showing 12 month survival in the early revascularisation and initial medical stabilisation arms of the SHOCK trial Reproduced from Hochman et al2 with permission of the American Medical Association
Etiology of suspected cardiogenic shock in the combined SHOCK trial registry and trial (total n = 1422 only first 232 trial patients are included)
MANAGEMENT OF CARDIOGENIC SHOCK COMPLICATING ACUTE MYOCARDIAL INFARCTION
1Venu Menon1 Judith S Hochman2
5
Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction Model The American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
bull gt300000 patients in the American College of Cardiology-National Cardiovascular Data Registry
bull 483 consecutive patients who underwent emergency PCI for cardiogenic shock
bull In conclusion analysis of patients from the ACC-NCDR who underwent emergency PCI for acute myocardial infarction in the
presence of cardiogenic shock shows an in-hospital mortality rate of 60 when PCI is attempted
BHallinancopy512007
N Engl J Med 2012 3671287-1296
300 patients in the IABP group
298 in the control group
The rate of death from any cause was significantly lower in the culprit-lesion-only PCI group than in the multivessel PCI group (433 vs 516 relative risk 084 95 CI 072 to 098 P=003)
CULPRIT-SHOCK ClinicalTrialsgov number NCT01927549
N Engl J Med 2017 3772419-2432
8
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Mortality bull Approximately 50
These people are dying from pump failure in an era when we clearly have mechanical pumps available that restore flow reliably
11
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Lack of Institutional protocols for treatment of AMICS with MCS bull Haphazard at best nationally bull Develop a TEAM Concept
The trial protocol allowed for the insertion of a ventricular assist device on the basis of the investigators clinical judgment Currently there are no well-defined clinical criteria for the insertion of ventricular assist devices and scientific evidence is scarce
N Engl J Med 2012 3671287-1296
12
Timing Is Everything
bull Strict time limits in all situations bull Lessons from Shock Trauma
13
The Golden Hour
wwwamazoncouk
14
MCS ACUTE THERAPY
BUNCr ndash 6164 ASTALT ndash 1416660 TBILI - 41
The current systems PHP and ECMO and How They are Used
J Am Coll Cardiol Intv 20169871ndash83
J Am Coll Cardiol Intv 20169871ndash83
Extra-Corporeal Support
21
21- 23 Fr 5 ndash 9 Fr
15 ndash 19 Fr
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
2
CARDIOGENIC SHOCK
bull Acute Myocardial Infarction Cardiogenic Shock bull Points
bull It remains a problem bull Timing is everything bull Save the organism not the organ bull Unloading is good and offers a substantial platform to improve
current results
3
Acute MI complicated by Cardiogenic Shock bull The SHOCK ( Should we emergently revascularize Occluded Coronaries for cardiogenic shocK )
bull Randomized controlled clinical study that evaluated efficacy of revascularization ( PCI or CABG ) versus conventional
medical therapy bull No reduction in 30 day mortality significant survival benefit at 6 months and 1 year bull 6 month 497 and 1 year 467
bull Survivors NHYA I or II
Hochman J S et al JAMA 20062952511-2515
PCI of the Infarct Related Artery is the mainstay of Therapy Decreasing time to intervention has not increased yield AMICS mortalities remain unacceptably high
Kaplan-Meier curve showing 12 month survival in the early revascularisation and initial medical stabilisation arms of the SHOCK trial Reproduced from Hochman et al2 with permission of the American Medical Association
Etiology of suspected cardiogenic shock in the combined SHOCK trial registry and trial (total n = 1422 only first 232 trial patients are included)
MANAGEMENT OF CARDIOGENIC SHOCK COMPLICATING ACUTE MYOCARDIAL INFARCTION
1Venu Menon1 Judith S Hochman2
5
Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction Model The American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
bull gt300000 patients in the American College of Cardiology-National Cardiovascular Data Registry
bull 483 consecutive patients who underwent emergency PCI for cardiogenic shock
bull In conclusion analysis of patients from the ACC-NCDR who underwent emergency PCI for acute myocardial infarction in the
presence of cardiogenic shock shows an in-hospital mortality rate of 60 when PCI is attempted
BHallinancopy512007
N Engl J Med 2012 3671287-1296
300 patients in the IABP group
298 in the control group
The rate of death from any cause was significantly lower in the culprit-lesion-only PCI group than in the multivessel PCI group (433 vs 516 relative risk 084 95 CI 072 to 098 P=003)
CULPRIT-SHOCK ClinicalTrialsgov number NCT01927549
N Engl J Med 2017 3772419-2432
8
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Mortality bull Approximately 50
These people are dying from pump failure in an era when we clearly have mechanical pumps available that restore flow reliably
11
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Lack of Institutional protocols for treatment of AMICS with MCS bull Haphazard at best nationally bull Develop a TEAM Concept
The trial protocol allowed for the insertion of a ventricular assist device on the basis of the investigators clinical judgment Currently there are no well-defined clinical criteria for the insertion of ventricular assist devices and scientific evidence is scarce
N Engl J Med 2012 3671287-1296
12
Timing Is Everything
bull Strict time limits in all situations bull Lessons from Shock Trauma
13
The Golden Hour
wwwamazoncouk
14
MCS ACUTE THERAPY
BUNCr ndash 6164 ASTALT ndash 1416660 TBILI - 41
The current systems PHP and ECMO and How They are Used
J Am Coll Cardiol Intv 20169871ndash83
J Am Coll Cardiol Intv 20169871ndash83
Extra-Corporeal Support
21
21- 23 Fr 5 ndash 9 Fr
15 ndash 19 Fr
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
3
Acute MI complicated by Cardiogenic Shock bull The SHOCK ( Should we emergently revascularize Occluded Coronaries for cardiogenic shocK )
bull Randomized controlled clinical study that evaluated efficacy of revascularization ( PCI or CABG ) versus conventional
medical therapy bull No reduction in 30 day mortality significant survival benefit at 6 months and 1 year bull 6 month 497 and 1 year 467
bull Survivors NHYA I or II
Hochman J S et al JAMA 20062952511-2515
PCI of the Infarct Related Artery is the mainstay of Therapy Decreasing time to intervention has not increased yield AMICS mortalities remain unacceptably high
Kaplan-Meier curve showing 12 month survival in the early revascularisation and initial medical stabilisation arms of the SHOCK trial Reproduced from Hochman et al2 with permission of the American Medical Association
Etiology of suspected cardiogenic shock in the combined SHOCK trial registry and trial (total n = 1422 only first 232 trial patients are included)
MANAGEMENT OF CARDIOGENIC SHOCK COMPLICATING ACUTE MYOCARDIAL INFARCTION
1Venu Menon1 Judith S Hochman2
5
Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction Model The American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
bull gt300000 patients in the American College of Cardiology-National Cardiovascular Data Registry
bull 483 consecutive patients who underwent emergency PCI for cardiogenic shock
bull In conclusion analysis of patients from the ACC-NCDR who underwent emergency PCI for acute myocardial infarction in the
presence of cardiogenic shock shows an in-hospital mortality rate of 60 when PCI is attempted
BHallinancopy512007
N Engl J Med 2012 3671287-1296
300 patients in the IABP group
298 in the control group
The rate of death from any cause was significantly lower in the culprit-lesion-only PCI group than in the multivessel PCI group (433 vs 516 relative risk 084 95 CI 072 to 098 P=003)
CULPRIT-SHOCK ClinicalTrialsgov number NCT01927549
N Engl J Med 2017 3772419-2432
8
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Mortality bull Approximately 50
These people are dying from pump failure in an era when we clearly have mechanical pumps available that restore flow reliably
11
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Lack of Institutional protocols for treatment of AMICS with MCS bull Haphazard at best nationally bull Develop a TEAM Concept
The trial protocol allowed for the insertion of a ventricular assist device on the basis of the investigators clinical judgment Currently there are no well-defined clinical criteria for the insertion of ventricular assist devices and scientific evidence is scarce
N Engl J Med 2012 3671287-1296
12
Timing Is Everything
bull Strict time limits in all situations bull Lessons from Shock Trauma
13
The Golden Hour
wwwamazoncouk
14
MCS ACUTE THERAPY
BUNCr ndash 6164 ASTALT ndash 1416660 TBILI - 41
The current systems PHP and ECMO and How They are Used
J Am Coll Cardiol Intv 20169871ndash83
J Am Coll Cardiol Intv 20169871ndash83
Extra-Corporeal Support
21
21- 23 Fr 5 ndash 9 Fr
15 ndash 19 Fr
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
Etiology of suspected cardiogenic shock in the combined SHOCK trial registry and trial (total n = 1422 only first 232 trial patients are included)
MANAGEMENT OF CARDIOGENIC SHOCK COMPLICATING ACUTE MYOCARDIAL INFARCTION
1Venu Menon1 Judith S Hochman2
5
Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction Model The American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
bull gt300000 patients in the American College of Cardiology-National Cardiovascular Data Registry
bull 483 consecutive patients who underwent emergency PCI for cardiogenic shock
bull In conclusion analysis of patients from the ACC-NCDR who underwent emergency PCI for acute myocardial infarction in the
presence of cardiogenic shock shows an in-hospital mortality rate of 60 when PCI is attempted
BHallinancopy512007
N Engl J Med 2012 3671287-1296
300 patients in the IABP group
298 in the control group
The rate of death from any cause was significantly lower in the culprit-lesion-only PCI group than in the multivessel PCI group (433 vs 516 relative risk 084 95 CI 072 to 098 P=003)
CULPRIT-SHOCK ClinicalTrialsgov number NCT01927549
N Engl J Med 2017 3772419-2432
8
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Mortality bull Approximately 50
These people are dying from pump failure in an era when we clearly have mechanical pumps available that restore flow reliably
11
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Lack of Institutional protocols for treatment of AMICS with MCS bull Haphazard at best nationally bull Develop a TEAM Concept
The trial protocol allowed for the insertion of a ventricular assist device on the basis of the investigators clinical judgment Currently there are no well-defined clinical criteria for the insertion of ventricular assist devices and scientific evidence is scarce
N Engl J Med 2012 3671287-1296
12
Timing Is Everything
bull Strict time limits in all situations bull Lessons from Shock Trauma
13
The Golden Hour
wwwamazoncouk
14
MCS ACUTE THERAPY
BUNCr ndash 6164 ASTALT ndash 1416660 TBILI - 41
The current systems PHP and ECMO and How They are Used
J Am Coll Cardiol Intv 20169871ndash83
J Am Coll Cardiol Intv 20169871ndash83
Extra-Corporeal Support
21
21- 23 Fr 5 ndash 9 Fr
15 ndash 19 Fr
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
5
Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction Model The American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
bull gt300000 patients in the American College of Cardiology-National Cardiovascular Data Registry
bull 483 consecutive patients who underwent emergency PCI for cardiogenic shock
bull In conclusion analysis of patients from the ACC-NCDR who underwent emergency PCI for acute myocardial infarction in the
presence of cardiogenic shock shows an in-hospital mortality rate of 60 when PCI is attempted
BHallinancopy512007
N Engl J Med 2012 3671287-1296
300 patients in the IABP group
298 in the control group
The rate of death from any cause was significantly lower in the culprit-lesion-only PCI group than in the multivessel PCI group (433 vs 516 relative risk 084 95 CI 072 to 098 P=003)
CULPRIT-SHOCK ClinicalTrialsgov number NCT01927549
N Engl J Med 2017 3772419-2432
8
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Mortality bull Approximately 50
These people are dying from pump failure in an era when we clearly have mechanical pumps available that restore flow reliably
11
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Lack of Institutional protocols for treatment of AMICS with MCS bull Haphazard at best nationally bull Develop a TEAM Concept
The trial protocol allowed for the insertion of a ventricular assist device on the basis of the investigators clinical judgment Currently there are no well-defined clinical criteria for the insertion of ventricular assist devices and scientific evidence is scarce
N Engl J Med 2012 3671287-1296
12
Timing Is Everything
bull Strict time limits in all situations bull Lessons from Shock Trauma
13
The Golden Hour
wwwamazoncouk
14
MCS ACUTE THERAPY
BUNCr ndash 6164 ASTALT ndash 1416660 TBILI - 41
The current systems PHP and ECMO and How They are Used
J Am Coll Cardiol Intv 20169871ndash83
J Am Coll Cardiol Intv 20169871ndash83
Extra-Corporeal Support
21
21- 23 Fr 5 ndash 9 Fr
15 ndash 19 Fr
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
N Engl J Med 2012 3671287-1296
300 patients in the IABP group
298 in the control group
The rate of death from any cause was significantly lower in the culprit-lesion-only PCI group than in the multivessel PCI group (433 vs 516 relative risk 084 95 CI 072 to 098 P=003)
CULPRIT-SHOCK ClinicalTrialsgov number NCT01927549
N Engl J Med 2017 3772419-2432
8
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Mortality bull Approximately 50
These people are dying from pump failure in an era when we clearly have mechanical pumps available that restore flow reliably
11
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Lack of Institutional protocols for treatment of AMICS with MCS bull Haphazard at best nationally bull Develop a TEAM Concept
The trial protocol allowed for the insertion of a ventricular assist device on the basis of the investigators clinical judgment Currently there are no well-defined clinical criteria for the insertion of ventricular assist devices and scientific evidence is scarce
N Engl J Med 2012 3671287-1296
12
Timing Is Everything
bull Strict time limits in all situations bull Lessons from Shock Trauma
13
The Golden Hour
wwwamazoncouk
14
MCS ACUTE THERAPY
BUNCr ndash 6164 ASTALT ndash 1416660 TBILI - 41
The current systems PHP and ECMO and How They are Used
J Am Coll Cardiol Intv 20169871ndash83
J Am Coll Cardiol Intv 20169871ndash83
Extra-Corporeal Support
21
21- 23 Fr 5 ndash 9 Fr
15 ndash 19 Fr
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
The rate of death from any cause was significantly lower in the culprit-lesion-only PCI group than in the multivessel PCI group (433 vs 516 relative risk 084 95 CI 072 to 098 P=003)
CULPRIT-SHOCK ClinicalTrialsgov number NCT01927549
N Engl J Med 2017 3772419-2432
8
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Mortality bull Approximately 50
These people are dying from pump failure in an era when we clearly have mechanical pumps available that restore flow reliably
11
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Lack of Institutional protocols for treatment of AMICS with MCS bull Haphazard at best nationally bull Develop a TEAM Concept
The trial protocol allowed for the insertion of a ventricular assist device on the basis of the investigators clinical judgment Currently there are no well-defined clinical criteria for the insertion of ventricular assist devices and scientific evidence is scarce
N Engl J Med 2012 3671287-1296
12
Timing Is Everything
bull Strict time limits in all situations bull Lessons from Shock Trauma
13
The Golden Hour
wwwamazoncouk
14
MCS ACUTE THERAPY
BUNCr ndash 6164 ASTALT ndash 1416660 TBILI - 41
The current systems PHP and ECMO and How They are Used
J Am Coll Cardiol Intv 20169871ndash83
J Am Coll Cardiol Intv 20169871ndash83
Extra-Corporeal Support
21
21- 23 Fr 5 ndash 9 Fr
15 ndash 19 Fr
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
8
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Mortality bull Approximately 50
These people are dying from pump failure in an era when we clearly have mechanical pumps available that restore flow reliably
11
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Lack of Institutional protocols for treatment of AMICS with MCS bull Haphazard at best nationally bull Develop a TEAM Concept
The trial protocol allowed for the insertion of a ventricular assist device on the basis of the investigators clinical judgment Currently there are no well-defined clinical criteria for the insertion of ventricular assist devices and scientific evidence is scarce
N Engl J Med 2012 3671287-1296
12
Timing Is Everything
bull Strict time limits in all situations bull Lessons from Shock Trauma
13
The Golden Hour
wwwamazoncouk
14
MCS ACUTE THERAPY
BUNCr ndash 6164 ASTALT ndash 1416660 TBILI - 41
The current systems PHP and ECMO and How They are Used
J Am Coll Cardiol Intv 20169871ndash83
J Am Coll Cardiol Intv 20169871ndash83
Extra-Corporeal Support
21
21- 23 Fr 5 ndash 9 Fr
15 ndash 19 Fr
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
11
ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
bull Lack of Institutional protocols for treatment of AMICS with MCS bull Haphazard at best nationally bull Develop a TEAM Concept
The trial protocol allowed for the insertion of a ventricular assist device on the basis of the investigators clinical judgment Currently there are no well-defined clinical criteria for the insertion of ventricular assist devices and scientific evidence is scarce
N Engl J Med 2012 3671287-1296
12
Timing Is Everything
bull Strict time limits in all situations bull Lessons from Shock Trauma
13
The Golden Hour
wwwamazoncouk
14
MCS ACUTE THERAPY
BUNCr ndash 6164 ASTALT ndash 1416660 TBILI - 41
The current systems PHP and ECMO and How They are Used
J Am Coll Cardiol Intv 20169871ndash83
J Am Coll Cardiol Intv 20169871ndash83
Extra-Corporeal Support
21
21- 23 Fr 5 ndash 9 Fr
15 ndash 19 Fr
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
12
Timing Is Everything
bull Strict time limits in all situations bull Lessons from Shock Trauma
13
The Golden Hour
wwwamazoncouk
14
MCS ACUTE THERAPY
BUNCr ndash 6164 ASTALT ndash 1416660 TBILI - 41
The current systems PHP and ECMO and How They are Used
J Am Coll Cardiol Intv 20169871ndash83
J Am Coll Cardiol Intv 20169871ndash83
Extra-Corporeal Support
21
21- 23 Fr 5 ndash 9 Fr
15 ndash 19 Fr
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
13
The Golden Hour
wwwamazoncouk
14
MCS ACUTE THERAPY
BUNCr ndash 6164 ASTALT ndash 1416660 TBILI - 41
The current systems PHP and ECMO and How They are Used
J Am Coll Cardiol Intv 20169871ndash83
J Am Coll Cardiol Intv 20169871ndash83
Extra-Corporeal Support
21
21- 23 Fr 5 ndash 9 Fr
15 ndash 19 Fr
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
14
MCS ACUTE THERAPY
BUNCr ndash 6164 ASTALT ndash 1416660 TBILI - 41
The current systems PHP and ECMO and How They are Used
J Am Coll Cardiol Intv 20169871ndash83
J Am Coll Cardiol Intv 20169871ndash83
Extra-Corporeal Support
21
21- 23 Fr 5 ndash 9 Fr
15 ndash 19 Fr
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
The current systems PHP and ECMO and How They are Used
J Am Coll Cardiol Intv 20169871ndash83
J Am Coll Cardiol Intv 20169871ndash83
Extra-Corporeal Support
21
21- 23 Fr 5 ndash 9 Fr
15 ndash 19 Fr
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
J Am Coll Cardiol Intv 20169871ndash83
J Am Coll Cardiol Intv 20169871ndash83
Extra-Corporeal Support
21
21- 23 Fr 5 ndash 9 Fr
15 ndash 19 Fr
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
J Am Coll Cardiol Intv 20169871ndash83
Extra-Corporeal Support
21
21- 23 Fr 5 ndash 9 Fr
15 ndash 19 Fr
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
Extra-Corporeal Support
21
21- 23 Fr 5 ndash 9 Fr
15 ndash 19 Fr
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
J Am Coll Cardiol Intv 20169871ndash83
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
Publications ECMO
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
The TandemHearttrade Percutaneous Ventricular Assist Device (pVAD) differs from other assist devices in that it can be inserted either by cardiovascular surgeons in the operating room or by cardiologists in the cardiac catheterization laboratory
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
J Am Coll Cardiol Intv 20169871ndash83
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
New European Technology
The need for immediate mobile compact life-sustaining resuscitation occurs on a daily basis
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
31
Market
- turning lives around -
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
32
Impella AKA HM II on a Stick
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
Inflowoutflow cannula configurations for the TandemHeart and Impella Recover 25 percutaneous ventricular assist devices (PVADs)
Biswajit Kar et al Circulation 20121251809-1817
Copyright copy American Heart Association Inc All rights reserved
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
Percutaneous Circulatory Support in Cardiogenic Shock
by Biswajit Kar Sukhdeep S Basra Nishant R Shah and Pranav Loyalka
Circulation Volume 125(14)1809-1817
April 10 2012
Copyright copy American Heart Association Inc All rights reserved
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
Mechanically Unloading the Left Ventricle Before Coronary Reperfusion Reduces Left Ventricular Wall Stress and Myocardial Infarct Size
Clinical Perspective
by Navin K Kapur Vikram Paruchuri Jose Angel Urbano-Morales Emily E Mackey Gerard H Daly Xiaoying Qiao Natesa Pandian George Perides and Richard H Karas
Circulation Volume 128(4)328-336
July 23 2013
Copyright copy American Heart Association Inc All rights reserved
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
A Swine model of acute myocardial infarction (MI) and MI with activation of a percutaneous left atrialndashtondashfemoral artery (pLA-FA) centrifugal bypass pump after 120 minutes of left anterior descending artery (LAD) occlusion with persistent occlusion of the LAD for an
additional 30 minutes followed by 120 minutes of reperfusion
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
Changes in pressure-volume (PV) loops during myocardial infarction (MI) with and without mechanical unloading
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
Three-dimensional echocardiography strain analysis
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
Reperfusion injury salvage kinase pathway activation
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
Myocardial infarct quantification
Navin K Kapur et al Circulation 2013128328-336
Copyright copy American Heart Association Inc All rights reserved
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
Hypothermia
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock
Am J Cardiol 2017119845e851
287 consecutive unselected patients enrolled in the catheter-based ventricular assist device registry presenting with AMICS who underwent percutaneous coronary intervention (PCI) were included in this analysis
Survival was 66 when MCS was initiated lt125 hours from shock onset 37 when initiated within 125 to 425 hours and 26 when initiated after 425 hours (p [ 0017)
Survival was 68 46 35 35 and 26 for patients requiring 0 1 2 3 and gt= 4 inotropes before MCS support respectively (p lt0001)
MCS implantation early after shock onset before initiation of inotropes or vasopressors and before PCI is independently associated with improved survival in patients presenting with AMICS
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
1 Myocardial Unloading in AMICS is a good Thing 2 Organism vs Organ 3 Avenue Enabler of Novel Therapy to increase
Myocardial Salvage
Recognition of Current limitations of Technology and Clinical Paradigms Structure
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
46
Cardiogenic Shock
bull Paradigm Shifts
bull It is no longer about the Heart bull VADs do nothing detrimental to myocardial recovery ndash
instead they actually promote myocardial recovery bull Why wait to pull the trigger bull Thinking outside the Box
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
bull Perspective bull Evolving strategies in the treatment of acute myocardial infarction-induced cardiogenic shock bull Vakhtang Tchantchaleishvili Heidi Schubmehl Michael F Swartz William Hallinan H Todd Massey bull Division of Cardiac Surgery University of Rochester Medical Center Rochester New York USA
Correspondence to H Todd Massey MD University of Rochester Medical Center School of Medicine and Dentistry 601 Elmwood Ave Box SURG Rochester NY 14642 USA Email Todd_MasseyURMCRochesteredu
bull Despite advances in medical technology and re-vascularization interventions the mortality rate for cardiogenic shock (CS) following acute myocardial infarction has remained at 50 The majority of these mortalities are from left ventricular failure resulting in multi-system organ dysfunction The field of mechanical circulatory support (MCS) has evolved within the past decade with improved outcomes from extracorporeal membrane oxygenation as well as continuous-flow left ventricular assist devices (CF LVADs) In this paper we discuss our institutional treatment strategies the rationale for the protocol development and our improved outcomes when using MCS in patients with refractory CS following acute myocardial infarction
bull Keywords Cardiogenic shock (CS) acute myocardial infarction ventricular assist device (VAD) mechanical circulatory support (MCS)
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
August 2011Volume 17 Issue 8 Supplement Page S108
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
130 retrospective patients AMICS
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
00
200
400
600
800
30-Day 90-Day6-Month
HM-II LVAD
Other MCS Device
SHOCK TrialEmergentRevascularization
SHOCK InitialMedical Stabilzation
Comparison of Mortality in Treatment of Cardiogenic Shock
HM II 62 6262 OTH MCS 422517614 SHOCK RX 56 63 SHOCK IRA 47 50
30d 6 mo 1 yr
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
Kaplan-Meier survival was 827 at 6 months and 739 at 12 months J Thorac Cardiovasc Surg 20181551059-68
Retrospective review of 43 consecutive patients with refractory shock caused by acute myocardial infarction (n=21) or acute decompensated heart failure (n = 22) who were treated with primary implantation of a durable LVAD in a single institution
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
Summary Acute Support bull You must be comfortable with three facts
bull 5-7 of STEMIs will have Shock bull The hospital mortality for Shock in the setting of AMI ACS is 50 bull Early institution of modern mechanical circulation will yield
outcomes better than 50 bull Institutions must have a pre-identified process recognizing
and supporting patients
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
The Journal of Thoracic and Cardiovascular Surgery c Volume 155 Number 4
In light of the recent UNOS changes in heart allocation continued prospective clinical outcomes studies will be important to confirm that reductions in wait list mortality by using VA-ECMO as BTT are balanced with satisfactory posttransplant outcomes If not good then we should go VAD
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-
In the whole cohort 176 (605) patients listed for high-urgent HT were discharged alive from hospital Cumulative rates of survival from listing to hospital discharge in patients with T-LVADsT-BiVADs and VA-ECMO were 786 558 and 544 respectively (P = 0002)
- MCS and Heart Transplant in Acute MI Cardiogenic Shock
- CARDIOGENIC SHOCK
- Acute MI complicated by Cardiogenic Shock
- Slide Number 4
- Mortality After Emergent Percutaneous Coronary Intervention in Cardiogenic Shock Secondary to Acute Myocardial Infarction and Usefulness of a Mortality Prediction ModelThe American Journal of Cardiology Volume 96 Issue 1 1 July 2005 Pages 35-41
- Slide Number 6
- Slide Number 7
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Slide Number 9
- Slide Number 10
- ACUTE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK
- Timing Is Everything
- The Golden Hour
- MCS
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Extra-Corporeal Support
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Publications ECMO
- Slide Number 27
- Slide Number 28
- Slide Number 29
- New European Technology
- Market
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Cardiogenic Shock
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Summary Acute Support
- Slide Number 54
- Slide Number 55
- Slide Number 56
- Slide Number 57
-