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What is (are) the correct proposition(s) about LVAD ? A) Long-term LVAD decreases cardiac myocytes hypertrophy B) Decreases SRAA activation at the cellular level C) Favors left ventricle inverse remodeling D) Inverse remodeling with continuous flow is > pulsatile flow E) Despite inverse remodeling at the cellular level, myocardial repair with LVEF normalization is scarce
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Cardiac assistance: role of haemodynamics
January 14th, 20168h30-10h
What is (are) the correct proposition(s) about LVAD ?
A) Long-term LVAD decreases cardiac myocytes hypertrophy
B) Decreases SRAA activation at the cellular level
C) Favors left ventricle inverse remodeling
D) Inverse remodeling with continuous flow is > pulsatile flow
E) Despite inverse remodeling at the cellular level, myocardial repair with LVEF normalization is scarce
What is (are) the correct proposition(s) about LVAD ?
A) Long-term LVAD decreases cardiac myocytes hypertrophy
B) Decreases SRAA activation at the cellular level
C) Favors left ventricle inverse remodeling
D) Inverse remodeling with continuous flow is > pulsatile flow
E) Despite inverse remodeling at the cellular level, myocardial repair with LVEF normalization is scarce
Kato T et al. Circ Heart Fail 2011; 4: 546
Inverse LV remodeling : comparison between pulsatile (P) and continuous (C) flow LVAD
Echocardiographic data evolution(n=61 patients):
What are the predictive factors of good prognosis after LVAD leading to withdrawal?
A) A younger age
B) Non ischemic aetiology (e.g idiopathic DCM)
C) A shorter length of LVAD
D) A continuous flow LVAD versus pulsatile flow
E) Faith
What are the predictive factors of good prognosis after LVAD leading to withdrawal?
A) A younger age
B) Non ischemic aetiology (e.g idiopathic DCM)
C) A shorter length of LVAD
D) A continuous flow LVAD versus pulsatile flow
E) Faith
Of note: LVAD withdrawal= 25% after pulsatile flow versus 3.3% after continuous flow
Krabatsch T et al. Ann Thor Surg 2011; 91: 1335)
Which anticoagulant and antiagregant treatment after HeartMate II or HeartWare?
A) AVK (INR 2-3)
B) AVK (INR 2,5 à 3,5)
C) AVK (INR 2-3) + aspirin
D) AVK (INR 2-3) + aspirin + clopidogrel
E) Aspirin + clopidogrel
Which anticoagulant and antiagregant treatment after HeartMate II or HeartWare?
A) AVK (INR 2-3)
B) AVK (INR 2,5 à 3,5)
C) AVK (INR 2-3) + aspirin
D) AVK (INR 2-3) + aspirin + clopidogrel
E) Aspirin + clopidogrel
INR range after HeartMate II or HeartWare
Device INR rangeAbioCor TAH 2.5-3.5HeartMate II 2.0-3.0HeartWare HVAD 2.0-3.0MicroMed DeBakey 2.5-3.5Syncardia TAH 2.5-3.5Thoratec IVAD 2.5-3.5Thoratec PVAD 2.5-3.5
a) Cournand
b) Rickets et Abrams
c) Gruentzig
d) Campeau
e) Igaki-Tamai
Match the discovery and their discoverer(s)
1) development of the radial route
2) 1st bioabsorbable coronary stent implantation
3) conception of the 1st intra-arterial probe
4) 1st coronary balloon angioplasty
5) 1st coronary angiography through percutaneous transfemoral approach
C: a3; b5; c4; d1; e2
B: a1; b4; c5; d3; e2
A: a4; b5; c3; d1; e2
D: a5; b2; c4; d1; e3
a) Cournand
b) Rickets et Abrams
c) Gruentzig
d) Campeau
e) Igaki-Tamai
Match the discovery and their discoverer(s)
1) development of the radial route
2) 1st bioabsorbable coronary stent implantation
3) conception of the 1st intra-arterial probe
4) 1st coronary balloon angioplasty
5) 1st coronary angiography through percutaneous transfemoral approach
C: a3; b5; c4; d1; e2
B: a1; b4; c5; d3; e2
A: a4; b5; c3; d1; e2
D: a5; b2; c4; d1; e3
1) Gruentzig : 1st coronary balloon angioplasty
2) Igaki-Tamai : 1st bioabsorbable coronary stent implantation
3) Cournand : conception of the 1st intra-arterial probe
4) Campeau : development of the radial route
5) Rickets et Abrams : 1st coronary angiography through percutaneous transfemoral approach
And now classify them by chronologic order!Oldest
NewestC: 3; 5; 4; 1; 2
D: 1; 4; 5; 3; 2
A: 1; 2; 3; 4; 5
B: 3; 5; 1; 4; 2
1) Gruentzig : 1st coronary balloon angioplasty
2) Igaki-Tamai : 1st bioabsorbable coronary stent implantation
3) Cournand : conception of the 1st intra-arterial probe
4) Campeau : development of the radial route
5) Rickets et Abrams : 1st coronary angiography through percutaneous transfemoral approach
And now classify them by chronologic order!Oldest
NewestC: 3; 5; 4; 1; 2
D: 1; 4; 5; 3; 2
A: 1; 2; 3; 4; 5
B: 3; 5; 1; 4; 2
Cournand : conception of the 1st intra-arterial probe
Rickets et Abrams : 1st coronary angiography through percutaneous transfemoral approach
Gruentzig : 1st coronary balloon angioplasty
Campeau : development of the radial route
Igaki-Tamai : 1st bioabsorbable coronary stent implantation
And now classify them by chronologic order!
1941
1962
1977
1989
1999
What is (are) the contra-indication(s) to LVAD implantation?
A) Aortic bioprosthesis
B) Aortic mechanical prosthesis
C) Mitral bioprosthesis
D) Mitral mechanical prosthesis
E) Patent foramen ovale (PFO)
What is (are) the contra-indication(s) to LVAD implantation?
A) Aortic bioprosthesis
B) Aortic mechanical prosthesis
C) Mitral bioprosthesis
D) Mitral mechanical prosthesis
E) Patent foramen ovale (PFO)
Explanations
Aortic mechanical prosthesis: risk of thrombosis due to decreased transprothetic flow
Patent foramen ovale (PFO): refactory hypoxemia due to a right-left shunt induced by LV discharge
Patient with HFpEF Vs HFrEF are more frequently:
A) Men
B) Obese
C) In atrial fibrillation
D) With a coronary artery disease
E) Anemic
Patient with HFpEF Vs HFrEF are more frequently:
A) Men
B) Obese
C) In atrial fibrillation
D) With a coronary artery disease
E) Anemic
Characteristics Reduced EF (n=2429)
Preserved EF (n=2167)
P Value
Age (yr) 71.7±12.1 74.4±14.4 <0.001
Male sex (%) 65.4 44.3 <0.001
Obesity (%) 35.5 41.4 0.007
Hemoglobin on admission (g/dl) 12.5±2.0 11.8±2.1 <0.001
Coronary artery disease (%) 63.7 52.9 <0.001
Atrial fibrillation (%) 28.5 41.3 <0.001
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Adapted from Owan TE, NEJM 2006;355:251-59
Patient with HFpEF Vs HFrEF are more frequently:
Which proposition(s) about fractional flow reserve (FFR) is/are correct?
A) FFR= Aortic pressure/ distal coronary pressure
B) FFR between 0.6 and 0.8= grey zone, no diagnosis
C) FFR < 0.8 = ischemia
D) FFR measurement must be done when the valves are closed
E) FFR measurement must be done after Risordan injection
Which proposition(s) about fractional flow reserve (FFR) is/are correct?
A) FFR= Aortic pressure/ distal coronary pressure
B) FFR between 0.6 and 0.8= grey zone, no diagnosis
C) FFR < 0.8 = ischemia
D) FFR measurement must be done when the valves are closed
E) FFR measurement must be done after Vasopressin injection
FFR in practice
Tonino et al JACC 2010 - De Bruyne FAME 2 Nejm 2014
FFR : major role for coronary lesion functional classification
In which situations should we decrease the speed of the LVAD pump?
A) Digestive Haemorrhage
B) Sepsis
C) No aortic cusps opening
D) Suction phenomenon
E) Suspicion of pump thrombosis
In which situations should we decrease the speed of the LVAD pump?
A) Digestive Haemorrhage
B) Sepsis
C) No aortic cusps opening
D) Suction phenomenon
E) Suspicion of pump thrombosis
Explanations
Digestive Haemorrhage: decrease of shear stress may be responsible for acquired Willebrandt syndrom
No aortic cusps opening : risk of cusps fusion with thrombosis
Suction phenomenon: favoured by hypovolemia in case of too high speed of pump