Ventricular Assist Devices

Dr. Kewal Krishan MBBS MS MCh DNB MNAMS FIACS (CTVS)Advanced Fellow, Mayo Clinic & Mount Sinai, USA

Program Head, Heart Transplant & Ventricular Assist Devices

Senior Consultant Cardiac Surgeon

Max Superspeciality Hospital, Saket, NewDelhi

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Advanced Heart Failure - Definition

Patients have significant cardiac dysfunction and marked symptoms: dyspnea, fatigue end-organ hypoperfusion at rest or with minimal exertion despite maximal medical

therapy AHA Stage D Refractory symptoms requiring specialized

interventions to manage symptoms or prolong lifeGoodlin et al, Journal of Cardiac Failure Vol. 10 No. 3 2004Hunt SA et al JACC 2001;38:2101–13.

INTERMACS Profiles 1-3 Interagency Registry for Mechanical Circulatory Support

‘Frequent Flyer’Stevenson, JHLTX; 09:535

INTERMACS Profiles 4-7

Stevenson, JHLTX; 09:535

‘Housebound’

‘Class IIIb’

Deg

ree

of C

ircul

ator

y Su

ppor

t

IABP

PARTIAL SUPPORTCI* ↑15% CI ↑30-60%

ECMO

+

FULL SUPPORTCI ↑100%

Levitronix CentriMagAbiomed BVS 5000Abiomed AB 5000Abiomed Impella 5.0 LP Abiomed Impella 5.0 LD

TandemHeart pVADAbiomed Impella 2.5 LP

Short-term MCS Devices

*CI – cardiac index

VAD Components

Inflow cannula

Outflow Graft

Percutaneous drive line

Pump

HEART WARE

• Weigh 145 gms• Pumps 4-5 liter/min• No pocket required• Under clinical trial

Peripherals

Circulite

HeartMate II® Left Ventricular Assist System

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CASE 1

Mr. SDC a 38 yr old man Kn case of Dilated CMP with AICD x 2yrs Admitted to another hospital, He was put on ventilator due

to pul.edema and was in multiorgan failure. He was told he would die in next few hrs. I received call if emegernt extracorporeal LVAD can be

considered Transferred the patient to our hospital IV infusions( inotropes/Swan/ IABP was inserted to

optimise him as he had fever(39.5)

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CASE 1

Lab at admission were TLC 24000, Cr.7.8 Urea 272, SGOT/PT 8700/5660 Neurological status was unknown. CRRT started for high Cr. – Remained for 4 days and Cr.

Came down to 2.2 After 2 days he woke up On esmolol infusion for VT Started recovering and 2 options were discussed with

family Heart Transplant and LVAD Becoz of Puacity of organ donation LVAD looked more

appropriate

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CASE 1

Inotopes weaned to minimal/ Esmolol stopped/ With the anticipation of putting LVAD IABP was removed

to avoid intravascular lines. 3 hrs after removal of IABP – Crashed - Reintubated—

IABP reinserted LVAD was implanted after few days on Feb 16. IABP was removed - All inotropes weaned off – Moved to

Room Had post op AF –settled with pharmacotherapy Discharged home after 3 wks of surgery.

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19CT AORTOGRAM

20CT AORTOGRAM

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Case 2

36 yrs old young man Kn cae of dilated cardiomayopathy since Aug 2013.

CRT was not offerred becoz of narrow QRS complex Had 2 episodes of acute heart failure with abnormal

labs. Airlifted few days ago to another hospital for

pulm.edema Labs showed raised LFT and RFT and low perfusion

state.

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Case 2

Advised LVAD – shifted to our hospital IV inotropes /Swan /diretics – Medical optimization

Cardiac index at time of insertion was 0.75 Got better – LVAD implanted on March 12, 2015 Extubated next morning – Recovered uneventfully. Off inotropes/ Swan removed in 4 days Discharged home on POD 11

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Per operative View

Intracorporeal Ventricular assist device ( Heart Ware)

Short-Term Extracorporeal Assist DeviceDevi

Levitronix CentriMag

Magnetically-levitated centrifugal pump Continuous-flow rotary pump Electrical actuation– magnetic coupling of

the motor and impellor Capable of 6 ~ 9 L/min at 5500 RPM Left, Right, or Biventricular support Operative placement requiring sternotomy Bridge to recovery

Courtesy of Levitronix, Inc.

Extra Corporeal Membrane Oxygenation ( ECMO)

www.kewalkrishan.com

Thank you