Perf Tech 3 Test 9 Flashcards
Rotary VAD (2nd Gen VAD)
- processes volume as it gets it, no pulsatile flow, no chambers to fill, axial flow design
- rotating impellers to propel blod forward
- supported with bearings
- powered by spinning shaft/magnetic forces
- problems= heat and bearings
Rotary VAD Dates
1960- first described continuous flow pump
1998- DeBakey and Noon= axial flow LVAD
1999= Jarvik 2000
2000- Nimbus/HM2 axial flow pump
Micromed
axial flow, smaller, easier, lower blood contact, less expensive/less parts
Heartmate II
- electric, smaller, same system monitor/PBU as HMXVE
- rotor spins with magnetic field on inlet and outlet of bearings (its the only movie part of pump)
- uses RUBY bearings
- flow is estimated! (by RPM and power consumption motor)- flow is not accurate below 3 l/min
- VSA 1.15 to 3.15
- implanted below L costal margin under rectus abdominus
- still goes through diaphragm
- issus- thrombus (can tell by increase power)- treat with TPA
HMII History
-developed in early 1990s at U of Pittsburg
Nimbus to ThermoCardiosystmes (98) to Thoratec (2001) to St. Jude Medical (2016)
REMATCH Trial
“randomized evolution of mechanical assistance for the treatment of congestive heart failure”
-Tested HMXVE vs. medical therapy alone
-1996
=found benefit at 1-2 year compared to medical therapy alone
-HMXVE approved for DT in 2002
HMII and Clinical Trials
HMII vs HMXVE
=end point was 2 years or adverse effect
-46% of HMII after 2 years had no adverse effects
-survival one year= 68%, two years= 58%
-HMII approved for BTT 2008 and DT in 2010
Heartware HVAD
- 3rd gen
- rotary pump with centrifugal and non contact bearing design (magnet) - thin layer of blood
- placed in pericardial cavity at apex= NO abdominal pocket
- first implant 2006
- Advance trial= approved for BTT in 2012
DuraHeart LVAS
- rotary pump with Levitation system and impeller
- does have abdominal pocket
Momentum 3 Trial
HMII vs HMIII for DT and BTT
Heartmate III
- fully levitated magnetic impeller= no friction
- pulsatile and textured surface= decrease clots
- implanted above diaphragm
Percutaneous Devices
1) Abiomed Impella 2.5/5.0= intracatheter VAD
2) Thoratec Heartmate Percutaneous Heart Pump= similar to impella but inflates from 13 FR to 24 Fr (used for emergencies and NOT for CABG)
Misc VADs
3) Tandem Heart= takes blood from LA and gives it femoral artery!= transseptal cannula (flow is cannula dependent)
- floats in fluid bearing to cool and lubricate
- integraded air bubble detector, device self diagnose
4) Berlin Heart (Excor)= BTT 2011, compassionate use only, pneumatic device
two types of Angioplasty
1) percutaneous transluminal coronary angioplasty (PTCA)
- bloon that inflate
2) Stent
Angioplasty Criteria
-bloon must pass through blockage and can be removed by catheter
-blockage can NOT be in left main
-patient can’t be in heart failure
-
Angioplasty Advantages and risks
adv= less invasive, lower risk/cost/anesthesia, percuatious incision, less recovery risk/complications= bleeding, damage by catheter, restenosis, vessel closure, clots (treat with aspirin and clopidogrel), infections, MI, emergency CPB -restenosis= 30-50% metal, 7-15% drug eluting
Drug Eluting Stents
1) Boston= Taxus= chemotherapeutic drug
2) Johnson and Johnson/Cordis= Sirolimus= immunosuppressive
3) Medtronic= Zotarolium= immunosuppressive
Atherectomy
= cutting out plaque (for calcified, fibrotic, hard plaque)
1) directional= cutting window- cuts and retrieves
2) Rotational= just spins/DIAMONDS- saline flush to cool= particles go down stream
3) Transluminal= cut and aspirate= lactated ringers and suction back
4) Laser
5) Transluminal Angiogenesis TMR= increase blood to areas that surgery/angioplasy can’t reach, uses CO2 laser
- go outside to inside and promotes new vessel growth
Surgical Techniques
off bypass= MIDCAB, OPCAB (beating heart), assisted PADCAB
- OPCAB= caution to life up heart, Medtronic Octopus 2, Ultima 2
- DaVinci Robotic
Percutaneous Mitral Valves
1) Abbot Mitraclip= first
2) Edwards Fortis= not is US
3) Neovasc= transapical insertion
4) Edwards Sapien XT= transapical (also for Aorta)
Percutaneous Aortic Valves
1) Edwards Sapien 3/XT= cow tissue and added skirt (with 3)
2) Medtronic CoreValve and Evolut R (smaller)= approved for failed bioprosteic valve= “valve-in-valve”
- increases survival and lowers stroke
3) Sorin Perceval
Percutaneous Valve Inserted at
transfemoral, transapical, subclavian , direct aortic
