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Perf Tech 3 > VADs > Flashcards

VADs Flashcards

0
Q

Development of balloon pump

A

1963

Followed Klaus’ atrial counter pulsation

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1
Q

First successful true VAD

A

1965 DeBakey
Pneumatically driven
Paracorporeal

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2
Q

First total artificial heart to temporarily support pt to transplant

A

1969 Cooley

Liotta heart

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3
Q

First permanent TAH

A

1982 University of Utah

Dr. William DeVries

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4
Q

First bridge to transplant decide

A

2004 Tucson

Dr. Olsen and Copeland

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5
Q

First successful BTT with LVAD

A

1984 Stanford University

Novacor

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6
Q

First FDA approved implantable LVAD

A

Heartmate

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7
Q

Biologic barriers to VAD design

A

Blood vs foreign surface
Moving parts
Patient coagulation and immune system in response to mechanical pump
Pharmacological modifications

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8
Q

Indications for BTT VAD

A

Worsening hemodynamics despite high level of IV inotropes and/or vasodilator therapy or refractor arrhythmias

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9
Q

Indications for destination therapy VAD

A

Not transplant candidates
EF <25%
NYHA class 4 symptoms despite optimal therapy

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10
Q

Contraindications to VADs

A 
High surgical risk
Recent stroke
Neurological deficits
Coexisting terminal condition
Abdominal aortic aneurysm
Active infection
Fixed pulmonary hypertension
Pulmonary dysfunction
Organ failure
Inability to tolerate anticoagulation 
HIT
Psychiatric illness
Lack of social support
Pregnancy
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11
Q

Design considerations for VADs

A

Configured for application
Anatomically compatible
Structurally stable in corrosive saline environment
Operative continuously without regular maintenance for years
Don’t fail under increased stress
Reduce power requirements to save battery
Efficient: reduce heat waste

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12
Q

2 kinds of VAD pumps

A

Positive displacement

Rotary

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13
Q

Positive displacement pumps

A 
Propel fluid by changing internal volume of pumping chamber
Pulsatile flow
One way valves
5-10LPM
BP: 100-150mmHg
HR: <120bpm
Mean filling pressure: 20mmHg
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14
Q

Throatec PVAD/IVAD

A

Supports right, left, or both ventricles

BiVAD common after transplant failure, cardiomyopathy, acute MI, myocarditis

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15
Q

Preop risks for right heart failure

A

Ability of RV to generate pressure

Low pulse pressure with high CVP (use BiVAD)

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16
Q

Indicators for BiVAD

A 
Early insertion of LVAD before significant organ failure
High preop bilirubin
High preop creatinine
Emergent implant
Intraop bleeding
Greater transfusion requirements
17
Q

Throatec PVAD/IVAD characteristics

A 
SV: 65mL 
2 mechanical valves
40-110 bpm
1.3-7.2LPM
Placed in anterior abdominal wall
External location suitable for small patients (BSA >.73m2)
18
Q

Pump considerations for implant of Throatec PVAD/IVAD

A 
Bicaval cannulation
Normothermic
No CPG or XC
LV vented
Ultrafiltrate to keep HCT greater than 30%
19
Q

Anticoagulation for Thoratec

A

Chronic warfarin
INR: 2.5-3.5
Start with heparin until PTT is 1.5x baseline, GI fxn stable, and low bleeding risk (10-14 days)
Switch to warfarin and ASA

20
Q

PVAD

A 
Paracorporeal
Bridge to transplant
Mean support: 51.8 days
Longest support: 3.3 years
Can be used in Peds
21
Q

IVAD

A 
Intracorporeal (implantable)
Used for longer term support 
Polished titanium body
Reduced weight
Narrower leads (9mm vs. 20mm)
22
Q

Heartmate XVE

A

Circulatory assist without anticoagulation
Has antiplatelet agent
Promotes pseudointimal layer
Con: immunologically active

23
Q

Characteristics of Heartmate XVE

A 
Positive displacement pump
Powered pneumatically or electrically 
Cannulate LV apex and ascending aorta
SV: 83mL
Flow: 4-10LPM
24
Q

Pseudointima

A

Thin layer ofnbiologic matrix that resists thrombogenesis
Composed of cellular elements, collagen,progenitor cells
Immunologically active
Promoted by Heartmate XVE

25
Q

Implantation of Heartmate XVE

A 
Dacron grafts must be preclotted
Placed interperitoneal or peritoneal pocket upper L quadrant
Leads exit to right
Must fix AI, MS, PFO 
Requires CPB
No CPG or cooling
BSA >1.5
Only use ASA
26
Q

Survival of Heartmate XVE BTT

A

65% survive to transplant

If survive first month, 85% success

27
Q

Micromed rotary pump

A

Limited foreign surface area
Few moving parts (reduces cost, more durable)
Axial flow
Small size so simple implantation and can be used on more patients

28
Q

Development of Micromed

A

Debakey and NASA
Europe
Has ultrasonic probe encircling outflow graft
Use Coumadin for anticoagulation

29
Q

Complication with Micromed

A

Fibrin deposition on impellar leading to thrombus

Treat with TPA and heparin

30
Q

Heartmate II

A 
Smaller than XVE
Axial flow
Electric motor 
Only moving part is magnetic rotor 
Must preclot Dacron grafts
Flow is ESTIMATE
31
Q

Implantation of Heartmate II

A

Below L costal margin under rictus abdominal muscle
Leave LV apex to diaphragm to pump
Approved for destination therapy

32
Q

Survival with Heartmate II

A

1 year: 68%

2 years: 58%

33
Q

VentrAssist

A

3rd generation

Not produced due to lack of funds

34
Q

Heartware HVAD

A

Small continuous flow rotary pump
Placed in pericardial cavity at LV apex
First human Implant in 2006

35
Q

DuraHeart LVAS

A

Continuous flow rotary pump
Upper hosing with levitation and impeller
Bottom housing has external drive motor
2-8LPM
1200-2400rpm
Placed in abdominal pocket
First device with centrifugal pump and magnetic levitation

36
Q

Levacor VAD

A

Bearing less centrifugal pump with impeller magnetically levitated
Implanted in small subcostal, pre-peritoneal space
Not approved

37
Q

Abiomed Impella 2.5/5.0

A

Intracatheter VAD

Pulls blood for LV tip to aorta

38
Q

Abiomed Abiocor

A

First completely self contained replacement heart
Up to 12LPM
Internal motor and rechargeable battery
External battery pack

39
Q

Tandem Heart

A

10cc centrifugal pump
8LPM
Cannula dependent
Floats on fluid bearing (10cc/hr saline drip into lower chamber that cools and lubricates)

40
Q

Syncardia TAH

A 
9.5 LPM through both ventricles
After stable, patient is considered 1a
6 moving parts
Never had a device failure 
All electronics outside body 
Pneumatic driver
41
Q

Berlin heart

A

BTT
Available for compassionate use
Stock all sizes in hospital

Perf Tech 3 (9 decks)

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