DR SUVANKAR GHOSH BANKERS HEART INSTITUTE AND RESEARCH CENTRE Physiology Myocardial Oxygen Supply and Demand ab Goals of Hemodynamic Support During HighRisk PCI Types of Hemodynamic Support in the ID: 1038317
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1. HEMODYNAMIC SUPPORT IN PCI AND BEYONDDR. SUVANKAR GHOSHBANKERS HEART INSTITUTE AND RESEARCH CENTRE
2. Physiology Myocardial Oxygen Supply and Demanda,b
3. Goals of Hemodynamic Support During High-Risk PCI
4. Types of Hemodynamic Support in the Cath Lab
5. Hemodynamic Support Devices for the Cath Lab
6. Indications for Cath Lab Hemodynamic SupportCath Lab hemodynamic supportElective high-risk PCI PCI in Cardiogenic shock Impaired LV functionPCI to a single last patent conduit PCI of vessel(s) supplying a large myocardial territory Recent high-risk ACSHeterogeneous Non-atherosclerotic CADUnderlying LV impairment, scar, valvular disease or dysrhythmia
7. Percutaneous Cardiac Assist Devices (cont)
8. SCHEMATIC REPRESENTATION OF ECMO
9. Assist TreatmentsEffect on Myocardial Oxygen Demand
10. Pressure vs Flow DevicesMechanisms
11. Complementary Mechanisms
12. Patient SelectionIABPa
13. SCHEMATIC REPRESENTATION OF IABP
14. IABP Randomized TrialsCRISP AMI
15. IABP Randomized TrialsCRISP AMI Substudy
16. IABP Randomized TrialsBCIS-1
17. Patient Selection IABP (cont)
18. IABP in MISHOCK and SHOCK II Trials
19.
20. AFPPatients with ST-Segment Elevation AMI and/or Cardiogenic Shocka
21. SCHEMATIC REPRESENTATION OF IMPELLA
22. Individualizing Cardiac Support Therapy
23. Individualizing Cardiac Support Therapy (cont)
24. IABP vs AFP vs CFPTypical Practice Scenarios
25. Conclusions
26. Evidence for IMPELLA system
27. PROTECT II Trial Design
28. Procedural Characteristics
29. LVEF and NYHA Improvement Post PCI
30. PROTECT II: Per Protocol MAE (N=427)
31. PROTECT II MAE Outcome Pre-specified High Risk PCI Without Atherectomy Group Per Protocol (N=374)
32. USPELLA Registry: Impella® Insertion Timing (N= 154)O’Neill et al, J Interven Cardiol 2013;9999:1-11
33. Outcome: Impella Pre or Post PCI
34. Outcome By Support Strategy Survival to discharge
35. Conclusions Impella & IABP are most frequently used hemodynamic support devices in the cath lab that facilitate performance of high-risk elective PCI & during cardiogenic shock Impella provides better balance of efficacy, safety & feasibility during high risk PCI & provides superior hemodynamic support compared to IABP, especially if placed pre-PCI
36. A LOOK BEYOND: THE AORTIX DEVICE
37. A BEYOND LOOK: AORTIX REPRESENTATION
38.