2010ESC心室辅助装置治.pptVIP

The Best Choice of LVADs Treating Herart Failure--2010ESC guide-line When it’s late, but not “too late” in heart failure : Ventricular Assist Devices. VADs VADs Step 1: Evaluating the patient and the full extent of the heart failure syndrome.Step 2: The choice of VADs(the right pump for the right patient) The good news Lots of pumps to choose from The bad news Limited availability at most hospital Comparative trails infrequent Physician preference clouds a lot of the discussion. Temporary support: Background Cardiogenic shock -Compromise of cardiac output leading to end-organ hypo-perfusion. -Complex cascade of end-organ dysfunction combined with activation of inflammatory pathways. -Complicates about 7% of ST segment elevation MI and 2.5% of non-STsegment elevation MI. Who would benefit from temporary support? Acute cardiogenic shock -Acute myocardial infarction -Acute myocarditis -Complications post MI: Papillary muscle rupture and ventricular septal defect Post cardiotomy failure Acute on chronic (end-stage) heart failure Electrical “storm” or post-VT ablation Drug overdose with myocardial depression Hypothermia The pump choices for the acutely ill patient Advantages of Percutaneous Device Placed quickly Avoid need for “open surgery” Placed at many centers even those without VAD or transplant program More easily removed in setting of recovery Placed by interventional cardiologists and surgeons Allow for recovery or transport to another center Disadvantages of percutaneous Devices Bleeding Limited to left ventricular support (except ECMO) Not for biventricular support Not for RV support Ventricular arrhythmias Ischemic limb Unable to mobilize or rehab Sepsis ECMO ECMO-Advantages Cardio-pulmonary bypass Can be placed peripherally (without thoracotomy) The only percutaneous option for biventricular support The only option in the setting of lung injury E