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Ventricular Assist Device: An: Advanced Surgical Intervention For The Treatment of End Stage Heart Failure

ppt on ventricular assist device

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SATYAJIT CHOUDHURY am15d401
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46 views43 pages

Ventricular Assist Device: An: Advanced Surgical Intervention For The Treatment of End Stage Heart Failure

ppt on ventricular assist device

Uploaded by

SATYAJIT CHOUDHURY am15d401
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Ventricular Assist Device: An

Advanced Surgical
Intervention for the Treatment
of End Stage Heart Failure
Laura Coyle, MSN, ACNP-BC
VAD Coordinator
Advocate Christ Medical Center

Impact of Heart Failure with an Aging


Population
5+ million Americans*
Nearly 700,000 new cases per year*
More than 280,000 patients die of heart failure
in the US each year*
- 2nd highest mortality at one year with optimal
medical management

Impact of Heart Failure with an Aging Population


Nearly 250,000 patients are considered at high risk for
repeated hospitalizations
-More than 1 million hospitalized for worsening heart
failure at a cost of nearly 35 billion*
- 20% of hospitalizations are persons over 65*
Currently 100,000 patients have advanced end-stage heart
failure characterized by:
- frequent hospitalizations
- reduced quality of life
- a complex therapeutic regimen, and a high mortality
rate+
*Rosamond W, Flegal K, Furie K, et al. Heart Disease and stroke statistics 2008 update: a report from the American Heart Association Statistics
Committee and Stoke Statistics Subcommittee. Circulation. 2008: 117(4): 25-146
+American Heart Association. Heart Disease and Stroke Statistics: 2007 Update. Dallas, Texas: www.americanheart.org.

Progression of
Heart Failure

Natural History of Heart Failure


Class III
10

75
50

25
0

.1
I

II

III

IV

Hospitalizations / year

Annual Survival Rate

100

Deceased

NYHA CLASS
Adapted from Bristow, MR Management of Heart Failure, Heart Disease: A Textbook of Cardiovascular Medicine,
6th edition, ed. Braunwald et al.

25% of HF Patients

Frequent
hospitalizations

Worsening symptoms
despite drug therapy

Significant opportunity
for new therapies

Survival Rate
Hospitalizations

Treatment Options for Advanced


Heart Failure
Optimal Medical Therapy
Beta Blockers, ACE Inhibitors, ARBs, Aldosterone
Antagonists, Diuretic Therapy, Oral Nitrates and
Hydralazine, etc.

Electrophysiologic Testing and the Use of


Devices in Heart Failure
-Prophylactic ICD Placement
-Biventricular Resynchronization Pacing
2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of hEart Failure in Adults. J. Am. Coll.
Cardiol. Published March 26, 2009

Advanced Surgical Interventions for EndStage Heart Failure


Cardiac Transplantation
gold standard
-Severely limited by
shortage of donors; only
2,163 heart transplants
in 2008 in US*
Ventricular Assist
Device for Bridge to
Transplant or
Destination Therapy for
patients ineligible for
heart transplantation.
United States Department of Health and Human Services.
www.unos.org Accessed April 23, 2009.

What is a Ventricular Assist Device?


A ventricular assist device (VAD) is an
implantable device designed to partially replace
the function of the failing heart, restoring
circulation of blood flow to the body through
mechanical circulatory support.
VADs are designed to assist either the right
(RVAD) or left (LVAD) ventricle, or both at once
(BiVAD). Which of these types is used depends
primarily on the underlying heart disease and the
pulmonary arterial resistance that determines the
load on the right ventricle

Advanced Surgical Interventions for EndStage Heart Failure


Use of Left Ventricular
Assist Devices
- Bridge

to Decision
- Bridge to Recovery
- Bridge to Transplant
- Permanent Use for
Destination Therapy
Non Study Device
Implants

REMATCH Trail
Multi-Center Randomized Controlled Study
designed for patients in Class IV (NYHA) end
stage heart failure who did not qualify for a
heart transplant.
68 patients randomized to XVE HeartMate
LVAD
61 patients randomized to optimal medical
therapy

REMATCH Conclusion
DT

OMT
51% 1-year survival 28% 1-year survival
in the LVAD group
in the OMT
27% 2-year survival
in the LVAD group

10% 2-year survival


in the OMT

CHF Reunion
at One Year
OMM Therapy
Group
28 Alive

VAD Therapy Group


52 Alive

CHF Reunion
at Two Years
OMM Therapy
8 Alive

VAD Therapy
29 Alive

Beginning of Destination Rematch


Study Conclusion- Therapy
Risk from death from any cause was 48% lower in
the LVAD group
Using an LVAD in patients with advanced heart
failure improves survival and quality of life. An
LVAD is an acceptable alternative therapy in some
CHF patients
N Engl J Med 2001; 345:1435-1443, Nov 15, 2001

Improved survival and quality of life with a


LVAD

Long JW et al. Long-term Destination Therapy with the HeartMate XVE left Ventricular Assist Device: improved outcomes since the
REMATCH study. CHF. 2005;11:133-138.

Patient Selection: Who benefits from a VAD?


New York Heart Association (NYHA) Functional Class
III to IV or Refractory Heart Failure
Left Ventricular Ejection Fraction 25%
Peak VO2 < 14 ml/kg/min
Severe HF symptoms despite optimal medical therapy
Inability to tolerate medical therapy
Requiring inotropes
Do not respond to biventricular pacing
One or more heart failure related hospital admissions in
past 6 months
Ineligible for cardiac transplantation

Ventricular Assist Devices


Provide mechanical circulatory support to restore the
circulation of blood flow to the body.
Decreases preload
Decreases cardiac workload
Increases systemic circulation & tissue perfusion
Decreases neurohormonal response

Indications for Use


Bridge to Decision/ Postcardiotomy/Failure to wean
from Bypass
Bridge to Recovery
Bridge to Transplant
Permanent Use for Destination Therapy

Ventricular Assist Devices


A VAD runs on electrical power 24 hours a
day 365 days of the year.
Patients may connect to a power base unit to
provide consistent power or connect to a set
of batteries which must be changed every
few hours (varies per device) to maintain a
reliable power source. Patients must be
connected to power at ALL times.

Ventricular Assist Devices


There are several many
different VADs. All VADs have
the following four parts:
An inflow cannula which takes
blood from the ventricular to the
pump
A pump
An outflow cannula that takes the
pumped blood to the ascending
aorta
A power source for the pump

Types of Ventricular Assist Devices:


Pulsatile vs. Continuous Flow
Pulsatile VADs mimic the natural pulsing
action of the heart using positive
displacement
Device Specific preload/volume dependent

Continuous Flow normally use either a


centrifugal pump or an axial flow pump
Device Specific HVAD vs. HM II LVAD

Indications for Use:Pulsatile vs.


Continuous Flow
Pulsatile Devices
PVAD
IVAD
Heartmate XVE
LVAD
Continuous Flow
Heartmate II LVAD
Heartware HVAD

FDA Approved Devices for Bridge to


Transplant
PVAD/IVAD
Heartmate XVE LVAD
Heartmate II LVAD
Heartware HVAD (currently
undergoing clinical trials)
FDA Approved Device for
Destination Therapy
Heartmate XVE LVAD
Heartmate II LVAD (pending
FDA approval 2009-2010)

IVAD

PVAD

Biventricular Support

Portable TLC-II Driver

TLC-II Portable VAD Driver

TLC-II Interface and Control


Panel

Full Signal Inputs

Battery
A

External
Power

Computer
Input

Key
Switch

Battery
Clip

Urgent
Alarm

Pneumatic Connections

Battery
B

Message Display

Change External
Batt. A
Power
Light
Light

VAD Full
Lights

Mode
Button

Scroll
Button

Alarm
Silence
Button

Normal
Alarm

Change
Batt. B
Light

Heartmate XVE

Heartmate II

Components of a Ventricular Assist Device

Carry On Components of a Ventricular Assist Device


Power Base Unit
System Display Module
All Batteries
Emergency Power Pack
Back-up System Controller/Driver
Battery Module
Battery Clips
Battery Holster/Pocket Pack
Cell Phone
Daily Driveline Dressing Supplies
Emergency Contact Information
*Total Weight 72.5 lbs

Components of a Ventricular Assist Device

Heartware HVAD

HeartWare System Peripherals


IN THE HOSPITAL

HeartWare Monitor with pump


parameters & flow waveforms

AT HOME

HeartWare Controller with


LCD display, audible alarms and
30 day data storage

HeartWare Batteries & Charger:


2 Li-ION batteries last up to 12 hours

SO why want a Ventricular Assist Device?


IMPROVED Survival
-Improved end organ function
-Reduced hospitalizations for HF

IMPROVED Quality Of Life


-Return to normal activities of daily living
-Live independently
-Drive
-Work
-Travel

What They Look Like


CHF Infusion Clinic
Patient

VAD Referral in ICU

Enjoying a Ride on his


Motorcycle

Distance Traveled

Patient vacationing in
San Juan, Puerto Rico

Patient in Puerto Rico following instruction


to avoid bathes, swimming pools, and oceans

Patient enjoying the streets of


Madrid, Spain

Patient sightseeing in
Seattle, Washington

Patient visiting New


Orleans, Louisiana

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