Clinical effectiveness and requirements of pulsatile flow perfusion with a centrifugal pump
|
|
Y.J. Gu, MD, PhD. University Medical Centre Groningen, Groningen, The Netherlands. |
|
Cardiopulmonary bypass has been successfully applied during open-heart surgery for more than half of century for treating patients suffering from various types of heart diseases1. However, patients who have experienced cardiopulmonary bypass are still vulnerable to postoperative complications and organ dysfunction as a result of poor organ perfusion2-4. For optimal organ perfusion during cardiopulmonary bypass, the pulsatile perfusion flow is considered more physiological than the non-pulsatile flow5-8. For more than three decades, several types of pulsatile pumps have been introduced and undergone extensive evaluations either in animal experiments or in cardiac surgical patients. These pumps include the modified roller pump head that allows rapid acceleration and deceleration9,10, the pulsatile assist device or pulsator to add pulsation on the arterial line11,12, the intra-aortic balloon pump or pulsatile catheter pump to produce pulsatility to the flow from within the aorta13,14, and the centrifugal pump to make periodical acceleration of the pump speed15,16 |
|
|
|
|
|
|
|
Analyse van de hemodynamica van continue LVAD’s.
|
|
Ir. W. Sleegers, KPIO. Academisch medisch centrum Amsterdam. |
|
De HeartMate II continue LVAD wordt bij patiënten met eind stadium hartfalen geïmplanteerd, waarbij het natieve hart nog slechts een geringe tot geen contractie meer heeft. Bij deze patiënten is hartfunctie monitoring tijdens ondersteuning met een dergelijk assist device een moeilijke zaak. Daarnaast is het zo dat bij de HeartMate II geen informatie over de prestaties gegeven worden die direct gemeten zijn, er wordt een schatting van de geleverde flow gegeven en daarbij ook een pulsatility index die hierop gebaseerd is. Het is dan ook erg interessant om te gaan kijken wat nu de werkelijke prestaties van de HeartMate II zijn en wat waardes van bijvoorbeeld de pulsatility index nu werkelijk voorstellen. |
|
|
|
|
|
|
|
A Systematic Review and Meta-analysis of Intra Aortic Balloon Pump Therapy in ST-elevation Myocardial Infarction. Should we change the Guidelines?
|
|
K.D. Sjauw. Cardiology fellow, Academic Medical Center, University of Amsterdam. |
|
Abstract
The body of evidence supporting IABP therapy in STEMI and in STEMI with cardiogenic shock remains limited. We conducted two meta-analyses respectively comparing IABP therapy with no IABP therapy for the treatment of STEMI and the treatment of STEMI complicated by cardiogenic shock. The principal findings of the meta-analysis of randomized clinical trials of IABP therapy in STEMI showed no efficacy benefit of adjunctive IABP therapy. We neither observed a 30-day survival benefit nor improved left ventricular ejection fraction. Instead, IABP therapy was associated with a significant absolute increase in the rates of stroke and bleeding of respectively 2% and 6%. These clinically relevant higher complication rates are not outweighed by any clinical benefit. |
|
|
|
|
|
|
|
|
|
José P. S. Henriques, MD, PhD. Cardiologist, head of dept. cardiac catherisation, University Medical Centre Amsterdam. |
|
In-hospital mortality rates of STEMI complicated by CS are around 50%, despite reperfusion by primary percutaneous coronary intervention (PCI). The IABP was introduced in the setting of CS in 1968 and is still the most frequently used method of mechanical cardiac assistance. However, IABP therapy has failed to show clinical benefit in STEMI patients. Impella technology offers the opportunity for mechanical LV support in many clinical settings. Both the Impella 2.5 and the percutaneously implantable Impella 5.0 may be a preliminary answer to the need for a minimally invasive and easy cardiologist, head of dept. cardiac catherisation, University Medical Centre Amsterdamdeployable mechanical assist device that provides superior hemodynamic support compared to IABP. After four decades of IABP support, the development and increasing clinical experience with percutaneous left ventricular assist devices heralds the dawn of a new era of superior hemodynamic support to eventually improve outcome in STEMI patients with and without CS. |
|
|
|
|
|
|
|
Opvang van acuut en verergerd chronisch hartfalen in Rotterdam.
|
|
Drs. R.J. van Thiel. Internist-intensivist Erasmus Medisch Centrum Rotterdam. |
|
In 1999 zijn we in Rotterdam begonnen met het gebruik van ventrikel assist devices. Initieel met de Abiomed BVS 5000 voor acute ondersteuning voor links en/of rechts, en met de Heartmate VE LVAD voor meer chronische ondersteuning. Van de 6 acute patiënten heeft 1 het overleefd, na 2 weken ondersteuning, en van de 4 Heartmate patiënten zijn er 2 naar huis ontslagen. Vanwege dit beperkte succes, en omdat de financiering op het afdelingsbudget drukte, heeft het programma tussen 2001 en (eind) 2004 stil gelegen. Nadien werd er een financieringsregeling getroffen, en hebben wij het programma herstart. |
|
|
|
|
|
|
|
0902_a1.pdf