更多经皮瓣膜介入治疗循环支持课件.ppt

More Percutaneous Valves:Circulatory Support Eric E. Roselli, MD Disclosure Medtronic Consultant Edwards Investigator Direct Flow Medical Consultant Rapid Ventricular Pacing Valve Deployment REVIVAL II TransapicalTechnical Success 87.5% Migration / Embolization 12.5% Failure to cross 0 Mean deployment time 11.7 min Mean procedure time 87.1 min Accurate Deployment is Critical Lessons Learned Reoperation is not an independent predictor of mortality in conventional cardiac surgery RESCUE What is the role of circulatory support in transcatheter AVR? RESCUE Indications for Rescue in Transcatheter AVR Hemodynamic Instability Coronary impingement Severe AI after BAV Ascending aorta or annulus injury Circulatory Support Options Full Cardiopulmonary Fem-fem bypass ECMO Biomedicus centrifugal pump Tandem heart Case 83 y/o female Severe symptomatic AS Valve area 0.6cm Severe COPD, h/o CVA, renal insufficiency, PVD, frail Underwent transfemoral AVR – 23mm Hypotension did not recover Echo showed dilatation and severe LV dysfunction Is there another role for circulatory support during transcatheter AVR? Corevalve Results 91 - 97% technical success Gradients ~50 ? 5mmHg 14% 2+ AI PPM 9-25% Mortality 15% Feasibility trial 9% CE mark Registry In select high risk patients, there may benefit to unloading the LV with circulatory support Conclusions Transcatheter AVR has become a technically successful off-pump procedure Prime role for circulatory support is to facilitate RESCUE from life-threatening complications NYHA class, Prior CABG, and MR 2+ trend as predictors of death in TAVR There may be a role for LA-Fem partial bypass (TandemHeart) in these high risk patients * * * * * * * * * * Prior CABG is a significant predictor of mortality * * * * * Relevant disclosures are listed here And the valve is deployed by balloon inflation. * * * * * * * * * Prior CABG is a significant predictor of mortality * * * Balloon Valvuloplasty Unable to cross - 3 161 Pati