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0:04
Shifting gears to
surgically placed
temporary mechanical
circulatory support.
0:12
We've talked about Impella,
but if we use a
larger introducer
sheath to house a
larger, a pigtail drain,
then these patients
are going to need
surgical cutdown for insertion.
Indications for the
Impella 5.0/5.5,
a high risk percutaneous
coronary intervention,
cardiogenic shock,
and these are placed femoral
most often and are going to
drain again the
left ventricle and
the outflow into the aorta
like the Impella CP,
but this Impella 5.0/5.5 handles
a larger amount of volume
at greater than five
liters per minute.
Recent studies indicate
improved mortality
with the use of the
Impella 5.0/5.5 higher flows
and higher cardiac output.
1:08
The CentriMag can be used for
left ventricular assist
device or it can be used for
biventricular support
as well. When it's
used with ECMO as a pump itself.
So, indications for the
CentriMag. Recently,
the indications were
somewhat widened with
temporary circulatory
support up to 30 days.
In Europe, it's been that
way for a few years,
but the FDA just
approved it recently
here in the States.
Placement is going
to be surgical via
sternotomy or
lateral thoracotomy.
The CentriMag can provide
support with a cannula placed
in the left atrium, inflow
then, and return to
the aorta up to about seven
to ten liters of flow.
If placed in the right ventricle,
then the inflow would be
right atrium and
the outflow would
be diverting to the
pulmonary artery.
The CentriMag uses
a magnetically levitated
extracorporeal
centrifugal flow pump
and often is used for
postcardiotomy patients
that are failure to
wean from bypass in
the operating room as a bridge
to recovery or a bridge
to decision and
survival is linked with
30-day survival of
41-60% after placement.
Contraindications, of
course, unable to be
anticoagulated and
complications, no surprise,
bleeding, acute renal
failure, and infection at
about 28% for each of
those complications.
We talked about VA ECMO
central cannulation.
