Types of mechanical circulatory support devices and their applications: durable and mechanical circulatory support devices

Published on May 30, 2024   29 min

A selection of talks on Clinical Practice

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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.

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Types of mechanical circulatory support devices and their applications: durable and mechanical circulatory support devices

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