← All decks
Cardiology
Percutaneous Mechanical Circulatory Support for Cardiogenic Shock Micro-Axial Flow Pumps, In
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
11 sections · 130 slides
Cardiogenic shock: the clinical problem
- Definition of cardiogenic shock
- Burden of cardiogenic shock
- Causes of cardiogenic shock
- Drivers of improved survival
- Mechanistic rationale for percutaneous support
- Algorithmic shock care and the evidence gap
- Randomised evidence: the overall picture
- Survivorship bias in device complication rates
- Devices covered in this topic
- Overview of Contemporary Clinical Trials of Mechanical Circulatory Support in Acute Myocardial Infarction with Cardiogenic Shock ⏎
- Overview of Contemporary Clinical Trials of Mechanical Circulatory Support in Acute Myocardial Infarction with Cardiogenic Shock ⏎
- Overview of Contemporary Clinical Trials of Mechanical Circulatory Support in Acute Myocardial Infarction with Cardiogenic Shock ⏎ (continued)
- Overview of Contemporary Clinical Trials of Mechanical Circulatory Support in Acute Myocardial Infarction with Cardiogenic Shock ⏎
- Overview of Contemporary Clinical Trials of Mechanical Circulatory Support in Acute Myocardial Infarction with Cardiogenic Shock ⏎ (continued)
- Overview of Contemporary Clinical Trials of Mechanical Circulatory Support in Acute Myocardial Infarction with Cardiogenic Shock ⏎
- Overview of Contemporary Clinical Trials of Mechanical Circulatory Support in Acute Myocardial Infarction with Cardiogenic Shock ⏎ (continued)
Anatomic considerations
- Vascular access calibre by device
- Physiologic risk factors for vascular complications
- Therapeutic risk factors for vascular complications
- Mitigating access-site risk
- Aortic insufficiency as a contraindication
- Aortic stenosis, prostheses and left ventricular thrombus
- Pre-procedure imaging assessment
- Abdominal aortic aneurysm and the balloon pump
Pressure-volume loop fundamentals
- The pressure-volume diagram
- The four phases of the cardiac cycle on the loop
- Reading stroke volume, pressure and stroke work
- Pressure-volume loops in normal and diseased ventricles
- End-systolic pressure-volume relationship
- End-diastolic pressure-volume relationship
- Pressure-volume changes in acute myocardial infarction
- Chronic remodelling after the acute insult
- Left ventricular unloading on the pressure-volume loop
- Effect of each support device on the pressure-volume loop
Indications and guideline recommendations
- 2023 ESC acute coronary syndrome guidelines
- 2025 ACC/AHA acute coronary syndrome guidelines
- Downgrading of routine intra-aortic balloon pump use
- Absence of guidance for right ventricular support devices
- Percutaneous Mechanical Circulatory Support Device Indications and Contraindications ⏎
- Percutaneous Mechanical Circulatory Support Device Indications and Contraindications ⏎
- Percutaneous Mechanical Circulatory Support Device Indications and Contraindications ⏎
- Percutaneous Mechanical Circulatory Support Device Indications and Contraindications ⏎
Equipment and platforms
- Durable left ventricular assist devices
- Biventricular support and temporary-first policy
- Intra-aortic balloon pump equipment
- VA-ECMO equipment
- Micro-axial flow pump equipment
- Dedicated right-sided pump equipment
- Percutaneous Mechanical Circulatory Support Device Characteristics ⏎
- Percutaneous Mechanical Circulatory Support Device Characteristics ⏎ (continued)
- Percutaneous Mechanical Circulatory Support Device Characteristics ⏎
- Percutaneous Mechanical Circulatory Support Device Characteristics ⏎ (continued)
Intra-aortic balloon counterpulsation
- Origins of diastolic augmentation
- Proposed mechanisms of benefit
- BCIS-1: balloon counterpulsation in high-risk PCI
- IABP-SHOCK II
- Change in balloon pump practice
- Balloon pump vascular access and preparation
- Balloon positioning in the descending aorta
- Left ventricular mechanical circulatory support devices
- Arterial pressure tracing during counterpulsation
Micro-axial flow pumps
- Impella platforms for left ventricular support
- Archimedes screw as the pump principle
- From irrigation pump to Hemopump
- Impella CP implantation
- Impella 5.5 implantation by axillary cutdown
- Motor, controller and purge infusate
- Haemodynamic effect of increasing Impella flow
- Unloading before reperfusion
- PROTECT I
- PROTECT II design
- PROTECT II results
- ISAR-SHOCK
- IMPRESS
- DanGer Shock trial design
- DanGer Shock primary result
- DanGer Shock subgroups and complications
- Patient selection after DanGer Shock
- Lower-profile investigational devices
Veno-arterial extracorporeal membrane oxygenation
- Origins and registry experience
- What distinguishes VA-ECMO from the other devices
- Components of the VA-ECMO circuit
- Distal perfusion cannula
- VA-ECMO cannulation configurations
- Differential hypoxia during femoral VA-ECMO
- Avoiding differential hypoxia
- Increased afterload on VA-ECMO
- Strategies for left ventricular unloading on ECMO
- Intensive care management of ECMO patients
- Extracorporeal cardiopulmonary resuscitation
- ARREST trial
- PRAGUE and INCEPTION trials
- ECMO-CS and ECLS-SHOCK
TandemHeart
- TandemHeart device and cannulation
- Haemodynamic effects of TandemHeart
- TandemHeart clinical evidence
Right ventricular support
- Medical therapy for right ventricular failure
- Impella RP Flex
- ProtekDuo dual-lumen cannula
- Separate cannula configurations and pump options
- BiPella configuration for biventricular support
- Right ventricular mechanical circulatory support devices
Contraindications and conclusions
- Contraindications common to IABP, Impella and VA-ECMO
- Managing prohibitive peripheral arterial disease
- Bleeding, coagulopathy and anticoagulation
- Where the field stands
- Directions for the field
- Take-home points
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
- Join our WhatsApp groups