60-something y/o male patient who isn’t physically active but does ADLs. Scheduled for CABG but has AI, PVD, EF 40%, HTN, HLD. Would you suggest an AVR or not…. along with the CABG?
What would you suggest?
Category: TEE
Transcatheter Mitral Valve Replacement
Our hospital will be partaking in the Medtronic APOLLO study.
The data so far from other hospitals in an easy to read format.
Echo in mitral valve intervention. ESC 2012.
Transcatheter Mitral Valve Intervention, An Issue of Interventional Cardiology Clinics, E-Book.
Transcatheter Mitral Valve Repair. Summer 2014Volume 19, Issue 2, Pages 219–237.
Transthoracic Echocardiography (TTE)
Transthoracic echo: a beginner’s guide #tte #cardiac #echo #meded
Knowing how to do a quick focused echo exam can be instrumental in diagnosis as well as treatment. This has helped me determine how severe cardiac tamponade has been in an emergent case prior to induction when there was no prior echo. There are so many more useful answers that a bedside echo can provide. Time to get acquainted.
Helpful links:
- Virtual Transthoracic Echo
- TeachingMedicine.com
- A beginner’s guide to learning basic echocardiography
- Echocardiographer.org
- E-echocardiography.com
- Echo of the Day
- Case of the Week
- Sample Echo search by category
Helpful articles:
- Focused Cardiac Ultrasound: Recommendations from the American Society of Echocardiography
- Philips Tutorial: Intro to TTE
- YouTube: Bedside Ultrasound Basic Cardiac
- YouTube: Standard TTE views
Mitraclip and TEE for MR
Everest Clinical Trial results PPT
ASE Echo 2016: Percutaneous approaches to MR. UofMichigan PPT.
2015: The role of 3D TEE in the MitraClip procedure – UofColorado PPT
Abbott TTE checklist for MitraClip
EuroValve Congress 2015: MR in the MitraClip Era
2012: Echo in mitral valve intervention.
Abbott MitraClip device and delivery system package insert
Neth Heart J (2017) 25:125–130. MitraClip step by step; how to simplify the procedure.
Transseptal Puncture technique with TEE
JACC Cardiovascular Imaging: July 2012. Role of echo in percutaneous mitral valve interventions.
MitraClip Cases with TEE: Mayo Clinic.
Mitral Stenosis on TEE
Sometimes you need a refresher on measurements of the mitral valve via TEE. Here’s a great 2D TEE walk through for mitral stenosis.
http://tele.med.ru/book/cardiac_anesthesia/text/pe/pe009.htm
General anaesthesia vs. conscious sedation for transfemoral aortic valve implantation: a single UK centre before-and-after study – Miles – 2016 – Anaesthesia – Wiley Online Library
HeartWare vs. HeartMate LVAD
A couple of weeks ago, I took care of a patient who desperately needed to get better from acute CHF. At that time, we placed the patient on an impella… but the next day, it was deemed that he needed ECMO to reperfuse his organs. After a week on ECMO with continued impella support, ECMO was titrated down and off while maintaining 3.9L/min flow from the impella. During the wean off ECMO, the patient had been extubated and was mentating clearly and interacting appropriately.
Fast forward a couple days after getting extubated, the patient was ripe for an LVAD. But which one? (We ended up placing the patient on HeartWare LVAD).
YouTube: LVAD 101 – Anatomy & Physiology
HeartWare
YouTube vid of HeartWare (no sound) ; Vid of HeartWare with detailed explanation
HeartMate II
Summary
- Cost-effectiveness: HeartWare > HeartMate II (UK NHS study, April 2014)
- LV Geometry: HeartWare = HeartMate II (J CT Surg, 2013)
- Stroke & GI bleed risk: HeartWare > HeartMate II (J Card Surg 2013)
- Risk of device failure: HeartWare < HeartMate II
- ENDURANCE trial: Randomized patients eligible for DT 2:1 to the HeartWare centrifugal flow LVAD versus the HeartMate II axial flow LVAD. The trial did reach its primary noninferiority endpoint of stroke free survival at 2 years (55.0% in the HeartWare patients versus 57.4% in the HeartMate II patients). Of note, a change in the design of the HeartWare device during the trial (sintering of the inflow cannula) appeared to decrease the incidence of pump thrombosis. Overall, the stroke rate was higher in the HeartWare arm whereas device malfunctions requiring exchange or urgent transplantation were more common in the HeartMate II arm. Data analysis suggested that better blood pressure control in the HeartWare arm may decrease the stroke rate and a second cohort of patients is being enrolled with more attention being paid to blood pressures management.
- ROADMAP study: (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Heart Failure Patients) was an observational study of the Thoratec HeartMate II LVAD compared to optimal medical management in patients with advanced heart failure. Thirty day mortality was the same in both groups (1%) while one year survival was 80% in the LVAD group compared to 64% in the medical group (on an as treated basis). Functional status and quality of life improved significantly more in the LVAD group (analyzed by 6 minute walk, health related quality of life, and NYHA class). Unfortunately, adverse events in the LVAD group remained similar to what was previously reported in the DT trial, with bleeding being the most frequent adverse event.
- Bridge to Transplant: HeartWare = HeartMate II (Ann Thor Surg, Feb 2014)
- ADVANCE trial (bridge to transplant): 94% survival at 180 days with HeartWare
- PPT: LVAD Update 2015
- Anesthesia for LVAD
- TEE:
