Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Cardiac Surgery (shared) > Mechanical Circulatory Support > Flashcards

Mechanical Circulatory Support Flashcards

(35 cards)

Start Studying
1
Q

REMATCH Trial - primary endpoint and result

A

Survival at 1yr

50% - HeartMate XVE

25% - Control

Survival at 2yrs

20% - HeartMate XVE (Impacted by device failure/complications)

10% - Control

(NEJM 2001)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Trial demonstrating feasibility and safety of Continuous Flow vs. Pulsatile Flow devices

A

HeartMate II BTT/DT Trial (NEJM 2009/ATS 2006)

Compared HeartMate VE (continuous) vs. HeartMate XVE (pulsatile)

BTT

Primary Endpoint: 2-year Composite ⇒ 45% vs. 10%

  1. Death
  2. Disabling Stroke
  3. Reop for Device Failure​

DT

HeartMate VE improved

  1. Adverse Event Profile (device malfunction)
  2. Hospital Readmission
  3. Functional capacity
  4. Survival
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ENDURANCE Trial Primary Endpoint and Results

A

(NEJM 2017) RCT

HeartWare vs. HeartMate II

Primary Endpoint: 2-year Composite ⇒ 55% vs. 60% non-inferior

  1. Death
  2. Disabling Stroke
  3. Reop for Device Failure

HeartWare ⇒ more device failure

HeartMate II ⇒ more strokes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Momentum III Trial Primary Endpoint and Results

A

(NEJM 2016) RCT

HeartMate III vs. II

Primary Endpoint: 6-month Composite ⇒ 85% vs. 75%

  1. Death
  2. Disabling Stroke
  3. Reop for Device Failure

HeartMate III ⇒ less pump failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pulsatile vs. Continuous Flow Device - Adverse Event Profile

A

Table

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Temporary MCS Devices

A

IABP

ECMO

Impella (2.5/5.0/CP/RP)

CentriMag

TandemHeart (pVAD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Compare/Contrast the ACC/AHA vs. NYHA Classifications of CHF

A

Table

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does INTERMACS stand for?

A

Inter-Agency Registry for Mechanically Assisted Circulatory Support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

INTERMACS Classification System

A

1) “Crash and Burn” - persistent HoTN despite increasing inotropes; MSOF; increasing lactate, worsening acidosis

2) “Sliding on Inotropes” - worsening renal function, nutritional delpetion, refractory volume overload

3) “Dependant Stability” - stable BP, oragn function and nutritional status but unable to wean inotropes

4) “Frequent Flyer” - recurrent episodes of volume overload and hospital readmissions

5) “Housebound” - NYHA IV; fatigues with ADLs

6) “Walking Wounded” - comfortable at rest but fatigues with exertion

7) “Placeholder” - Advanced NYHA III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Contraindications to Longterm MCS Device Implantation

A

Irreversible End Organ Dysfunction

Severe Hemodynamic Instability

Profound Coagulopathy

Complex Congenital Abnormalities

Restrictive Cardiac Disease (small LV dimensions)

Questionable Neurological Status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

HeartMate II Multivariate Risk Score (HMRS)

A

Predicts 90-day postoperative mortality

Variables:

  1. Age
  2. Albumin
  3. Creatinine
  4. INR
  5. Implanting Center Volume

Low Risk < 1.5 ⇒ 5%

Medium Risk 1.5-2.5 ⇒ 15%

High Risk > 2.5 ⇒ 30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MELD vs. MELD-XI vs. MELD-Na Scores

A

MELD

  1. Bilirubin
  2. Creatinine
  3. INR

MELD-XI (anticoagulation compatible)

  1. Bilirubin
  2. Creatinine

MELD-Na

  1. Bilirubin
  2. Creatinine
  3. INR
  4. Sodium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cardiac lesions that should be addressed at the time of longterm VAD implantation

A

Moderate to severe AI

PFO/ASD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you deal with AI at the time of LVAD inplantation?

A
  1. Park Stich
  2. Bicuspidize
  3. Oversew the Valve
  4. Bioprosthesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causes of Acquired AI with LVAD

Study These Flashcards
A
  1. Elevated Sheer Stress
  2. Elevated Transvalvular Gradient
  3. Decreased AoV Opening
  4. Abnormal AoV Biomechanics
17
Q

Guidelines for when to address AI, PFO, MS and TR at the time of LVAD Impantation

Study These Flashcards
A

Class I

Presence of PFO ⇒ Close

AI > mild ⇒ Park Stitch, Oversew, BioAVR

MS > mild ⇒ Repair or BioMVR

Class IIa

TR > mild ⇒ Repair

MR reasonable to repair if bridge to recovery

18
Q

Risk Factors for RHF after LVAD Implantation

Study These Flashcards
A
  1. Preop Mechanical Ventilation
  2. Increased CVP
  3. Increased CVP/PCWP
  4. Decreased RV Stroke Work Index
  5. RV Dysfunction
  6. TR
  7. Elevated WBC
  8. Elevated BUN
19
Q

Echocardiographic Predictors of RHF after LVAD

Study These Flashcards
A
  1. Reduced free-wall strain
  2. RV/LV diameter ratios
  3. TR severity
  4. RVEF
20
Q

Which devices are currently FDA approved for…

Bridge-to-Transplant?

Destination Therapy?

Study These Flashcards
A

Bridge-to-Transplant:

  1. HeartMate II
  2. HeartMate III
  3. Heartware (HVAD)
  4. SynCardia TAH

Destination Therapy

  1. HeartMate II
21
Q

Factors Required to meet Indication for Destination Therapy

Study These Flashcards
A
  1. Not a Transplant Candidate
  2. Refractory HF despite OMT
    1. ​NYHA III-IV
    2. Frequent Flyer
    3. Diruetic Dependant
    4. VO2 < 14mL/kg/min
  3. Life Expectancy > 2-years
  4. No Irreversable End Organ Damage
  5. No Hx of Non-Compliance or Psychosocial Limitations
22
Q

Durable (Longterm) MCS Devices

Study These Flashcards
A
  1. HeartMate II
  2. HeartMate III
  3. HeartWare (HVAD)
  4. SynCardia TAH (pulsitile)
23
Q

TEE Parameters used to adjust LVAD speed intraoperatively

Study These Flashcards
A
  1. Chamber Size
  2. Interventricular Septum Position
  3. Degree of MR
  4. RV Function
  5. Aortic Valve Opening
24
Q

Direct and Calculated VAD Parameters

Study These Flashcards
A

Direct

  1. Speed (rpm)
  2. Power expenditure (watts)

Calculated

  1. Flow (L/min)
  2. Pulsitility Index (HeartMate II only)
25
Causes of **Increased Velocity** at the **Inflow** **Cannula**
1. **Suction Event** (hypovolemia or inadequate preload) 2. Poor **Cannula Placement** (spetum or trabeculae) 3. **Pump Thrombosis**
26
Standardized Markers of **RV Dysfunction** following **LVAD**
1. Inability to wean from **CPB** 2. **MAP** \< 55mmHg 3. **CVP** \> 16mmHg 4. **SvO2** \< 55% 5. LV **Flow** Rate Index \< 2L/min/m2 6. Significant **Inotrope** Dependence
27
**Management** of **RHF** after **LVAD** Implantation
1. **Inotropes** (Milrinone, Dobutamine, Isoproterenol, Epinephrine) 2. **Diuresis** 3. **Sinus Rhythm** 4. Redeuce PVR (**Inhaled NO**) 5. **RVAD**
28
**ISHLT** Guidelines for **Anticoagulation** with **Durable VAD** Therapy
POD #1 1. IV **Heparin** POD #3 1. **Aspirin** 2. **Warfarin** (INR 2-3)
29
**Surivival** following **LVAD** Implantation
**30-day** Survival - **90%** **1-year** Survival - **85%** (HeartWare ADVANCE Trial and INTERMACS Registry)
30
**Risk Factors** Predicting Poor **Survival** After **LVAD** Implantation
1. **INTERMACS 1 or 2** 2. **Renal** Dysfunction 3. **Age \> 70** 4. **RV** Dysfunction 5. Need for **BiVAD** 6. Increased **Surgical Complexity**
31
**LVAD** vs. **Rx** pre-Transplant **Mortality** and **QOL**
30-day, 1 and 2-year Survival is Statistically equivalent **30-day** Survival - **95%** **1-year** Survival - **80%** **2-year** Survival - **70%** **QOL improves** with **LVAD** while awaiting transplant
32
**Adverse Event** Rates of **LVAD** Therapy
1. **Bleeding** (Reop for bleeding 30% with \>50% requiring blood products; GI bleeding rates 20-30% ) 2. **Device Malfunction** 3. **Renal Failure** (15-30%) 4. **Infection** (10-20% driveline infections by 1-year) 5. **Stroke** (10/20% at 1-/2-years - ischemic = hemorrhagic) 6. **Death** **30**-days - **40%** **1**-year - **70%** **2**-years - **80%** **3**-years - **85%**
33
Proposed **causes** of increased **GI bleeding** with **CF** **VADs**
1. Acquired **von Willebrand** Syndrome 2. **AVM** Formation (**Non-Pulsitile** flow) 3. **Anticoagulation**
34
Suspected vs. Confirmed **Pump Thrombosis**
Suspected 1. **Hemolysis** (Serum-free hemoglobin \>40mg/dL or LDH \>600IU/L) 2. Unexplained **CHF** Symptoms 3. Abnormal Pump **Parameters** Confirmed 1. **Direct** Inspection 2. **Radiographic** Imaging
35
**Histologic** and **Hormonal** Features of **Reverse Remodeling** for BTR
**Histologic** 1. Decreased **Collagen/Fibrosis** 2. Decreased **MMP** Activity 3. Decreased Myocardial **Apoptosis** 4. Decreased Myocardial **Hypertrophy/Myofibrillar Disarray** 5. Increased **SR Calcium** **​** **Hormonal** 1. Decreased **Sympathetic Tone** 2. Decreased **BNP** 3. Decreased **RAAS** 4. Decreased **ET-1** 5. Decreased Infalmmatory **Cytokines** (IL-6, IL-8, TNFa)

Cardiac Surgery (shared) (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions