Insertion, AMI Cardiogenic Shock, Surgical Applications
EACTS 2022 on Demand - MCS for PCCS, Structural Heart Disease, and Advanced Cardiogenic Shock
Innovative Strategies for Superior Outcome in Cardiac Surgery Including pMCS Support in Therapy Pathway
Discover the recordings of our scientific session at EACTS 2022 about "Innovative Strategies for Superior Outcome in Cardiac Surgery Including pMCS Support in Therapy Pathway".
Chair
Prof. Dr. Roberto Lorusso, Maastricht, Netherlands
Prof. Dr. Dr. Hermann Reichenspurner, Hamburg, Germany
Speakers & Key Topics
Prevention of PCCS in high-risk Cardiac Surgery patients by elective implant of pMCS
Prof. Dr. Assad Haneya, Kiel, Germany
Structural Heart Disease – Innovative Approaches Extending Therapy Scope by Using pMCS Support
PD Dr. Bastian Schmack, Essen, Germany
Tailored Solutions to Treat Advanced CGS Patients Combining ECMO with pMCS
Prof. Dr. Evgenij Potapov, Berlin, Germany
Prevention of PCCS in High-risk Cardiac Surgery Patients by Elective Implant of pMCS
Dr. Veronika Walter, a colleague of Prof. Dr. Assad Haneya, delivers his presentation on innovative strategies for superior outcome in cardiac surgery at EACTS 2022. She reviews MCS devices suitable for postcardiotomy cardiogenic shock (PCCS), focusing on ECLS (or VA ECMO), microaxial pumps (Impella® heart pumps), and a combination of both. Dr. Walter explains that patients with severely reduced left ventricular ejection fraction (LVEF) undergoing coronary artery bypass surgery (CABG) are at increased risk of PCCS and optimal timing of adequate hemodynamic support impacts outcome. Her data indicate that prophylactic LV unloading with Impella heart pumps seems to be a safe approach to prevent PCCS and to improve the outcomes in this high-risk patient population.
Structural Heart Disease – Innovative Approaches Extending Therapy Scope by Using pMCS Support
“Mitral valve regurgitation, especially, is a super complex pathology,” explains Dr. Bastian Schmack in this presentation from EACTS 2022. He explains the pros and cons of surgery in these patients with severe mitral valve regurgitation and poor ventricular function. While surgery can comprehensively treat the root of the underlying issue, there is high risk for peri/early postoperative low cardiac output syndrome. Dr. Schmack also discusses the role of transcatheter edge-to-edge repair (TEER) in these patients. He then describes the surgical protocol at his institution for Impella 5.5® with SmartAssist® heart pump short-term pMCS for MV surgery and severely reduced LV function as well as plans for studies to demonstrate that it is possible to transform inoperable patients into appropriate patients for high-risk structural heart surgery supported with Impella 5.5® with SmartAssist® with improved outcomes and lasting results.
Tailored Solutions to Treat Advanced CGS Patients Combining ECMO With pMCS
Prof. Dr. Evgenij V. Potapov discusses tailored solutions for treating advanced cardiogenic shock by combining ECLS with pMCS (ECMELLA). He explains how he uses single arterial access for ECMELLA at his institution with case video demonstrating the technique. He then describes the results seen in patients between May 2020 and September 2022 and the algorithm at his institution for temporary MCS device selection in cardiogenic shock. He concludes that axillary implanted Impella heart pumps based temporary MCS is the first choice for patients with severe cardiogenic shock and that an algorithm-based approach for escalation and de-escalation improves survival in patients with severe cardiogenic shock.
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