Perf Tech 3 Test 9

Question 1

Rotary VAD (2nd Gen VAD)

Answer 1

• processes volume as it gets it, no pulsatile flow, no chambers to fill, axial flow design
• rotating impellers to propel blod forward
• supported with bearings
• powered by spinning shaft/magnetic forces
• problems= heat and bearings

Question 2

Rotary VAD Dates

Answer 2

1960- first described continuous flow pump
1998- DeBakey and Noon= axial flow LVAD
1999= Jarvik 2000
2000- Nimbus/HM2 axial flow pump

Question 3

Micromed

Answer 3

axial flow, smaller, easier, lower blood contact, less expensive/less parts

Question 4

Heartmate II

Answer 4

• electric, smaller, same system monitor/PBU as HMXVE
• rotor spins with magnetic field on inlet and outlet of bearings (its the only movie part of pump)
• uses RUBY bearings
• flow is estimated! (by RPM and power consumption motor)- flow is not accurate below 3 l/min
• VSA 1.15 to 3.15
• implanted below L costal margin under rectus abdominus
• still goes through diaphragm
• issus- thrombus (can tell by increase power)- treat with TPA

Question 5

HMII History

Answer 5

-developed in early 1990s at U of Pittsburg

Nimbus to ThermoCardiosystmes (98) to Thoratec (2001) to St. Jude Medical (2016)

Question 6

REMATCH Trial

Answer 6

“randomized evolution of mechanical assistance for the treatment of congestive heart failure”
-Tested HMXVE vs. medical therapy alone
-1996
=found benefit at 1-2 year compared to medical therapy alone
-HMXVE approved for DT in 2002

Question 7

HMII and Clinical Trials

Answer 7

HMII vs HMXVE
=end point was 2 years or adverse effect
-46% of HMII after 2 years had no adverse effects
-survival one year= 68%, two years= 58%
-HMII approved for BTT 2008 and DT in 2010

Question 8

Heartware HVAD

Answer 8

• 3rd gen
• rotary pump with centrifugal and non contact bearing design (magnet) - thin layer of blood
• placed in pericardial cavity at apex= NO abdominal pocket
• first implant 2006
• Advance trial= approved for BTT in 2012

Question 9

DuraHeart LVAS

Answer 9

• rotary pump with Levitation system and impeller

- does have abdominal pocket

Question 10

Momentum 3 Trial

Answer 10

HMII vs HMIII for DT and BTT

Question 11

Heartmate III

Answer 11

• fully levitated magnetic impeller= no friction
• pulsatile and textured surface= decrease clots
• implanted above diaphragm

Question 12

Percutaneous Devices

Answer 12

1) Abiomed Impella 2.5/5.0= intracatheter VAD
2) Thoratec Heartmate Percutaneous Heart Pump= similar to impella but inflates from 13 FR to 24 Fr (used for emergencies and NOT for CABG)

Question 13

Misc VADs

Answer 13

3) Tandem Heart= takes blood from LA and gives it femoral artery!= transseptal cannula (flow is cannula dependent)
- floats in fluid bearing to cool and lubricate
- integraded air bubble detector, device self diagnose
4) Berlin Heart (Excor)= BTT 2011, compassionate use only, pneumatic device

Question 14

two types of Angioplasty

Answer 14

1) percutaneous transluminal coronary angioplasty (PTCA)
- bloon that inflate
2) Stent

Question 15

Angioplasty Criteria

Answer 15

-bloon must pass through blockage and can be removed by catheter
-blockage can NOT be in left main
-patient can’t be in heart failure
-

Question 16

Angioplasty Advantages and risks

Answer 16

adv= less invasive, lower risk/cost/anesthesia, percuatious  incision, less recovery
risk/complications= bleeding, damage by catheter, restenosis, vessel closure, clots (treat with aspirin and clopidogrel), infections, MI, emergency CPB
-restenosis= 30-50% metal, 7-15% drug eluting

Question 17

Drug Eluting Stents

Answer 17

1) Boston= Taxus= chemotherapeutic drug
2) Johnson and Johnson/Cordis= Sirolimus= immunosuppressive
3) Medtronic= Zotarolium= immunosuppressive

Question 18

Atherectomy

Answer 18

= cutting out plaque (for calcified, fibrotic, hard plaque)

1) directional= cutting window- cuts and retrieves
2) Rotational= just spins/DIAMONDS- saline flush to cool= particles go down stream
3) Transluminal= cut and aspirate= lactated ringers and suction back
4) Laser
5) Transluminal Angiogenesis TMR= increase blood to areas that surgery/angioplasy can’t reach, uses CO2 laser
- go outside to inside and promotes new vessel growth

Question 19

Surgical Techniques

Answer 19

off bypass= MIDCAB, OPCAB (beating heart), assisted PADCAB

• OPCAB= caution to life up heart, Medtronic Octopus 2, Ultima 2
• DaVinci Robotic

Question 20

Percutaneous Mitral Valves

Answer 20

1) Abbot Mitraclip= first
2) Edwards Fortis= not is US
3) Neovasc= transapical insertion
4) Edwards Sapien XT= transapical (also for Aorta)

Question 21

Percutaneous Aortic Valves

Answer 21

1) Edwards Sapien 3/XT= cow tissue and added skirt (with 3)
2) Medtronic CoreValve and Evolut R (smaller)= approved for failed bioprosteic valve= “valve-in-valve”
- increases survival and lowers stroke
3) Sorin Perceval

Question 22

Percutaneous Valve Inserted at

Answer 22

transfemoral, transapical, subclavian , direct aortic