Christine Gasperetti
Christine Gasperetti, University of Pennsylvania Health System, USA
Title: Hemodynamic Concepts Important to Protected PCI
Biography
Biography: Christine Gasperetti
Abstract
With advancements in cardiac technology, it has now become possible to offer patients with complex and high-risk coronary artery disease, including those with cardiogenic shock (CGS) revascularization with percutaneous coronary intervention (PCI). Such patients often require hemodynamic support and are the procedure is thus termed "protected PCI". Protected PCI has led to breakthrough in the survival ceiling for patients presenting with CGS complicating acute myocardial infarction (Ml) and to redefinition of protocols with which to best offer PCI in the setting of CGS. Ultimately, use of varying support models may lead to improved understanding of the components of shock states in ischemia and infarction.
The presentation includes two patients who required high risk PCI in the setting of CGS. The first patient presented with Inferior Ml complicated by RV infarction and was supported with RV Assist Device
(RVAD). The second patient presented with cardiac arrest during Anterior Ml and underwent emergent PCI with limited support in the off-site cardiac catheterization laboratory setting.
Following these presentations, an introduction to analysis of hemodynamics of support using the Harvi model developed by Daniel Burkhoff, MD PhD and colleagues will be given and used to illustrate important hemodynamic concepts in ventricular supfjort including changes in cardiac power, uncoupling of systemic and LV pressures, changes in contractility and coronary perfusion pressure, and comparison of devices used.
References
1. Burkhoff D, Sayer G, Doshi D, et al. (2015) Hemodynamics of Mechanical Circulatory Support.
JACC Vol. 66. No. 23. 2015 2663-74.
2. Burkhoff, D, Naidu SS (2012) The science behind percutaneous hemodynamic support: review
and comparison of support strategies. Catheterization and Cardiovascular Interventions. Vol. 80.
No. 5. 2012. 816-29.
3. Kapur NK, Qias X, Parchuri V, et al. (2015) Mechanical Pre-Conditioning With Acute Circulatory
Support Before Reperfusion Limits Infarct Size in Acute Myocardial Infarction. JACC Heart Failure
(2015) Vol. 3. No. 11. 2015. 873-82.
4. Napp LC, Kuh C, Bauersachs J. (2017) ECMO in cardiac arrest and cardiogenic shock. Herz 2017:
vol. 42. 27-44.
5. O'Neill W, Basir M, Dixon S, et al. (2017) Feasibility of Early Mechanical Support During
Mechanical Reperfusion of Acute Myocardial Infarct Cardiogenic Shock. JACC Vol. 10. No. 6.
2017 624-5.
6. Rihal CS, Naidu SS, Givertz MM, et al. (2015) 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus
Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in
Cardiovascular Care. JACC Vol. 65. No.l9. 2015 e7-e26.