device therapy: the future is now....device therapy: the future is now. author european society of...
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Device Therapy:the future is now.
Mariell Jessup MD FAHA, FACC, FESCProfessor of Medicine
University of PennsylvaniaPhiladelphia, Pennsylvania, USA
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Disclosure: Mariell Jessup MD
• Speakers Bureau:• Advisory Board:• Honorarium:
University of Pennsylvania
NONE
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Devicedɪˈvʌɪsnouna thing made or adapted for a particular purpose, especially a piece of mechanical or electronic equipment.
synonyms: implement, gadget, utensil, tool, appliance, piece of equipment, apparatus, piece of apparatus, piece of hardware, instrument, machine, mechanism, contrivance, contraption, invention, convenience, amenity.
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Heart Failure Device Therapy
• Implanted electrical devices: ICD, CRT• Mechanical circulatory support devices
– Short term versus durable devices• Valvular closure or replacement devices• Monitoring devices• Stimulation HF devices• Personal wearable devices.
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Heart Failure Device Therapy
• Implanted electrical devices: ICD, CRT• Mechanical circulatory support devices
– Short term versus durable devices• Valvular closure or replacement devices• Monitoring devices• Stimulation HF devices• Personal wearable devices.
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Secondary Prevention
2008 ACC/AHA/HRS Guidelines for Device-Based Therapy
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Primary Prevention
2008 ACC/AHA/HRS Guidelines for Device-Based Therapy
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Camm and Nisam Europace (2010) 12, 1063–1069
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Masoudi et al. J Am Coll Cardiol 2013;62:1931–47
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Camm and Nisam Europace (2010) 12, 1063–1069
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17% reduction in mortality.
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ACC/AHA guidelines, 2012
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Heart Failure Device Therapy
• Implanted electrical devices: ICD, CRT• Mechanical circulatory support devices
– Short term versus durable devices• Valvular closure or replacement devices• Monitoring devices• Stimulation HF devices• Personal wearable devices.
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the OPTIONS
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Sick patient
Temporary supportChronic support
Unclear situation
1. Support circulation2. Oxygenate patient
Choice dictated by clinical status:temporary supportECMO
Durable VADs pulsatile non-pulsatile
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~ ½ of the patients who need an MCSD for shock survive, and ~ ½ of these survivors require an
implantable VAD. Ongoing CPR is predictive of in- hospital
mortality.
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VADs are getting better, but heart transplant is still the gold standard.
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Heart Failure Device Therapy
• Implanted electrical devices: ICD, CRT• Mechanical circulatory support devices
– Short term versus durable devices• Valvular closure or replacement devices• Monitoring devices• Stimulation HF devices• Personal wearable devices.
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Mitral Clip
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“we conclude the non-inferiority of the MitraClip as a treatment for severe, symptomatic MR, in comparison to conventional valvular surgery. Despite a higher risk profile in the MitraClip patients, the
clinical outcomes were comparable although surgery was more effective in reducing MR in the early post procedure period. “
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TAVR
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Heart Failure Device Therapy
• Implanted electrical devices: ICD, CRT• Mechanical circulatory support devices
– Short term versus durable devices• Valvular closure or replacement devices• Monitoring devices• Stimulation HF devices• Personal wearable devices.
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Heart Failure Device Therapy
• Implanted electrical devices: ICD, CRT• Mechanical circulatory support devices
– Short term versus durable devices• Valvular closure or replacement devices• Monitoring devices• Stimulation HF devices• Personal wearable devices.
![Page 28: Device therapy: the future is now....Device therapy: the future is now. Author European Society of Cardiology Subject Device therapy: the future is now. Keywords Heart Failure 2015,](https://reader034.vdocuments.us/reader034/viewer/2022042307/5ed2e27c4768b17a677426a4/html5/thumbnails/28.jpg)
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Heart Failure Device Therapy
• Implanted electrical devices: ICD, CRT• Mechanical circulatory support devices
– Short term versus durable devices• Valvular closure or replacement devices• Monitoring devices• Stimulation HF devices• Personal wearable devices.
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Further understanding of information shared by the public in this forum could suggest new approaches for improving resuscitation related education.
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Thank You