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*In the name of GOD
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Treatment of End Stage Heart
FailureSurgical Treatments
Intra Aortic Balloon Pump(IABP)
Ventricular Assisst Device(VAD)
Cardiac Resynchronization
Treatment(CRT) & ICD
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Surgical Treatment of Heart
FailureCABGs in ischemic cardiomyopathy
Mitral valve repair in patients with dilated
cardiomyopathy
Surgical Ventricular reconstruction(Dor
procedure)
Heart Transplantation
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Dor procedure for Ischemic
Cardiomyopathy
Purse string stitch around a nonviable scarred aneurysm to
minimize the excluded area. The residual defect is
sometimes covered by a patch made from Dacron,
pericardium, or an autologous tissue flap 4
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Considered Criteria for Surgical
Repair
Anteroseptal MI, with dilated left ventricle
(end-diastolic volume index >100 mL/m2)
Depressed LVEF
Left ventricular regional dyskinesis or
akinesis >30 percent of the ventricular
perimeter, and
Recurrent symptoms of angina, heart
failure, or arrhythmias
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The following are considered to be relative
contraindications
Systolic pulmonary artery pressure >60
mmHg
Severe right ventricular dysfunction
Regional dyskinesis or akinesis without
dilation of the ventricle
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LV Reconstruction for Non-
ischemic Cardiomyopathy
Cardiomyoplasty experience has led to
other novel approaches to heart failure.
Observations suggested that some
patients benefited from the diastolic
"girdling" effect of the muscle wrap
This observation led to the development of
the Acorn device and Myosplint
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Carpentier peformed the first successful
surgery on a humen in 1985
Cardiomyoplasty
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LV Reconstruction for Non-
ischemic Cardiomyopathy
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Indication of Heart
TransplantationResistance Cardiogenic Shock
Stage D Heart Failure
Recurrent Resistance Ventricular
Arrhythmia
Resistance Angina
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Who Should Not Be Offered
a Heart Transplant?
Irreversible PHTN or severe pulmonary parenchymal disease
Irreversible renal or hepatic dysfunction
Severe peripheral or cerebrovasculardisease
IDDM with end-organ damage
Cancer
Non-compliance, addiction,HCV,HIV
Elderly patients (aprox > 70y)
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Heart Transplantation
Heart transplantation remains the ultimate
treatment for heart failure
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Intra Aortic Balloon Pump (IABP)
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What is an IABP?
The Intra-Aortic Balloon Counterpulsation
system is a volume displacement device.
It should be positioned so that the tip is
approximately 1 to 2 cm below the origin
of the left subclavian artery and above the
renal arteries.
On chest x-ray the tip should be visible in
the 2nd or 3rd intercostal space.
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The end of the balloon should be just
distal to the takeoff of the left subclavian
artery
Position should be confirmed by
fluoroscopy or chest x-ray
Positioning
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Pressure Waveforms
DEFLATED INFLATED DEFLATED INFLATED
Red wave = normal arterial pressure
trace
Blue wave = arterial pressure trace on
IABP
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IABP Indications
Cardiogenic Shock
Refractory Ventricular Arrhythmia
Refractory Angina
Bridge to Heart Transplantation
Perioperative Treatment of Complications
due to Myocardial Infarction
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Ventricular Assist Devices (VADs)
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Ventricular Assist Devices
(VADs)
• Indications for VAD therapy
• Postcardiotomy cardiogenic shock
• Bridge to recovery or cardiac
transplantation
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Left ventricular assist
device
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THANKS FOR YOUR ATTENTION
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