Device Therapy: the future is now . Mariell Jessup MD FAHA, FACC, - - PowerPoint PPT Presentation

Device Therapy: the future is now.

Mariell Jessup MD FAHA, FACC, FESC Professor of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA

Disclosure: Mariell Jessup MD

• Speakers Bureau:
• Advisory Board:
• Honorarium:

University of Pennsylvania

NONE

Device

dɪˈvʌɪs

noun a thing made or adapted for a particular purpose, especially a piece of mechanical

• r 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.

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.

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.

Secondary Prevention

2008 ACC/AHA/HRS Guidelines for Device-Based Therapy

Primary Prevention

2008 ACC/AHA/HRS Guidelines for Device-Based Therapy

Camm and Nisam Europace (2010) 12, 1063–1069

Masoudi et al. J Am Coll Cardiol 2013;62:1931–47

Camm and Nisam Europace (2010) 12, 1063–1069

17% reduction in mortality.

ACC/AHA guidelines, 2012

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.

the OPTIONS

Sick patient Temporary support Chronic support Unclear situation

• 1. Support circulation
• 2. Oxygenate patient

Choice dictated by clinical status: temporary support ECMO

Durable VADs

pulsatile non-pulsatile

~ 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.

VADs are getting better, but heart transplant is still the gold standard.

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.

Mitral Clip

“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. “

TAVR

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.

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.

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.

Further understanding of information shared by the public in this forum could suggest new approaches for improving resuscitation related education.

Thank You