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The science behind percutaneous hemodynamic support: a review and comparison of support strategies

Burkhoff, D., Naidu, S. S.

Abstract

Patients in a variety of cardiovascular disease states may benefit from temporary percutaneous cardiac support, including those in acute decompensated heart failure, fulminant myocarditis, acute myocardial infarction with or without cardiogenic shock and those undergoing high-risk percutaneous coronary intervention. The ideal percutaneous cardiac support device is safe, easy to use and versatile enough to meet the needs of various clinical situations and patient cohorts. In addition, it should provide maximal hemodynamic support and protection against myocardial ischemia. With these goals in mind, the scientific principles that govern hemodynamic effectiveness and myocardial protection as they pertain to acute support devices are reviewed.

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What Is Acute Unloading?

International Cardiology Review on A-CURE 2016

A summary of the talks given at the 1st Annual A-CURE Symposium in Rome, Italy, in August of 2016.

Abstract

This supplement to the International Cardiology Review is devoted to the proceedings of the first annual A-CURE Symposium that was held in Rome, Italy, in August of 2016. The 1-day meeting brought together experts from a number of disciplines – including interventional cardiologists, heart failure specialists, cardiac surgeons, molecular biologists, and biomedical engineers – to discus the science behind and clinical applications of acute cardiac unloading.  Over 100 physicians, clinical and pre-clinical researchers, basic researchers, medical students, post-doctoral scientists, and graduate students from 21 different countries were in attendance. The ICR Supplement features a number of the presentations from the Symposium describing the basic science underlying acute cardiac unloading, its clinical applications, and the opportunities in and challenges of performing clinical trials.

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Videos

Dan Burkhoff, MD, PhD, Columbia University Perspective on Acute Unloading

Dan Burkhoff speaks on the hemodynamics of acute unloading and the important clinical implications at A-CURE 2017.

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Educational Tools

Harvi App

This first of its kind iPad app is an interactive simulation-based textbook of cardiovascular physiology and hemodynamics. The textbook is divided into 4 parts and will cover a full range of topics relevant to the understanding of hemodynamics in health and disease. This app includes Part 1: Basic Physiological Concepts, and covers topics including the cardiac cycle, pressure-volume relations, preload, afterload, contractility, lusitropy and ventricular-vascular coupling. Parts II, III and IV will cover advanced physiological concepts, pathophysiology, disease states and therapeutics and mechanical circulatory support. The full simulation is available from any place in the app, simply by rotating iPad into a landscape orientation. The simulation, linked with end-of-chapter questions and problem sets allow for a flexible “learn-by-doing” environment for experimentation and discovery.

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Publications of Interest

Hemodynamics of Mechanical Circulatory Support

Daniel Burkhoff, Gabriel Sayer, Darshan Doshi, Nir Uriel

Abstract

An increasing number of devices can provide mechanical circulatory support (MCS) to patients with acute hemodynamic compromise and chronic end-stage heart failure. These devices work by different pumping mechanisms, have various flow capacities,are inserted by different techniques,and have different sites from which blood is with drawn and returned to the body. These factors result in different primary hemodynamic effects and secondary responses of the body. However, these are not generally taken into account when choosing a device for a particular patient or while managing a patient undergoing MCS. In this review, we discuss fundamental principles of cardiac, vascular, and pump mechanics and illustrate how they provide a broad foundation for understanding the complex interactions between the heart, vasculature, and device, and how they may help guide future research to improve patient outcomes. (J Am Coll Cardiol 2015;66:2663–74) © 2015 by the American College of Cardiology Foundation.

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Videos

Dr. Daniel Burkhoff, MD, PhD Columbia University The Science Behind Acute Ventricular and Myocardial Unloading

Dr. Dan Burkhoff speaking on the science behind acute ventricular unloading and myocardial recovery at the 2016
A-CURE Symposium.

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