20 Developing comprehensive mechanical circulatory support in singapore
Heart transplantation was initiated in Singapore in 1990. Three to six heart transplants are performed annually. The waiting list mortality was about 30%. Hence, mechanical circulatory support was initiated with HeartMate I in 2001. Extracorporeal membrane oxygenation (ECMO) for acute life support became available by 2003. Durable implantable rotary left ventricular assist device (LVAD) with HeartMate IITM (HMII) was introduced in 2007, followed by HeartWareTM HVADTM in 2012 and HeartMate 3TM (HM3) in 2015.
90 consecutive durable implantable devices (58 HMII, 21 HVAD and 11 HM3), were placed from May 2009 to December 2017....
Source: Heart Asia - April 24, 2019 Category: Cardiology Authors: Sivathasan, C. Tags: Keynote Lecture Source Type: research
19 Update of LVAD therapy in japan
In conclusion, continuous flow LVAD was effective for bridge-to-transplant. Although the collected data indicate that the improved survival rate is acceptable, there remains potential for major complications which precludes wider application of LVAD. (Source: Heart Asia)
Source: Heart Asia - April 24, 2019 Category: Cardiology Authors: Matsumiya, G. Tags: Keynote Lecture Source Type: research
18 Surgery for heart failure: experiences from severance cardiovascular hospital, seoul, korea
In conclusion, size-mismatch did not affect LVAD outcomes for the East Asian population. Organ protection remains an important factor for long-term survival. In the short term, MCS including ECMO may be used to reverse organ dysfunction as a bridge to recovery or decision. Finally, LVAD will be a main strategy for bridge-to-transplant (BTT) in Korea. (Source: Heart Asia)
Source: Heart Asia - April 24, 2019 Category: Cardiology Authors: Kim, J.-H. Tags: Keynote Lecture Source Type: research
17 Left ventricular rconstruction surgery
Acute myocardial infarction and ischaemic cardiomyopathy are important causes of heart failure (HF). With ageing populations in developed nations, the incidences can be expected to rise in the coming decades.
Stretch of a left ventricle (LV) scar results in detrimental ventricular remodelling, LV dilatation and a change in geometry from elliptical to spherical. These result in higher wall stress and less effective ventricular contractions.
Surgical techniques to restore the shape of the remodelled ventricle were introduced in early 1980s.1 The RESTORE registry and others reported favourable outcomes in >5000 patients.2 ...
Source: Heart Asia - April 24, 2019 Category: Cardiology Authors: Tsui, S. S. Tags: Keynote Lecture Source Type: research
16 ECMO and MCS for patients undergoing PCI: experience from taipei veterans general hospital
Intra-aortic balloon pump (IABP), which simultaneously augments coronary blood flow and decreases myocardial oxygen demand, usually provides haemodynamic support in patients with impaired left ventricular function undergoing percutaneous coronary intervention (PCI)1 2 or for patients with established cardiogenic shock.3
Several observational studies have reported that prophylactic IABP insertion could reduce major adverse cardiovascular events (MACE) compared with a provisional counterpulsation strategy during high-risk PCI.4 However, meta-analysis did not reveal a benefit of routine elective use of IABP or percutaneous v...
Source: Heart Asia - April 24, 2019 Category: Cardiology Authors: Wang, W.-T. Tags: Keynote Lecture Source Type: research
15 Impella(R) use in protected PCI and cardiogenic shock
Intra-aortic balloon pump (IABP) has been used for many years in high-risk PCI or cardiogenic shock. However, the support provided by IABP is limited and a major randomised controlled trial failed to demonstrate a beneficial effect.1 Impella® is a family of percutaneous mechanical circulatory support (MCS) devices that are used in protected PCI and cardiogenic shock.2 Depending on the device model, they provide a blood flow ranging from 2.5 to 5 L/min. The resulting augmented support increases mean arterial blood pressure, cardiac output and coronary flow while unloading left ventricular filling pressure to reduce myoc...
Source: Heart Asia - April 24, 2019 Category: Cardiology Authors: Lung, C. K. Tags: Keynote Lecture Source Type: research
14 A life support-based comprehensive treatment regimen dramatically reduced in-hospital mortality of fulminant myocarditis patients
Fulminant myocarditis is chiefly caused by viral infections. Its onset is rapid, progresses quickly, and may lead to severe heart failure, circulatory failure and cardiogenic shock in a short time. Its mortality can be up to 50%–70%. Most importantly, there are no treatment options, and no evidence-based international guidelines or expert consensus statements. Here we provide the first expert consensus – the Chinese Society of Cardiology Expert Consensus Statement on the Diagnosis and Treatment of Fulminant Myocarditis – based on data from our recent registered clinical trial. In this statement, we descri...
Source: Heart Asia - April 24, 2019 Category: Cardiology Authors: Wang, D. W., Jiang, J., Li, S., Wang, Y., Wang, H., Zuo, H., Zhou, N., The Chinese Society of Cardiology Tags: Keynote Lecture Source Type: research
13 The shock team approach: the rationale and evidence
Cardiogenic shock (CS) is defined as a state of ineffective cardiac output caused by a cardiac disorder that results in both clinical and biochemical manifestations of inadequate tissue perfusion.1 Among patients presenting with CS, there is a spectrum of disease whereby some patients can be stabilised with pharmacologic interventions alone, while others require escalation to mechanical circulatory support (MCS).2 As patients and treatment options both become increasingly complex, comprehensive critical care may be best delivered in disease-specific service line ICUs.2 The model of the cardiac ICU has transitioned over tim...
Source: Heart Asia - April 24, 2019 Category: Cardiology Authors: Kiernan, M. S. Tags: Keynote Lecture Source Type: research
12 Challenges in shock management in the emergency department
The diagnosis and emergency management of patients with shock (poor end organ perfusion with reduced tissue oxygen delivery, usually associated with systolic hypotension) is difficult even in optimum circumstances. The challenge is multiplied when patients have to be managed in overcrowded and poorly resourced emergency departments (ED).
In Hong Kong, public hospital EDs manage over two million patient attendances annually, equivalent to 30% of Hong Kong’s population. Around 30% of ED patients require emergency hospital admission, with the majority being more than 80 years old. Hong Kong’s ageing population, wi...
Source: Heart Asia - April 24, 2019 Category: Cardiology Authors: Graham, C. A. Tags: Keynote Lecture Source Type: research
11 Hospice and palliative care for advanced cardiac diseases in hong kong
Advanced cardiac diseases are common non-cancer conditions that require good palliative care. Palliative Care should embrace both cancer and non-cancer conditions, and is applicable early in the course of illness, in conjunction with other therapies. There is a high prevalence of symptoms and distress in heat failure (HF) necessitating palliative care, which include not just dyspnoea and oedema but also a range of other symptoms that are all sub-optimally controlled at the end of life.1
For patients with HF, palliative care attends to physical, psychological, social and spiritual distress, caring for both patients and fam...
Source: Heart Asia - April 24, 2019 Category: Cardiology Authors: Lo, R. S. Tags: Keynote Lecture Source Type: research
10 When is it time to switch the ICD off in a heart failure patient?
It is well documented that implantable cardioverter defibrillator (ICD) saves lives in populations at risk for sudden death. However, mortality in advanced heart failure remains high despite advances in therapy.1 Twenty per cent of ICD patients receiving shocks in the final weeks of their lives experience pain and decreased quality of life, causing distress to patients and their families.2 Ethically and legally, there are no differences between refusing ICD therapy and requesting withdrawal of ICD therapy. Carrying out a request to withdraw life-sustaining treatment is neither physician-assisted suicide nor euthanasia.3 De...
Source: Heart Asia - April 24, 2019 Category: Cardiology Authors: Cheung, L. Tags: Keynote Lecture Source Type: research
9 Transitional states in frailty: implications for end of life support in heart failure
The frailty syndrome is defined as the loss of reserve in multiple physiological systems that occur with ageing. Frailty can result in vulnerability to any minor disturbances and exposes older adults to an array of adverse health outcomes such as falls, fractures, hospitalisations, and mortality. The most common phenotype associated with frailty is sarcopenia, the age-related loss of skeletal muscle mass and function. The heart is a muscular structure, yet we do not understand whether the decline in cardiac function in old age is directly related to sarcopenia. However, there has recently been increasing interests in the c...
Source: Heart Asia - April 24, 2019 Category: Cardiology Authors: Lee, J. S. Tags: Keynote Lecture Source Type: research
8 Reversibility of frailty in LVAD and heart transplant patients
Frailty is a condition that is characterised by reduced physiological reserve. Multiple instruments have been developed to measure frailty mainly in community-dwelling elderly people.1 We have adapted one of these instruments, the Fried frailty phenotype, to assess frailty in patients with advanced heart failure (AHF) referred for consideration of ventricular assist device (VAD) implantation and/or heart transplantation (HTx).
Since 2013, when possible all AHF patients referred to our centre have been assessed for frailty. Fried’s five physical domains – exhaustion, grip-strength, mobility, appetite and physica...
Source: Heart Asia - April 24, 2019 Category: Cardiology Authors: Macdonald, P. S. Tags: Keynote Lecture Source Type: research
7 Nurse-led ambulatory heart failure clinic at queen elizabeth hospital, hong kong SAR
Prior to establishment of the heart failure (HF) nurse clinic at Queen Elizabeth Hospital (QEH), Hong Kong in 2003, high rates of hospital readmission were seen in HF patients. Despite shortage of manpower and resources in the Hong Kong public healthcare sector, the clinic has over the years improved patient outcomes including functional capacity and rates of hospital readmission.
Initially, cardiac nurses contributed to promoting patients’ health seeking behaviour through education. By 2012, the clinic provided protocol-guided titration of medications to achieve optimal dosing of medications. The HF clinic nurses wo...
Source: Heart Asia - April 24, 2019 Category: Cardiology Authors: Chan, C. M. Tags: Keynote Lecture Source Type: research
6 Using mobile app to empower care and self-management in LVAD patients
Self-management (SM) of a left ventricular assist device (LVAD) is a complex process and arduous to many patients. Thus, support from a family caregiver and a nurse is required to achieve the ultimate treatment goal for implanting an LVAD – to increase quantity and quality of life.1 A mobile phone application (VAD Care App version 1.0®) was invented to simplify the LVAD SM process and empower patient’s engagement in SM.2 The purposes of this presentation are the following: (1) illustrate the main components of the app; (2) describe the app-directed and nurse-supported LVAD SM intervention; and (3) present t...
Source: Heart Asia - April 24, 2019 Category: Cardiology Authors: Casida, J. M. Tags: Keynote Lecture Source Type: research
