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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
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0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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Single-center short-term initial experience with magnetically levitated cardiac pumps in advanced heart failure
Session:
CO7 - Insuficiência Cardíaca
Speaker:
Christopher Strong
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Christopher Strong; António Tralhão; Carlos Aguiar; Miguel Abecasis; Marta Rafael Marques; António Ventosa; Miguel Mendes; José Pedro Neves
Abstract
<p><strong>Background:</strong> The prevalence of advanced heart failure (HF) is rising due to the growing number of patients with HF and their better treatment and survival. The short supply of donor hearts, however, has led to the development of mechanical circulatory support devices that can provide a solution for bridge or destination therapy.</p> <p><strong>Methods: </strong>Single-center retrospective study describing our initial experience with the HeartMate 3 (HM3) left ventricular assist device. Patients’ clinical characteristics, pre-implantation workup studies, and outcome were collected.</p> <p><strong>Results: </strong>Three patients have received HM3 since March 2017 (table), two of them as destination therapy (aged > 70 years old) and a younger patient as bridge to transplantation given a history of malignant gynecological cancer in remission and unsurety about tumor recurrence. All patients had severely depressed left ventricular ejection fraction (LVEF), two had borderline right ventricular function (1, 3) and none had more than mild aortic regurgitation. Patient 1 had G4 chronic kidney failure and Child-Pugh B congestive hepatopathy, the other patients had no significant non-cardiac organ dysfunction. During the peri-implantation period, all patients were bridged to HM3 implantation with intravenous inotropes. Patient 1 also needed right ventricular assist device implantation and tricuspid annuloplasty, besides the HM3. His post-operative period was complicated by significant blood dyscrasia with the need for multiple blood transfusions, vasopressor support and continuous renal replacement therapy, which ultimately lead to his death. The immediate post-operative period of patients 2 and 3 was uneventful. There was a longer time to resume ambulation in patient 3 due to a need for intensive physical therapy, given the significant muscle wasting before HM3 implantation. Until December 2018 patients 2 and 3 have resumed normal daily activities, with no bleeding, thromboembolic or infectious complications, and no significant aortic regurgitation or right ventricular failure in the follow-up echocardiograms thus far.</p> <p><strong>Conclusions: </strong>HM3 has become an important long-term alternative for the treatment of advanced HF, and has shown promising results for two of the patients who received the device. More severe heart failure with multi-organ dysfunction and a more complex surgery may have had an important impact in the post-operative period of patient 1. </p>
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