JIM Today 2018 - Friday - page 6

JIM today
Issue 2 
 23 February 2018
A new era in percutaneous
ventricular devices?
key speaker at this after-
noon’s Structural Heart 2
session will be Christian
Schulze, Professor of Medicine
and Chair of the Department of
Medicine and Division of Cardiol-
ogy at the University Hospital
Jena, Germany. Today he will be
looking at the impact of early
cardiac mechanical unloading in
patients with acute heart failure
and cardiogenic shock.
Professor Schulze will address
important ongoing work in the
field of percutaneous ventricular
assist devices – an arena in which
he has great experience. Until
2015, he was Associate Profes-
sor of Medicine at Columbia
University Medical Center, one
of the largest heart failure, me-
chanical assist device and cardiac
transplant centers in the US, and
has published more than 170
peer-reviewed manuscripts.
Professor Schulze explained
that, owing to the higher me-
chanical load that patients with
cardiogenic shock have, early
unloading in those patients might
lead to an early recovery of myo-
cardial function. “We know that
the early unloading of the left
ventricle can lead to favourable
outcomes for patients in compari-
son to the use of inotropic drugs,
which increase the contractile
force of the myocardium but also
oxygen consumption,” Professor
Schulze told
JIM Today
He added: “We also know
that patients on inotropic
medication have higher mortal-
ity than patients who are not on
inotropic medication.”
In recent years, a growing
amount of research has focused
on percutaneous assist devices:
“It has been shown that percuta-
neous assist devices can lead to
rapid mechanical unloading and
reduced the need for high doses
of inotropic support. Therefore,
we believe that the early imple-
mentation of percutaneous assist
devices leads to better outcomes
in cardiogenic shock.”
That’s still a hypothesis, at the
moment, which is why an ongo-
ing trial amongst German and
Danish colleagues is particularly
important. Professor Schulze will
discuss the DANGER – SHOCK
trial which will be randomising
patients with acute myocardial
infarction and cardiogenic shock
to implantation of the Impella as-
sist device (Abiomed, USA) versus
medical therapy only. “With this
trial, we will see if implantation
of a percutaneous assist device
changes outcomes,” he said.
“If this trial is positive, it will be
guideline defining.”
Professor Schulze will also talk
about the indications for mechan-
ical assist devices, percutaneous
techniques that can be used for
the implantation of these devices,
as well as ways to monitor and
ultimately remove devices.
Importantly, he will address
patients with a high risk during
coronary interventions, and how
a backup mechanical assist device
can lead to better outcomes.
“This is based on data show-
ing that the implantation of a
mechanical assist device early on,
before the coronary intervention,
can lead to better outcome be-
cause the patient is stabilised us-
ing a percutaneous assist device,”
he said. “This approach is called
protected PCI.”
In the future, he’s hoping that
such devices will become even
more useful. As such, he will
outline the outcome parameters
that should be considered in
upcoming trials. “We would like
these percutaneous devices to be
as minimally invasive as possible,”
he said.
And there is indeed pressing
need for randomised trials, added
Professor Schulze. “In patients
with cardiogenic shock – but also
with current high-risk coronary in-
terventions – we must first show
the validity of our hypothesis: that
mechanical assist devices improve
the outcomes in these high-risk
populations,” he said. “Secondly,
we must also determine the
ideal candidates.”
Structural heart 2 
Questions & Answers
Clinical crossroads on optimal
antithrombotic therapy in patients
treated with PCI
Room Parini
Chairpersons: Giuseppe Musumeci,
Gregg W. Stone
Intravenous antiplatelet therapy in
high-risk ACS
Clinical Case: High-Risk ACS
Giuseppe Tarantini
GPIIb/IIIa inhibitors are still the best option
Alberto Menozzi
Cangrelor is ready for the prime time
Dominick Angiolillo
Clinical case conclusion
Giuseppe Tarantini
13.08 Discussion
Antithrobotic therapy in patients
with non-valvular atrial fibrillation
undergoing PCI
Clinical Case: PCI in AF patients
Ferdinando Varbella
Short triple therapy and dedicated stents
Ghada Mikhail
Dual therapy is the right choice
Roxana Mehran
Clinical case conclusion
Ferdinando Varbella
13.38 Discussion
Long-term antiplatelet therapy in high
risk PCI patients
Clinical Case: Management of
long-term DAPT
Ugo Limbruno
Long term DAPT after ACS:
balancing risks and benefits
Marco Roffi
Perioperative management of patients
with coronary stents undergoing requiring
surgery: bridging therapy is an option
Roberta Rossini
Clinical case conclusion
Ugo Limbruno
14.08 Discussion
Closing remarks
Main Hall Washington
Chairperson: Jeffrey W. Moses
Co-chairperson: Maurice Buchbinder
University Hospital
Commentators: Alexandre C. Abizaid, Francesco
Bedogni, Alberto Cremonesi, Ted
Feldman, Alan Yeung
Guest operators: Paul Hsien-Li Kao,
Marco Wainstein
Online factoids relevant to the cases presented:
Francesco Giannini (Coordinator),
Gianmarco Iannopollo, Antonio Mangieri
Discussing the case
Live in the box. Acute neuro intervention
Bernhard Reimers
Discussants: Patrizia Presbitero, Horst Sievert
16.25 Coffee break
ThoraxCenter, Erasmus University Medical Center
Commentators: Eustachio Agricola, Paolo Denti,
Continued from page 4
Continued on page 8
“With this trial, we will see if
implantation of a percutaneous assist
device changes outcomes. If this trial is
positive, it will be guideline defining.”
Christian Schulze
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