#EACTS2021
The C TAH is probably the world's most advanced total artificial heart & is designed for patients with severe biventricular failure (i.e. for whom an LVAD would be insufficient).
It gained a CE mark last year and has an FDA approval for early feasibility studies
C TAH has 2 chambers, separated by a membrane into blood & fluid compartments. Electro-hydraulic pumps help produce pulsatile flow. Pressure sensors & electronics are embedded in the prosthesis. Biological valves are placed at the inlets and outlets of the ventricles
Prof Netuka shared an example of a 61yr old patient with severe BiV failure and fixed pulm HTN that could not be weaned from IABP and inotropic support
A Cardiomems device is placed as well to assist monitoring of pulmonary pressures
Well deserved round of applause at the end!
Eager to see where this technology goes. It's not new. I think Carmat started work on this in the early 1990s, initially a collaboration between Alain Carpentier & engineers from a subsidiary of Airbus. More tomorrow!
It takes time to read the paper, read the supplementary appendix, analyse the results, think about them etc!
Some thoughts...🧵
On Sunday I wrote a thread about asymptomatic severe AS and what we knew already from RECOVERY & AVATAR RCTs and what the guidelines currently advocate
Transthoracic echocardiography (TTE), when performed with care and diligence, can reveal a lot about the valve. TOE isn't necessary in all cases to determine leaflet pathology.
A worked example below:
In the PLAX view, you can assess the scallops of the leaflets
In a true PLAX view with aortic valve clearly visible, you mostly see the A2-P2 interface. Here, you can see a clear & large prolapse of the posterior leaflet
If you tilt upwards towards the PLAX RV outflow (pulmonary valve) view you see mostly the A1-P1 interface
Here, you can see the valve looks slightly different & no prolapse is seen
PE has garnered a reputation for huge profits as they typically buy into a company, aggressively ⬇️ costs whilst ⬆️ profit margins, leverage debt if needed, and then sell, often at a large profit
Does this matter when it comes to delivering healthcare services?
Sixty years ago this month - October 1963 - US cardiologist Dr Robert Bruce published a paper detailing his efforts to devise a multi-stage treadmill test
Little did he know this would go on to become the Bruce protocol the most widely used for exercise testing
A thread...
Prior to this, 'stress testing' to evaluate cardiac function was performed using the Masters 2-step technique, first described in 1935. This crude but simple test involved repeated steps up & down over 90 seconds
Bruce, amongst others, recognized the limitations of this test & set about developing an exercise treadmill test
His initial work focused upon a single stage protocol, but he soon realized this wasn't stressing fitter patients enough & the test was taking too long!