CARDIOGENIC SHOCK PROGRAM: NON-SURGICAL PERCUTANEOUS INTERVENTIONS IN CARDIOGENIC SHOCK (CCC-224)

Friday, October 27, 2023

11:00 – 11:45 EST

Location: Palais, 513ABC

Target Audience: Heart failure specialists, Cardiac surgeons, Critical care practitioners

Chair(s)

Adriana Luk, MD, MSc, FRCPC (she/her/hers)

Critical Care Cardiologist, Advanced Heart Failure and Transplantation
University Health Network
University Health Network

Co-Chair(s)

Maxime Tremblay-Gravel, MD MSc (he/him/his)

Cardiologist
Montreal Heart Institute
Université de Montréal
Christopher W. White, MD PhD (he/him/his)

Cardiac Surgeon
CSCS
Dalhousie University

Presenter(s)

EH

Eric Horlick, MD

Cardiologist, Peter Munk Chair in Structural Heart Disease Intervention
ccS
Yoan Lamarche, ccs, cancare

Cardiac Surgeon/Intensivist
Cancare, cctn, chfs, ccs
Montreal Heart Institute
CM

Caroline M. McGuinty, MD FRCPC

Cardiologist
CCS, CCTN
University of Ottawa
Thomas M. Roston MD PhD, FRCPC

Genetic & Critical Care Cardiologist
Univ British Columbia
University of British Columbia
Gurmeet Singh, MD, MSc, FRCSC

Critical Care & Cardiac Surgery
CANCARE & CSCS
CANCARE, CSCS
Michael B. Tsang, MD, FRCPC, MSc

Associate Professor, Division of Cardiology, Department of Medicine
CAIC
McMaster
Tiffany Yuen, MD, FRCPC

Cardiology Resident
University of Alberta

PDF

Panelist(s)

Anil Gupta

Cardiologist
Trillum Health Partners
Trillum Health Partners
Christopher Brian Overgaard, MD, MSc., FRCPC (he/him/his)

Director, Interventional and Complex PCI Program, Southlake Regional Healthcare Centre
ccs
CANCARE
Stephanie Poon, MD, MSc, FRCPC

Cardiologist
CCS, CHFS
University of Toronto

Planning Committee Member(s)

Phyllis Billia, MD, PhD, FRCPC

Clinician Scientist
CCS, CCTN, CHFS, CANCARE
Toronto General Research Institute
Anique Ducharme, MD (she/her/hers)

Cardiologist
CCS, CCTN, CHFS, CANCARE
University of Montreal
ER

Erin Rayner-Hartley, MD, FRCPC

Cardiology, Critical Care Medicine
CANCARE
University of British Columbia
Sean van Diepen, MD, MSc

Physician
University of Alberta
University of Alberta

Disclosure(s):

Maxime Tremblay-Gravel, MD MSc: No financial relationships to disclose

Christopher W. White, MD PhD: No relevant disclosure to display

Caroline M. McGuinty, MD FRCPC: Astra Zeneca: Research Grant (includes principal investigator, collaborator or consultant and pending grants as well as grants already received) (Ongoing); Novartis: Speaker/Honoraria (Ongoing); Pallium Canada: Speaker/Honoraria (Ongoing)

Thomas M. Roston, FRCPC: No financial relationships to disclose

Gurmeet Singh, MD, MSc, FRCSC: Abbott Laboratories: Ownership Interest (stocks, stock options, patent or other intellectual property or other ownership interest excluding diversified mutual funds) (Ongoing)

Michael B. Tsang, MD, FRCPC, MSc: Abiomed: Other Research Support (includes receipt of drugs, supplies, equipment or other in-kind support) (Ongoing); Boston Scientific: Other Research Support (includes receipt of drugs, supplies, equipment or other in-kind support) (Ongoing); Teleflex: Other Research Support (includes receipt of drugs, supplies, equipment or other in-kind support) (Ongoing)

Tiffany Yuen, MD, FRCPC: No financial relationships to disclose

Phyllis Billia, MD, PhD, FRCPC: Abbott Laboratories: Research Grant (includes principal investigator, collaborator or consultant and pending grants as well as grants already received) (Ongoing)

Erin Rayner-Hartley, MD, FRCPC: No financial relationships to disclose

Sean van Diepen, MD, MSc: No financial relationships to disclose

Learning Objectives / Objectifs d'apprentissage:

At the end of this session participants will be able to / Au terme de cette conférence, vous serez:

identify strategies for percutaneous MCS support in cardiogenic shock;
understand how to choose the right device in the right patient; and
when are patients with cardiogenic shock not candidates for surgery.

Workshop Description: Cardiac surgery is the most invasive of options in the patient with acute CS. While it may be the most definitive, the perioperative risks of serious morbidity and mortality are highest in patients with CS. At most centres, the cardiac surgeon is responsible for invasive tMCS, and is also called routinely for cases where coronary anatomy and/or valvular heart disease would be best managed surgically under normal circumstances. However, many CS patients are not well suited to open heart surgery at presentation owing to their poor chances of surviving the perioperative period. In such situations, the non-surgical members of the team are tasked with determining if any non-surgical procedural options may rescue patients from CS. These discussions often lead to questions surrounding the translatability of percutaneous options for CS such as high risk/suboptimal PCI, cardiac resynchronization therapy and transcatheter valve interventions. When such options are not available, feasible, or indicated, a change in approach is required, including the avoidance of initiating tMCS that is unlikely to alter the likelihood of survival, and the initiation of a compassionate palliative approach to the patient dying of CS.
This symposia will cover the situations where surgery may not be the best option for a patient with a traditional surgical indication, and outlines potential percutaneous interventions that may lack high quality evidence, but are increasingly implemented in shock centres. These situations create a natural opportunity to also examine a contemporary palliative approach to CS in an increasingly invasively managed disease.