HEART FAILURE 3/3 Cyborgs are devices implemented in humen beings for new modality of therapy (2)

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HEART FAILURE,Devices is a new era in cardiac therapy .

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  • Interestingly, most patients who suffer from sudden cardiac death (64%) are the patients who are minimally symptomatic with Class II heart failure. The sickest, most symptomatic patient (Class IV) experience heart failure deaths (56%) from pump failure, rather than sudden cardiac death (33%).
    It is important to remember that although it can be said that a heart failure patient in NYHA Class II may have a higher risk of SCD, their relative annual risk of dying is less than the other NYHA classes.
    The SCD-HeFT Trial (Sudden Cardiac Death in Heart Failure Trial) which enrolled NYHA Class II and III patients, hopes to answer whether patients in these classes are truly at a higher risk for SCD and need protection.
  • HEART FAILURE 3/3 Cyborgs are devices implemented in humen beings for new modality of therapy (2)

    1. 1. ‫أ.د. أحمد الحميدي مقرر 333 حين‬
    2. 2. CYBORGS ARE DEVICES IMPLEMENTED IN HUMEN BEINGS FOR NEW MODALITY OF THERAPY Dr SAMIR TAYFOUR CONSULTANT CARDIOLOGIST
    3. 3. CYBORG • • • • Kybernàn= pilotare “steerman” Cyber+ organism “ hybrid “ Mixture of machin+organism Norbert Wiener (1947) . Cybernaut , Cyberspace Borg (Star Trek) . a human being whose body has been taken over in whole or in part by electromechanical devices ; " a cyborg is a cybernetic organism .
    4. 4. Cyborg = cybernetics + organism Cybernetics or Communication in the human being or animal and the Machine. Based on the Greek “Kybernetics”, meaning “captain”to navigate cybernetics is the science or study of the control or regulation mechanism in human and machine systems, including computers.
    5. 5. What is a cyborg? ‘A cyborg is a cybernetic organism, a hybrid ‘mixture’ of machine and organism, a creature of social reality as well as a creature of fiction’ – Donna Haraway A Cyborg Manifesto A human cyborg is a human who has certain physiological processes aided or controlled by mechanical or electronic devices
    6. 6. Cyborg:a science of communication and control processes in animals and automated machines, where the study of control systems , such as the nervous system , in living organisms and the development of similar systems in the electronic and mechanical devices .
    7. 7. Monster or cyborg-object?
    8. 8. Cyborg = Cybernetic Organism Organism (natural) • Complex, inflexible feedback loop • Too much change – organism will die Cybernetic (artificial) • Flexible feedback loop • Responsive to stimuli, able to adapt to survive What does it mean to be human?
    9. 9. Dual chambres pacemaker
    10. 10. Cardiac resynchronization therapy (CRT) CRT device: Patients with NYHA Class Ⅲ /Ⅳ Sympotomatic despite optimal medical therapy QRS ≥ 120 msec LVEF ≤ 35% CRT plus ICD: Same as above with ICD indication
    11. 11. CHF and MRI • Dimensions • Contractility, Viability • Valve function MRI crossectional sequence of dilated LV March 2013 ghennersdorf DGK ESC SES 16
    12. 12. Consequences of contractility due to LBBB • In DCM, certain areas of the LV wall are contracted (blue) when others are already relaxed (red). Other areas are constrained (yellow)
    13. 13. 1980-82:ICD is First implanted patient in the U.S. (Johns Hopkins, Baltimore) and France (Lariboisière, AP-HP) Short-lived systems 250g, non-programmable Abdominal implant thoracotomy
    14. 14. 1966-1980 : works of Dr Mirowski, inventor and designer OF ICD
    15. 15. Severity of Heart Failure Modes of Death NYHA II NYHA III CHF 12% CHF Other 26% 59% Sudden Death 24% 64% 15% n = 103 NYHA IV 33% 11% Other Sudden Death n = 103 CHF Other 56% Sudden Death n = 27 MERIT-HF Study Group. Effect of Metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL randomized intervention trial in congestive heart failure (MERIT-HF). LANCET. 1999;353:2001-07.
    16. 16. ICD Therapy CLASS I INDICATIONS: 1. Ischemic cardiomyopathy with LVEF < 35%, at least 40 days post MI, NYHA class II OR III. (Strength of Evidence = A) 2. Ischemic cardiomyopathy with LVEF < 30%, at least 40 days post MI, NYHA class I. (Strength of Evidence = A) 3. Non Ischemic cardiomyopathy with LVEF ≤ 35%, NYHA class II OR III. (Strength of Evidence = B) The ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities
    17. 17. HEART SURGERY IN THE 21ST CENTURY
    18. 18. Indications • Bridge to Transplantation • Bridge to Recovery • Destination Therapy
    19. 19. Implantable Ventricular Assist Device
    20. 20. People Don’t want a LVAD, they want a Heart
    21. 21. Artificial Heart The HeartMateII is a continuous flow cardiac assist device. Heart surgeon "Bud" Frazier and his team are working with two such devices to develop a continuous flow artificial heart. (Courtesy: Texas Heart® Institute)
    22. 22. Multicenter Trial of the Orqis® Medical Cancion System for the ENhanced Treatment of CHF Unresponsive to Medical Therapy
    23. 23. Cancion System for Continuous Aortic Flow Augmentation (CAFA)
    24. 24. Continuous Aortic Flow Augmentation (CAFA) Changes Flow Signature in Heart Failure Early Diastole Backflow against the aortic wall Forward flow in the center of the aorta Early Diastole With CAFA
    25. 25. Cardiac Transplant On December 3rd 1967 Dr CHRISTIAN BERNARD At Groote Schuur Hospital
    26. 26. Management of Refractory Heart Failure • Inotropic drugs: – Dobutamine, dopamine, milrinone, nitroprusside, nitroglycerin • Mechanical circulatory support: – Intraaortic balloon pump – Left ventricular assist device (LVAD) • Cardiac Transplantation – A history of multiple hospitalizations for HF – Escalation in the intensity of medical therapy – A reproducable peak oxygen consumption with maximal exercise (VO2max) of < 14 mL/kg per min. (normal is 20 mL/kg per min. or more) is relative indication, while a VO2max < 10 mL/kg per min is a stronger indication.
    27. 27. Heart transplantation March 2013 ghennersdorf DGK ESC SES 56
    28. 28. Dick Cheney robot heart watch Several heart attacks, a bypass, a pump and now a heart transplant later, Dick Cheney is back in action. Is he a ROBOT NOW ?.
    29. 29. THANK YOU…!!

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