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

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%). <br /> 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. <br /> 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. <br />

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

  • ‫أ.د. أحمد الحميدي مقرر 333 حين‬
  • CYBORGS ARE DEVICES IMPLEMENTED IN HUMEN BEINGS FOR NEW MODALITY OF THERAPY Dr SAMIR TAYFOUR CONSULTANT CARDIOLOGIST
  • 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 .
  • 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.
  • 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
  • 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 .
  • Monster or cyborg-object?
  • 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?
  • Dual chambres pacemaker
  • 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
  • CHF and MRI • Dimensions • Contractility, Viability • Valve function MRI crossectional sequence of dilated LV March 2013 ghennersdorf DGK ESC SES 16
  • 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)
  • 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
  • 1966-1980 : works of Dr Mirowski, inventor and designer OF ICD
  • 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.
  • 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
  • HEART SURGERY IN THE 21ST CENTURY
  • Indications • Bridge to Transplantation • Bridge to Recovery • Destination Therapy
  • Implantable Ventricular Assist Device
  • People Don’t want a LVAD, they want a Heart
  • 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)
  • Multicenter Trial of the Orqis® Medical Cancion System for the ENhanced Treatment of CHF Unresponsive to Medical Therapy
  • Cancion System for Continuous Aortic Flow Augmentation (CAFA)
  • 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
  • Cardiac Transplant On December 3rd 1967 Dr CHRISTIAN BERNARD At Groote Schuur Hospital
  • 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.
  • Heart transplantation March 2013 ghennersdorf DGK ESC SES 56
  • 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 ?.
  • THANK YOU…!!