Artificial heart transplantation

1. TOTAL ARTIFICIAL HEART: SURGICAL TECHNIQUE IN
THE PATIENT WITH NORMAL CARDIAC ANATOMY
PRESENTED BY- MAHESH KUMAR
ROLL NO.- 191506.
DEPARTMENT OF BIOTECHNOLOGY, CUH
SUBMITTED TO- DR.BIJENDER SINGH
ARTICLE INFORMATION:
ANN CARDIOTHORAC SUG.2020 MARCH;9(2);81-88
DOI 10.21037/ACS.2020-2-09
PMCID:PMC71 60624
PMID: 32309155
JOSHUA S.CHUNG, DOMINICK EMERSION, DOMINICK MEGNA AND FRANCISCO
A.ARABIA.

2. INTRODUCTION
Total artificial heart-This is a pump that is surgically installed to provide heart
circulation and replace heart ventricles that has been damaged or diseased.
The ventricle pump blood out of the heart to the lungs and Other part of the body.
This is made up of total biocompatible plastic Which offers a high degree of
fatigue resistance and strength for long term stability.
The TAH consists of two artificial ventricles,made with biocompatible plastic Which
prevents the TAH from being rejected By the body.
This is discovered by Paul Winchell.
First implantation has been done in 1969.
There are 13 artificial heart design that has been made up but only one is
approved by FDA for transplantation.

4. WHAT IS THE PROBLEM BEHIND THIS ARTIFICIAL
HEART TRANSPLANTATION?
Bleeding.
Infections.
Organ failure.
Cardiac allograft vasculopathy is the common cause of heart failure.
A common problem with artificial heart transplant is their tendency to allow
blood to clot due to their rigid composition.
Blood clot can leads to stroke.

5. OBJECTIVE
The purpose is to develop a temporary machine or pump for a person who
is suffered from a heart disease.
Their survival without heart is impossible.
These temporary device can provide enough time to patient until a donor
heart is available.
To improve quality of life.

6. STRUCTURE OF TAH

7. PARTS FUNCTION
• It consists of two independent artificial ventricles and available in two sizes.
• A.The 70 cc has a maximum stroke volume of 70ml and is capable of generating a cardiac output
of upto 9.5L/minute.
• B.The 50 cc has a maximum stroke volume of 50ml and is capable of generating a flow rate of
upto 7.5 ml/minute .each ventricle is divided by a multi layer flexible polyurethane diaphragm that
separates the blood chamber from the air chamber.
• The polyurethane ventricles are connected by velcro, which allows for flexible poisoning inside the
chest cavity.The direction of the blood flow is controlled by synhall tilting disc valves that are
mounted in the inflow and outflow parts of each artificial ventricles.
• The cannula is partially covered with velour fabric to promote the tissues growth.They are capable
tunneled through the chest wall and attached to drivelines that are connected to the external
pneumatic driver.Initialy , while the patient is recovering from implantation,he or she is connected
the c2 driver , after the patient is clinically stable,they can be switched to the freedom driver-A
small ,lighter pneumatic pump for the TAH -used to increased mobility and the ability to be
discharged home.

8. FUTURE DEVICE
• Recently,a new artificial heart was developed and underwent a pilot study in France
.There are some examples-
• 1.CARMAT –A bioprosthetic artificial heart,was developed and underwent a pilot
study in France. It has following features-
• Made up with biocompatible material.
• Potential to reduce thromboembolic Risk’s.
• Pulsatility.
• 2. BIVOCORE- This is an artificial heart , created in Houston,Texan and is currently
undergoing animal studies.
• Features-
• Two centrifugal impellers-placed on a rotor that can provide high flow over 12 ltr..
• Smart controller – that adapts to the changes in the patient activities.
• Small size

9. MATERIAL
• Bandages.
• Catheters.
• Breathing tube.
• Heart lung machine.
• Ventilator.
• Defibrillator.
• Heart lung machine.
• Medications.

10. HEART-LUNG MACHINE

11. WHY IT IS DONE?
• Heart transplants are performed when other treatments for heart problems have not
worked, leading to the heart failure.
• In adults, Heart failure can be caused by-
• Cardiomyopathy.
• Coronary artery disease.
• Heart valve disease.
• Ventricular arrhythmias.
• Cognital heart defects.
• Failure of a previous heart transplant.

12. NORMAL HEART TRANSPLANTATION• In normal heart transplant-NORMAL HEART TRANSPLANTATION
• There are following steps involved-
• Firstly,The ribs of patients cut by doctors.
• So ,for this , doctors use a drill machine.
• After rib cutting, Heart is opened.after that , patient heart is is not in working condition because this is defunctionized by the
doctors.
• And after this a heart lung machine is connected with patients.
• Through this HL machine, Blood circulation is going on.
• After that doctors,fix the donors heart in the body of recipient.
• They give blood supply to patient .
• They give a electric pulse if heart is not pumping the blood.
• Note-
• Time – Approximately 10 Hours.
• Machine – defibrillator, heart-lung machine.
• Hospitalization time -7-20 days.
• Cost in India – 10 khkh -30 Lakh or more.

13. TAH SURGICAL PROCEDURE
• Before surgery-
• If you are not already in the hospital,You will likely spent at least a week in the hospital
to prepare for the TAH surgery.You will continue to take any heart medicines , your doctor
gave you.During this time,You will learn about the TAH that you are getting and how to
live with it.You may have the following tests before your surgery-
• 1.Blood test.
• 2.CT scan.
• 3. Chest MRI
• 4.Chest X-ray
• 5.Electrocardiogram.
• 6.Ecocardiogram.
• 7.Pulmonary function test.
• 8.TEE.

14. SURGICAL TEAM
• As many as 15 people might be in the operating room during the surgical
including-
• 1.Surgeons.
• 2.Surgical Nurses.
• 3.Anesthesiologists.
• 4.Perfusiologists.
• 5.Engineers.

15. DURING SURGERY:CONNECTING THE TAH DEVICE
• An anesthesiologist will give you medicine to make you sleep before the surgery. During the
surgery,the anesthesiologist will check your heart rate and blood pressure, oxygen level and
breathing.
• A breathing tube is placed in your mouth.
• This tube is connected to a ventilator machine that will support your breathing during the surgery.
• Medicine are used to stop your heart.This allow the surgeon to operate on your heart while it is not
moving.A heart lung machine bypass machine keeps oxygen-rich blood moving through your body
during the surgery.To perform the surgery, your surgeon wil cut into your chest bone to get your
heart.Your surgeon will open your ribcage, remove your heart ventricles and attach the TAH to the
upper chamber of your heart and to the aorta and to the pulmonary artery.When everything is
attached,the heart lung machine will be switched off and surgical team will activate the TAH .So ,it
starts working.
• If the TAH is working properly and you are not bleeding abnormaly,the surgeon will close your chest
again.In some cases,it will remain partially closed for a few days.The medical team will fully close the

16. AFTER SURGERY
• Your hospital stay after surgery could last a month or more.
• Recovery time ,after TAH surgery will depend a lot of on your
health before surgery.
• After surgery, you will be moved to the hospital’s intensive care
unit.
• You may still need a ventilator to help you breathing.For a while ,
You may receive fluids and nutrition through a feeding tube or an
intravenous line in your arm.Your health care team will monitor
another intravenous line in your neck or your leg to evaluate that
how the TAH is working.You will also have a tube inserted into
your urinary tract to evaluate how your kidneys are working.

17. ETHICAL ISSUES
• It begins by lacking at the history of funding of the artificial heart
programme through the National institute of health in 1965.
• Attention is paid to the problem of the lack of planing related to
social, ethical, economic and legal implications.
• There are three area of ethical issues-
• 1.Experimental versus the benefit and quality of life for the patient.
• 2.Cost.
• 3.Public involvement in the development of a device which has
turned over to the private business sector.

18. CONFLICTS RELATED TO HAT
• It’s a device used in patients with end stage of biventricular heart
failure while waiting for orthopaedic heart transplantation.
• The most common complications on TAH recipients include-
• Infections.
• Bleeding.
• Blood clotting.
• Liver failure.
• Neurological events such as stroke and device malfunction.

19. ADVANTAGES AND DISADVANTAGES
• Advantages-They are not rejected by the body immune system because they are made
from metal and plastic,so body doesn’t recognise them as a foreign and attack in the
same way it does with living tissue.
• Disadvantages-
• Infection.
• Larger in size.
• Stroke and bleeding are the possible complications with the artificial heart.
• Failure of electronic motor.
• Cost is high.
• Time consuming.
• The patient has to take drugs to thin their blood and make sure this doesn’t happen
which can cause problems with bleeding if they are hurt in an accident.

20. RESULTS
• According to Copland :From this article, an information is found about
ARTIFICIAL heart transplantation-
• In their ,81 patients-70%survival rate.
• Recently , Arabia et al. Report: During 2006-2007
• Survival rate-1year-53.9%
• 2nd year-33.9%
• Overall survival rate-53%
• Overall mortality rate- 34%
• Patient who have required pre implant dialysis, had a high mortality
rate.
• Implantation and managing the patient was very difficult.

21. CONCLUSION
• From this article,an information is found that by TAH-
• Bioventricular functions is very difficult stage in
implantation process.
• This is observed by the clinician.
• Although, it’s future is bright for mechanical Circulatory
support as new new artificial heart are being created with
the Continuing advances in technology.

22. REFERENCE
• 1.Benjamin EJ ,Munter P,Alonso A,et Al. Heart disease and stroke statistics-2019
Update: a report from the American heart association.
• Circulation2019,139:e56 ,e628.
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• Continuous flow left Ventricular
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23. •THANK YOU