Presentation for students

1. MECHANICAL CIRCULATORY SUPPORT DEVICES
&
ARTIFICIAL HEARTS
Department of Cardiac and Vascular Surgery
Medical University Plovdiv
Hristo Rahman

2. HEART FAILURE
• HF as a complication:
• Terminal stage of any heart disease
• HF affects:
• - Ventricular filling ( diastolic dysfunction );
• - Myocardial contraction ( systolic dysfunction ).
• The heart is unable to adequately provide blood circulation
needed for the normal functioning of the metabolic processes
within peripheral tissues, other organs and systems
• Secondary Multi-System Organ Failure (MSOF) develops as a
result of terminal HF

3. HF
DEFINITIONS AND STAGING

4. STAGE DEFINITION
А
At high risk for HF but without structural heart disease or symptoms
of HF and structural heart disease not present
( pts. with: hypertension and diabetes; cardiotoxic cancer
chemotherapy, etc. )
B
Structural heart disease appears including changes in chamber size
or shape, valvular lesions, LVH, but NO symptoms of HF
( pts. with: prior MI; asymptomatic valvular heart disease, etc.)
C
Structural heart disease with prior or current symptoms of HF
( pts. with: chronic systolic or diastolic LV dysfunction )
D
Refractory HF requiring specialised interventions
Patients are symptomatic at rest despite max. medical
therapy.
Need of MCSD and/or Heart Transplant

5. HF stage D ( ACCF & AHA )
ETIOLOGY
• ISCHAEMIC
CARDIOMYOPATHY
• DILATED CARDIOMYOPATHY
• 1) viral-induced
• 2) toxic
• 3) drug-induced
• 4) alcohol-induced
• SARCOIDOSIS
• PERIPARTUM
CARDIOMYOPATHY

6. MECHANICAL CIRCULATORY SUPPORT
( MCS )
• DEFINITION
• - Means of generating kinetic energy, needed to maintain
blood circulation by artificial devices
• AIMS
• - 1) To support: (
IABP, ECMO, Impella Recover, TandemHeart )
• - 2) To partially or fully replace: (
HeartMate XVE, Thoratec VAD, Jarvik 2000, SynCardia TAH )
• Pump function of compromised LV/RV or LV+RV

7. MECHANICAL CIRCULATORY SUPPORT
DEVICES ( MCSDs )
• TEMPORARY MCSDs:
• - 1) short period of time ( days )
• ( IABP, ECMO, Impella Recover, TandemHeart, ABIOMED BVS 5000
)
• - 2) long period of time ( weeks, months, years )
• ( HeartMate XVE, Thoratec VAD, CardioWest TAH )
• PERMANENT MCSDs ( Destination therapy )
• ( HeartMate II, AbioCor TAH, Jarvik 2000, INCOR LVAD )

8. MECHANICAL CIRCULATORY SUPPORT
DEVICES ( MCSDs )
• Mechanical pump mechanism location
• 1) outside of body ( extra-/paracorporeal )
• ( Thoratec PVAD )
• 2) within body ( intracorporeal )
• ( INCOR LVAD, HeartMate II, Jarvik 2000 )

9. MECHANICAL CIRCULATORY SUPPORT
DEVICES ( MCSDs )
• GOALS:
• SUPPORT OF COMPROMISED MYOCARDIAL PUMP FUNCTION UNTIL:
• 1) event of full myocardial recovery
• Bridge-to-Recovery
• 2) event of adequate decision for further management
• Bridge-to-Decision
• 3) event of continuing support with another type of MCSD
• Bridge-to-Bridge
• 4) event of heart transplant surgery
• Bridge-to-Transplantation
• 5) for the rest of life
• Destination therapy

10. MECHANICAL CIRCULATORY SUPPORT
DEVICES ( MCSDs )
• Source of energy
• 1) Electric ( HeartMate XVE )
• 2) Pneumatic ( Thoratec VAD )
• Position of energy source ( battery )
• 1) Intracorporeal ( AbioCor TAH )
• 2) Paracorporeal ( HeartMate II, SynCardia TAH )
( transcutaneously conducted electric energy )

11. MECHANICAL CIRCULATORY SUPPORT
DEVICES ( MCSDs )
• Characteristics of the generated blood flow
• 1) Pulsatile
• ( HeartMate XVE, Thoratec VAD, CardioWest TAH )
• 2) Laminar
• ( Impella Recover, HeartMate II, Jarvik 2000, INCOR LVAD )

12. MECHANICAL CIRCULATORY SUPPORT
DEVICES ( MCSDs )
• Implantation methods
• 1) Percutaneous
• ( IABP, ECMO, Impella Recover, TandemHeart )
• 2) Surgical
• ( HeartMate II, Thoratec VAD, INCOR, AbioCor TAH )
• 3) Percutaneous and/or Surgical
• ( IABP, ECMO, Impella Recover )

13. IABP

14. ECMO

15. Impella Recover

16. TandemHeart

17. ABIOMED BVS 5000

18. Thoratec VAD

19. HeartMate XVE

20. HeartMate II

21. HeartMate III

22. HeartMate III
• No CPB
• 2 mini-thoracotomies
• * minimally invasive
• E. Potapov, DHZB, 2016

23. HeartWare

24. HeartMate II vs. HeartMate III

25. Jarvik 2000

26. INCOR BerlinHeart

27. SynCardia TAH

28. Carmat TAH

29. AbioCor TAH

30. AbioCor
TAH

31. MAJOR COMPLICATIONS
OF
MCSDs & TAHs
• BLEEDING
• INFECTION
• THROMBOSIS