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Mechanical circulatory support
This document discusses mechanical circulatory support devices (MCSDs) and artificial hearts. It begins by explaining heart failure and its stages. It then describes various types of temporary and permanent MCSDs, including their goals, energy sources, blood flow characteristics, and implantation methods. Examples of specific MCSDs are provided like the IABP, ECMO, Impella, TandemHeart, HeartMate XVE, HeartMate II, HeartWare, Jarvik 2000, and total artificial hearts from SynCardia and Carmat. Major complications of MCSDs and artificial hearts discussed are bleeding, infection, and thrombosis.
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Mechanical circulatory support
- 1. MECHANICAL CIRCULATORY SUPPORTDEVICES & ARTIFICIAL HEARTS Department of Cardiac and Vascular Surgery Medical University Plovdiv Hristo Rahman
- 2. HEART FAILURE • HFas 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
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- 4. STAGE DEFINITION А At highrisk 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 )
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- 22. HeartMate III • NoCPB • 2 mini-thoracotomies • * minimally invasive • E. Potapov, DHZB, 2016
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- 24. HeartMate II vs.HeartMate III
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- 31. MAJOR COMPLICATIONS OF MCSDs &TAHs • BLEEDING • INFECTION • THROMBOSIS