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Ventricular Assist Devices and Total Artificial Hearts

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Book cover Device Therapy in Heart Failure

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Advanced heart failure (ACC/AHA stage D) affects about 10% of all patients with heart failure secondary to systolic dysfunction, and is defined by persistent symptoms and disease progression despite optimal medical and device therapy. This group of patients has a mortality rate that approaches 50% at 6 months. Heart transplantation, the best currently available solution for the appropriate patient, is unfortunately limited by donor availability. This chapter discusses alternative device therapy for patients with advanced heart failure, including ventricular assist devices and total artificial hearts.

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References

  1. Hunt, S.A., et al., ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the International Society for Heart and Lung Transplantation; Endorsed by the Heart Failure Society of America. Circulation, 2001. 104(24):2996–3007.

    Article  CAS  PubMed  Google Scholar 

  2. Stevenson, L.W. and R.L. Kormos, Mechanical Cardiac Support 2000: Current applications and future trial design. J Thorac Cardiovasc Surg, 2001. 121(3):418–24.

    Article  CAS  PubMed  Google Scholar 

  3. Vitali, E., et al., Different clinical scenarios for circulatory mechanical support in acute and chronic heart failure. Am J Cardiol, 2005. 96(12A):34L–41L.

    Article  PubMed  Google Scholar 

  4. Moulopoulos, S.D., S.R. Topaz, and W.J. Kolff, Extracorporeal assistance to the circulation and intraaortic balloon pumping. Trans Am Soc Artif Intern Organs, 1962. 8:85–9.

    CAS  PubMed  Google Scholar 

  5. Kantrowitz, A., et al., Initial clinical experience with intraaortic balloon pumping in cardiogenic shock. JAMA, 1968. 203(2):113–8.

    Article  CAS  PubMed  Google Scholar 

  6. Allen, G.S., K.D. Murray, and D.B. Olsen, The importance of pulsatile and nonpulsatile flow in the design of blood pumps. Artif Organs, 1997. 21(8):922–8.

    Article  CAS  PubMed  Google Scholar 

  7. Song, X., et al., Axial flow blood pumps. Asaio J, 2003. 49(4):355–64.

    PubMed  Google Scholar 

  8. Mudge, G.H., Jr., The management of mechanical hearts. Trans Am Clin Climatol Assoc, 2005. 116:283–91; discussion 292.

    PubMed  Google Scholar 

  9. Pennington, D.G., et al., Long-term follow-up of postcardiotomy patients with profound cardiogenic shock treated with ventricular assist devices. Circulation, 1985. 72(3 Pt 2):II216–26.

    CAS  PubMed  Google Scholar 

  10. Hill, J.D., et al., Bridge to cardiac transplantation: successful use of prosthetic biventricular support in a patient awaiting a donor heart. ASAIO Trans, 1986. 32(1):233–7.

    CAS  PubMed  Google Scholar 

  11. Farrar, D.J., The thoratec ventricular assist device: a paracorporeal pump for treating acute and chronic heart failure. Semin Thorac Cardiovasc Surg, 2000. 12(3):243–50.

    CAS  PubMed  Google Scholar 

  12. Thoratec, Heartmate XVE LVAS: Clinical Operation and Patient Management. 2006.

    Google Scholar 

  13. Rose, E.A., et al., Artificial circulatory support with textured interior surfaces. A counterintuitive approach to minimizing thromboembolism. Circulation, 1994. 90(5 Pt 2):II87–91.

    CAS  PubMed  Google Scholar 

  14. Slater, J.P., et al., Low thromboembolic risk without anticoagulation using advanced-design left ventricular assist devices. Ann Thorac Surg, 1996. 62(5):1321–7; discussion 1328.

    Article  CAS  PubMed  Google Scholar 

  15. Long, J.W., Advanced mechanical circulatory support with the HeartMate left ventricular assist device in the year 2000. Ann Thorac Surg, 2001. 71(3 Suppl):S176–82; discussion S183–4.

    Article  CAS  PubMed  Google Scholar 

  16. Spanier, T., et al., Activation of coagulation and fibrinolytic pathways in patients with left ventricular assist devices. J Thorac Cardiovasc Surg, 1996. 112(4):1090–7.

    Article  CAS  PubMed  Google Scholar 

  17. Spanier, T.B., et al., Time-dependent cellular population of textured-surface left ventricular assist devices contributes to the development of a biphasic systemic procoagulant response. J Thorac Cardiovasc Surg, 1999. 118(3):404–13.

    Article  CAS  PubMed  Google Scholar 

  18. Tayama, E., et al., The DeBakey ventricular assist device: current status in 1997. Artif Organs, 1999. 23(12):1113–6.

    Article  CAS  PubMed  Google Scholar 

  19. Noon, G.P., et al., Development and clinical application of the MicroMed DeBakey VAD. Curr Opin Cardiol, 2000. 15(3):166–71.

    Article  CAS  PubMed  Google Scholar 

  20. Noon, G.P., et al., Clinical experience with the MicroMed DeBakey ventricular assist device. Ann Thorac Surg, 2001. 71(3 Suppl):S133–8; discussion S144–6.

    Article  CAS  PubMed  Google Scholar 

  21. SoRelle, R., First US implantation of DeBakey ventricular assist device. Circulation, 2000. 101(24):E9056–7.

    CAS  PubMed  Google Scholar 

  22. Delgado, R. and M. Bergheim, HeartMate II left ventricular assist device: a new device for advanced heart failure. Expert Rev Med Dev, 2005. 2(5):529–32.

    Article  Google Scholar 

  23. Amir, O., et al., A successful anticoagulation protocol for the first HeartMate II implantation in the United States. Tex Heart Inst J, 2005. 32(3):399–401.

    PubMed  Google Scholar 

  24. Hoshi, H., T. Shinshi, and S. Takatani, Third-generation blood pumps with mechanical noncontact magnetic bearings. Artif Organs, 2006. 30(5):324–38.

    Article  PubMed  Google Scholar 

  25. Onuma, H., M. Murakami, and T. Masuzawa, Novel maglev pump with a combined magnetic bearing. Asaio J, 2005. 51(1):50–5.

    Article  PubMed  Google Scholar 

  26. Gray, N.A., Jr. and C.H. Selzman, Current status of the total artificial heart. Am Heart J, 2006. 152(1):4–10.

    Article  PubMed  Google Scholar 

  27. Dowling, R.D., et al., The AbioCor implantable replacement heart. Ann Thorac Surg, 2003. 75(6 Suppl):S93–9.

    Article  PubMed  Google Scholar 

  28. Smith, M.C., et al., CardioWest total artificial heart in a moribund adolescent with left ventricular thrombi. Ann Thorac Surg, 2005. 80(4):1490–2.

    Article  PubMed  Google Scholar 

  29. El-Banayosy, A., et al., CardioWest total artificial heart: Bad Oeynhausen experience. Ann Thorac Surg, 2005. 80(2):548–52.

    Article  PubMed  Google Scholar 

  30. DeVries, W.C., et al., Clinical use of the total artificial heart. N Engl J Med, 1984. 310(5):273–8.

    Article  CAS  PubMed  Google Scholar 

  31. Felker, G.M. and J.G. Rogers, Same bridge, new destinations rethinking paradigms for mechanical cardiac support in heart failure. J Am Coll Cardiol, 2006. 47(5):930–2.

    Article  PubMed  Google Scholar 

  32. Oz, M.C., et al., Screening scale predicts patients successfully receiving long-term implantable left ventricular assist devices. Circulation, 1995. 92(9 Suppl):II169–73.

    CAS  PubMed  Google Scholar 

  33. Deng, M.C., et al., Mechanical circulatory support for advanced heart failure: effect of patient selection on outcome. Circulation, 2001. 103(2):231–7.

    CAS  PubMed  Google Scholar 

  34. Piccione, W., Jr., Mechanical circulatory assistance: changing indications and options. J Heart Lung Transplant, 1997. 16(6):S25–8.

    PubMed  Google Scholar 

  35. Nakatani, S., et al., Prediction of right ventricular dysfunction after left ventricular assist device implantation. Circulation, 1996. 94(9 Suppl):II216–21.

    CAS  PubMed  Google Scholar 

  36. Burkhoff, D., et al., Feasibility study of the use of the TandemHeart percutaneous ventricular assist device for treatment of cardiogenic shock. Catheter Cardiovasc Interv, 2006. 68(2):211–7.

    Article  PubMed  Google Scholar 

  37. Marelli, D., et al., Temporary mechanical support with the BVS 5000 assist device during treatment of acute myocarditis. J Card Surg, 1997. 12(1):55–9.

    Article  CAS  PubMed  Google Scholar 

  38. Guyton, R.A., et al., Postcardiotomy shock: clinical evaluation of the BVS 5000 Biventricular Support System. Ann Thorac Surg, 1993. 56(2):346–56.

    Article  CAS  PubMed  Google Scholar 

  39. Samuels, L.E., et al., Management of acute cardiac failure with mechanical assist: experience with the ABIOMED BVS 5000. Ann Thorac Surg, 2001. 71(3 Suppl):S67–72; discussion S82–5.

    Article  CAS  PubMed  Google Scholar 

  40. Hoefer, D., et al., Outcome evaluation of the bridge-to-bridge concept in patients with cardiogenic shock. Ann Thorac Surg, 2006. 82(1):28–33.

    Article  PubMed  Google Scholar 

  41. Deng, M.C., et al., Mechanical circulatory support device database of the International Society for Heart and Lung Transplantation: third annual report – 2005. J Heart Lung Transplant, 2005. 24(9):1182–7.

    Article  PubMed  Google Scholar 

  42. Jaski, B.E., et al., Cardiac transplant outcome of patients supported on left ventricular assist device vs. intravenous inotropic therapy. J Heart Lung Transplant, 2001. 20(4):449–56.

    Article  CAS  PubMed  Google Scholar 

  43. Frazier, O.H., et al., Multicenter clinical evaluation of the HeartMate 1000 IP left ventricular assist device. Ann Thorac Surg, 1992. 53(6):1080–90.

    Article  CAS  PubMed  Google Scholar 

  44. Frazier, O.H., et al., Multicenter clinical evaluation of the HeartMate vented electric left ventricular assist system in patients awaiting heart transplantation. J Thorac Cardiovasc Surg, 2001. 122(6):1186–95.

    Article  CAS  PubMed  Google Scholar 

  45. Ashton, R.C., Jr., et al., Duration of left ventricular assist device support affects transplant survival. J Heart Lung Transplant, 1996. 15(11):1151–7.

    PubMed  Google Scholar 

  46. Aaronson, K.D., et al., Left ventricular assist device therapy improves utilization of donor hearts. J Am Coll Cardiol, 2002. 39(8):1247–54.

    Article  PubMed  Google Scholar 

  47. El-Banayosy, A., et al., Novacor left ventricular assist system versus Heartmate vented electric left ventricular assist system as a long-term mechanical circulatory support device in bridging patients: a prospective study. J Thorac Cardiovasc Surg, 2000. 119(3):581–7.

    Article  CAS  PubMed  Google Scholar 

  48. Navia, J.L., et al., Do left ventricular assist device (LVAD) bridge-to-transplantation outcomes predict the results of permanent LVAD implantation? Ann Thorac Surg, 2002. 74(6):2051–62; discussion 2062–3.

    Article  PubMed  Google Scholar 

  49. Goldstein, D.J., Worldwide experience with the MicroMed DeBakey ventricular assist device as a bridge to transplantation. Circulation, 2003. 108(Suppl 1):II272–7.

    Article  PubMed  Google Scholar 

  50. Frazier, O.H., et al., Use of the Jarvik 2000 left ventricular assist system as a bridge to heart transplantation or as destination therapy for patients with chronic heart failure. Ann Surg, 2003. 237(5):631–6; discussion 636–7.

    Article  CAS  PubMed  Google Scholar 

  51. Copeland, J.G., et al., Cardiac replacement with a total artificial heart as a bridge to transplantation. N Engl J Med, 2004. 351(9):859–67.

    Article  CAS  PubMed  Google Scholar 

  52. Bruckner, B.A., et al., Regression of fibrosis and hypertrophy in failing myocardium following mechanical circulatory support. J Heart Lung Transplant, 2001. 20(4): 457–64.

    Article  CAS  PubMed  Google Scholar 

  53. Baba, H.A., et al., Reversal of metallothionein expression is different throughout the human myocardium after prolonged left-ventricular mechanical support. J Heart Lung Transplant, 2000. 19(7):668–74.

    Article  CAS  PubMed  Google Scholar 

  54. McCarthy, P.M., et al., Structural and left ventricular histologic changes after implantable LVAD insertion. Ann Thorac Surg, 1995. 59(3):609–13.

    Article  CAS  PubMed  Google Scholar 

  55. Torre-Amione, G., et al., Decreased expression of tumor necrosis factor-alpha in failing human myocardium after mechanical circulatory support: A potential mechanism for cardiac recovery. Circulation, 1999. 100(11):1189–93.

    CAS  PubMed  Google Scholar 

  56. Blaxall, B.C., et al., Differential gene expression and genomic patient stratification following left ventricular assist device support. J Am Coll Cardiol, 2003. 41(7): 1096–106.

    Article  CAS  PubMed  Google Scholar 

  57. Klotz, S., et al., Left ventricular assist device support normalizes left and right ventricular beta-adrenergic pathway properties. J Am Coll Cardiol, 2005. 45(5):668–76.

    Article  PubMed  Google Scholar 

  58. Simon, M.A., et al., Myocardial recovery using ventricular assist devices: prevalence, clinical characteristics, and outcomes. Circulation, 2005. 112(9 Suppl):I32–6.

    PubMed  Google Scholar 

  59. Mancini, D.M., et al., Low incidence of myocardial recovery after left ventricular assist device implantation in patients with chronic heart failure. Circulation, 1998. 98(22):2383–9.

    CAS  PubMed  Google Scholar 

  60. Khan, T., et al., Dobutamine stress echocardiography predicts myocardial improvement in patients supported by left ventricular assist devices (LVADs): hemodynamic and histologic evidence of improvement before LVAD explantation. J Heart Lung Transplant, 2003. 22(2):137–46.

    Article  PubMed  Google Scholar 

  61. Dandel, M., et al., Long-term results in patients with idiopathic dilated cardiomyopathy after weaning from left ventricular assist devices. Circulation, 2005. 112(9 Suppl): I37–45.

    PubMed  Google Scholar 

  62. Dib, N., et al., Feasibility and safety of autologous myoblast transplantation in patients with ischemic cardiomyopathy. Cell Transplant, 2005. 14(1):11–9.

    Article  PubMed  Google Scholar 

  63. Rose, E.A., et al., Long-term mechanical left ventricular assistance for end-stage heart failure. N Engl J Med, 2001. 345(20):1435–43.

    Article  CAS  PubMed  Google Scholar 

  64. Park, S.J., et al., Left ventricular assist devices as destination therapy: a new look at survival. J Thorac Cardiovasc Surg, 2005. 129(1):9–17.

    Article  PubMed  Google Scholar 

  65. Long, J.W., et al., Long-term destination therapy with the HeartMate XVE left ventricular assist device: improved outcomes since the REMATCH study. Congest Heart Fail, 2005. 11(3):133–8.

    Article  PubMed  Google Scholar 

  66. Lietz, K., et al., Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era: implications for patient selection. Circulation, 2007. 116(5):497–505.

    Article  PubMed  Google Scholar 

  67. Stevenson, L.W., et al., Left ventricular assist device as destination for patients undergoing intravenous inotropic therapy: a subset analysis from REMATCH (Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure). Circulation, 2004. 110(8):975–81.

    Article  PubMed  Google Scholar 

  68. Oz, M.C., et al., Left ventricular assist devices as permanent heart failure therapy: the price of progress. Ann Surg, 2003. 238(4):577–83; discussion 583–5.

    PubMed  Google Scholar 

  69. Miller, L.W., et al., Hospital costs for left ventricular assist devices for destination therapy: lower costs for implantation in the post-REMATCH era. J Heart Lung Transplant, 2006. 25(7):778–84.

    Article  PubMed  Google Scholar 

  70. McGregor, M., Implantable ventricular assist devices: is it time to introduce them in Canada? Can J Cardiol, 2000. 16(5):629–40.

    CAS  PubMed  Google Scholar 

  71. Clegg, A.J., et al., The clinical and cost-effectiveness of left ventricular assist devices for end-stage heart failure: a systematic review and economic evaluation. Health Technol Assess, 2005. 9(45):1–148.

    CAS  Google Scholar 

  72. Minami, K., et al., Morbidity and outcome after mechanical ventricular support using Thoratec, Novacor, and HeartMate for bridging to heart transplantation. Artif Organs, 2000. 24(6):421–6.

    Article  CAS  PubMed  Google Scholar 

  73. Holman, W.L., et al., Infection in ventricular assist devices: prevention and treatment. Ann Thorac Surg, 2003. 75(6 Suppl):S48–57.

    Article  PubMed  Google Scholar 

  74. Padera, R.F., Infection in ventricular assist devices: the role of biofilm. Cardiovasc Pathol, 2006. 15(5):264–70.

    Article  CAS  PubMed  Google Scholar 

  75. Costerton, J.W., L. Montanaro, and C.R. Arciola, Biofilm in implant infections: its production and regulation. Int J Artif Organs, 2005. 28(11):1062–8.

    CAS  PubMed  Google Scholar 

  76. Chinn, R., et al., Multicenter experience: prevention and management of left ventricular assist device infections. Asaio J, 2005. 51(4):461–70.

    Article  PubMed  Google Scholar 

  77. Itescu, S., et al., Immunobiology of left ventricular assist devices. Prog Cardiovasc Dis, 2000. 43(1):67–80.

    Article  CAS  PubMed  Google Scholar 

  78. Ankersmit, H.J., et al., Activation-induced T-cell death and immune dysfunction after implantation of left-ventricular assist device. Lancet, 1999. 354(9178): 550–5.

    Article  CAS  PubMed  Google Scholar 

  79. Gonzalez-Stawinski, G.V., et al., Early and midterm risk of coronary allograft vasculopathy in patients bridged to orthotopic heart transplantation with ventricular assist devices. Transplantation, 2005. 79(9):1175–9.

    Article  PubMed  Google Scholar 

  80. Lazar, R.M., et al., Neurological events during long-term mechanical circulatory support for heart failure: the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) experience. Circulation, 2004. 109(20):2423–7.

    Article  PubMed  Google Scholar 

  81. Goldstein, D.J. and R.B. Beauford, Left ventricular assist devices and bleeding: adding insult to injury. Ann Thorac Surg, 2003. 75(6 Suppl):S42–7.

    Article  PubMed  Google Scholar 

  82. Horton, S.C., et al., Left ventricular assist device malfunction: an approach to diagnosis by echocardiography. J Am Coll Cardiol, 2005. 45(9):1435–40.

    Article  PubMed  Google Scholar 

  83. Horton, S.C., et al., Left ventricular assist device malfunction: a systematic approach to diagnosis. J Am Coll Cardiol, 2004. 43(9):1574–83.

    Article  PubMed  Google Scholar 

  84. Ruzevich, S.A., et al., Retrospective analysis of the psychologic effects of mechanical circulatory support. J Heart Transplant, 1990. 9(3 Pt 1):209–12.

    CAS  PubMed  Google Scholar 

  85. Dew, M.A., et al., Life quality in the era of bridging to cardiac transplantation. Bridge patients in an outpatient setting. Asaio J, 1993. 39(2):145–52.

    CAS  PubMed  Google Scholar 

  86. Petrucci, R., et al., Cardiac ventricular support. Considerations for psychiatry. Psychosomatics, 1999. 40(4):298–303.

    CAS  PubMed  Google Scholar 

  87. Bunzel, B., et al., Mechanical circulatory support as a bridge to heart transplantation: what remains? Long-term emotional sequelae in patients and spouses. J Heart Lung Transplant, 2007. 26(4):384–9.

    Article  PubMed  Google Scholar 

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Blitz, A., Fang, J.C. (2010). Ventricular Assist Devices and Total Artificial Hearts. In: Maisel, W. (eds) Device Therapy in Heart Failure. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-59745-424-7_13

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  • DOI: https://doi.org/10.1007/978-1-59745-424-7_13

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