Surgical Mechanical Circulatory Support

  • Forum Kamdar
  • Ranjit John


A significant and increasing number of Americans develop heart failure, and many die from the disease. Improved medical therapies are slowing its progression, but patients with advanced heart failure face limited options. This chapter explores treatment options for patients with advanced heart failure, focusing on mechanical circulatory support – categories, capabilities, indications, complications, and future direction.


Right Ventricular Mechanical Circulatory Support Destination Therapy Right Ventricular Failure Inflow Cannula 
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  1. 1.
    Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117(4):e125–46.Google Scholar
  2. 2.
    O’Connor C, Gattis W, Zannad F, et al. Beta-blocker therapy in advanced heart failure: clinical characteristics and long-term outcomes. Eur J Heart Fail. 1999;1:81–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345:1435–43.PubMedCrossRefGoogle Scholar
  4. 4.
    Califf RM, Adams KF, McKenna WJ, et al. A randomized controlled trial of epoprostenol therapy for severe congestive heart failure: the Flolan International Randomized Survival Trial (FIRST). Am Heart J. 1997;134:44–54.PubMedCrossRefGoogle Scholar
  5. 5.
    The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325:293–302.CrossRefGoogle Scholar
  6. 6.
    Packer M, Coats AJS, Fowler MB, et al. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med. 2001;344:1651–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Sandeep J. The artificial heart. N Engl J Med. 2004;350:522–44.CrossRefGoogle Scholar
  8. 8.
    Aaronson KD, Eppinger MJ, Dyke DB, Wright S, Pagani FD. Left ventricular assist device therapy improves utilization of donor hearts. Ann Thorac Surg. 2004;39:1247–54.Google Scholar
  9. 9.
    Morgan JA, John R, Rao V, et al. Bridging to transplant with the HeartMate left ventricular assist device: the Columbia Presbyterian 12-year experience. J Thorac Cardiovasc Surg. 2004;127:1309–16.PubMedCrossRefGoogle Scholar
  10. 10.
    John R, Liao K, Lietz K, et al. Experience with the Levitronix CentriMag circulatory support system as a bridge to decision in patients with refractory acute cardiogenic shock and multisystem organ failure. J Thorac Cardiovasc Surg. 2007;134(2):351–8.PubMedCrossRefGoogle Scholar
  11. 11.
    De Robertis F, Birks EJ, Rogers P, Dreyfus G, Pepper JR, Khagani A. Clinical performance with the Levitronix CentriMag short-term ventricular assist device. J Heart Lung Transplant. 2006;25:181–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Mueller JP, Kuenzli A, Reuthebuch O, et al. The CentriMag: a new optimized centrifugal blood pump with levitating impeller. Heart Surg Forum. 2004;7:E477–80.PubMedCrossRefGoogle Scholar
  13. 13.
    Shuhaiber JH, Jenkins D, Berman M, et al. The Papworth Experience with the Levitronix CentriMag ventricular assist device. J Heart Lung Transplant. 2008;27(2):158–64.PubMedCrossRefGoogle Scholar
  14. 14.
    De Robertis F, Rogers P, Amrani M, et al. Bridge to decision using the Levitronix CentriMag short-term ventricular assist device. J Heart Lung Transplant. 2008;27:474–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Samuels LE, Holmes EC, Thomas MP, et al. Management of acute cardiac failure with mechanical assist: experience with the ABIOMED BVS 5000. Ann Thorac Surg. 2001;71:S67–72.PubMedCrossRefGoogle Scholar
  16. 16.
    Westaby S, Banning AP, Saito S, et al. Circulatory support for long-term treatment of heart failure: experience with an intraventricular continuous flow pump. Circulation. 2002;105:2588–91.PubMedCrossRefGoogle Scholar
  17. 17.
    Slater JP, Rose EA, Levin HR, et al. Low thromboembolic risk without anticoagulation using advanced design left ventricular assist devices. Ann Thorac Surg. 1996;62:1321–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Pagani FD, Long JW, Dembitsky WP, et al. Improved mechanical reliability of the HeartMate XVE left ventricular assist system. Ann Thorac Surg. 2006;82:1413–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Wampler RK, Moise JC, Frazier OH, et al. In vivo evaluation of a peripheral vascular access axial flow blood pump. Trans Am Soc Artif Intern Organs. 1988;34:450–4.Google Scholar
  20. 20.
    Goldstein DJ, Zucker MJ, Pagani FD, et al. Rotary ventricular assist devices: ISHLT Monograph series. In: Frazier OK, Kirklin JK, editors. Mechanical circulatory support. Oxford: Elsevier; 2006. p. 77–104.Google Scholar
  21. 21.
    Slaughter MS, Rogers JG, Milano CA, et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009;361:2241–51.PubMedCrossRefGoogle Scholar
  22. 22.
    John R, Kamdar F, Liao K, et al. Improved survival and decreasing incidence of adverse events using the HeartMate II left ventricular assist device as a bridge-to-transplant. Ann Thorac Surg. 2008;86:1227–34.PubMedCrossRefGoogle Scholar
  23. 23.
    Miller LW, Pagani FD, Russell SD, et al. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med. 2007;357:885–96.PubMedCrossRefGoogle Scholar
  24. 24.
    Pagani FD, Miller LW, Russell SD. Extended mechanical circulatory support with a continuous flow rotary left ventricular assist device. J Am Coll Cardiol. 2009;54:312–20.PubMedCrossRefGoogle Scholar
  25. 25.
    Esmore D, Kaye R, Salamonsen M, et al. First clinical implant of the VentrAssist left ventricular assist system as destination therapy for end-stage heart failure. J Heart Lung Transplant. 2005;24:1150–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Spanier TB, Oz MC, Levin HR, et al. Activation of coagulation and fibrinolytic pathways in patients with left ventricular assist devices. J Thorac Cardiovasc Surg. 1996;112:1090–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Menconi MJ, Prockwinse S, Owen TA, Dasse KA, Stein GS, Lian GB. Properties of blood contacting surfaces of clinically implanted cardiac assist devices: gene expression, matrix composition, and ultrastructural characterization of cellular linings. J Cell Biochem. 1995;57:557.PubMedCrossRefGoogle Scholar
  28. 28.
    John R, Panch S, Hrabe J, et al. Activation of endothelial and coagulation system in left ventricular assist device recipients. Ann Thorac Surg. 2009;88(4):1171–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Amir AW, Bracey FW, Smart RM, Delgado 3rd RM, Shah N, Kar B. A successful anticoagulation protocol for the first HeartMate II implantation in the United States. Tex Heart Inst J. 2005;32:399–401.PubMedGoogle Scholar
  30. 30.
    Frazier OH, Delgado RM, Kar B, Patel V, Gregoric ID, Meyers TJ. First clinical use of the redesigned HeartMate II left ventricular assist system in the United States: a case report. Tex Heart Inst J. 2004;31:157–9.PubMedGoogle Scholar
  31. 31.
    Boyle AJ, Russell SD, Teuteberg JJ, et al. Low thromboembolism and pump thrombosis with the HeartMate II left ventricular assist device: analysis of outpatient anti-coagulation. J Heart Lung Transplant. 2009;28(9):881–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Tulchinsky M. Lower gastrointestinal bleeding diagnosed by red blood cell scintigraphy in a patient with a left ventricular assist device. Clin Nucl Med. 2008;33:856–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Daas AY, Small MB, Pinkas H, Brady PG. Safety of conventional and wireless capsule endoscopy in patients supported with nonpulsatile axial flow Heart-Mate II left ventricular assist device. Gastrointest Endosc. 2008;68:379–82.PubMedCrossRefGoogle Scholar
  34. 34.
    Garatti A, Bruschi G, Girelli C, Vitali E. Small intestine capsule endoscopy in magnetic suspended axial left ventricular assist device patient. Interact Cardiovasc Thorac Surg. 2006;5:1–4.PubMedCrossRefGoogle Scholar
  35. 35.
    Letsou GV, Shah N, Gregoric ID, Meyers TJ, Delgado R, Frazier OH. Gastrointestinal bleeding from arteriovenous malformations in patients supported by the Jarvik 2000 axial-flow left ventricular assist device. J Heart Lung Transplant. 2005;24:105–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Malehsa D, Meyer AL, Bara C, Struber M. Acquired von Willebrand syndrome after exchange of the HeartMate XVE to the HeartMate II ventricular assist device. Eur J Cardiothorac Surg. 2009;35:1091–3.PubMedCrossRefGoogle Scholar
  37. 37.
    Klovaite J, Gustafsson F, Mortensen SA, Sander K, Nielsen LB. Severely impaired von Willebrand factor-dependent platelet aggregation in patients with a continuous-flow left ventricular assist device (HeartMate II). J Am Coll Cardiol. 2009;53:2162–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Geisen U, Heilmann C, Beyersdorf F, et al. Non-surgical bleeding in patients with ventricular assist devices could be explained by acquired von Willebrand disease. Eur J Cardiothorac Surg. 2008;33:679–84.PubMedCrossRefGoogle Scholar
  39. 39.
    Crow S, Milano C, Joyce L, et al. Comparative analysis of von Willebrand Factor profiles in pulsatile and continuous left ventricular assist device recipients. ASAIO J. 2010;56:441–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Gordon SM, Schmitt SK, Jacobs M, et al. Nosocomial bloodstream infections in patients with implantable left ventricular assist devices. Ann Thorac Surg. 2001;72:725–30.PubMedCrossRefGoogle Scholar
  41. 41.
    Simon D, Fischer S, Grossman A, et al. Left ventricular assist device-related infection: treatment and outcome. Clin Infect Dis. 2005;40:1108–15.PubMedCrossRefGoogle Scholar
  42. 42.
    Frazier OH, Rose EA, Oz MC, et al. Multicenter clinical evaluation of the HeartMate vented electric left ventricular assist system in patients awaiting heart transplantation. J Thorac Cardiovasc Surg. 2001;122:1186–95.PubMedCrossRefGoogle Scholar
  43. 43.
    Kormos RL, Teuteberg JJ, Pagani FD, et al. HeartMate II Clinical Investigators. Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg. 2010;139(5):1316–24.PubMedCrossRefGoogle Scholar
  44. 44.
    Lee S, Kamdar F, Madlon-Kay R, et al. Effects of the HeartMate II continuous-flow left ventricular assist device on right ventricular function. J Heart Lung Transplant. 2010;29(2):209–15.PubMedCrossRefGoogle Scholar
  45. 45.
    Jessup M, Brozena S. Heart failure. N Engl J Med. 2003;348:2007–18.PubMedCrossRefGoogle Scholar
  46. 46.
    Haj-Yahia S, Birks EJ, Amrani M, et al. Bridging patients after salvage from bridge to decision directly to transplant by means of prolonged support with the CentriMag short-term centrifugal pump. J Thorac Cardiovasc Surg. 2009;138:227–30.PubMedCrossRefGoogle Scholar
  47. 47.
    Esmore D, Kaye D, Spratt P, et al. A prospective, multicenter trial of the VentrAssist left ventricular assist device for bridge to transplant: safety and efficacy. J Heart Lung Transplant. 2008;27(6):579–88. Epub 2008 Apr 23.Google Scholar
  48. 48.
    John R, Kamdar F, Liao K, et al. Low thromboembolic risk for patients with the HeartMate II left ventricular assist device. J Thorac Cardiovasc Surg. 2008;136:1318–23.PubMedCrossRefGoogle Scholar


  1. CentriMag is a registered trademark of Levitronix LLC –
  2. Abiomed is a registered trademark of Abiomed –
  3. HeartMate is a registered trademark of Thoratec Corporation –
  4. Hemopump is a registered trademark of [not sure – see references to Medtronic and Johnson and Johnson.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.University of MinnesotaMinneapolisUSA

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