1: Historical Aspects of Mechanical Circulatory Support
Early mechanical circulatory support devices and technology development
Ongoing technology developments and devices
2: Advanced Heart Failure and Cardiogenic Shock
Hemodynamic effects of cardiogenic shock
Neurohormonal response to cardiogenic shock
3: Risk Stratification in Advanced Heart Failure
Acute versus chronic heart failure
Heart failure with preserved ejection fraction
Sudden cardiac death versus progressive heart failure
Elderly versus transplant referral populations
Physical capacity and mortality risk in heart failure
Multivariable risk stratification in heart failure
4: Candidate Selection and Decision Making in Mechanical Circulatory Support
Indications for mechanical circulatory support
Contraindications to MCS—medical, cardiac
Contraindications to MCS—Medical, Noncardiac
Contraindications to MCS—nonmedical
Temporary support to assess candidacy
The spectrum of cardiogenic shock
Short-term mechanical circulatory support devices
Complication of temporary circulatory support
Clinical outcomes in shock patients supported with short-term mechanical circulatory support
6: The Role of Extracorporeal Membrane Oxygenation in Cardiac Support
Current ecmo technologies used in cardiac support
Ecmo configurations and cannulation strategies for cardiac support
Characteristics of ecmo vs other temporary mechanical circulatory support systems
Indications for ecmo in patients with cardiac disease
7: Understanding the Principles of Continuous-Flow Rotary Left Ventricular Assist Devices
CF rotary pump design: axial versus centrifugal pumps
Bearing design/impeller suspension
Hydrodynamic performance of CF pumps
Interaction of the CF rotary pump and native heart
Parallel and series circulation
Limitations in flow control with cf rotary pumps
8: Hemocompatibility in Mechanical Circulatory Support
Hemocompatibility-Related Engineering Aspects
9: The Biological Response to Ventricular Unloading
Contractile dysfunction, calcium handling, and cytoskeletal proteins
Cardiac metabolism and bioenergetics
Natriuretic peptides and neurohormones
Extracellular matrix and fibrosis
Gene expression, rna, and proteomic profiling
10: Current Types of Devices for Durable Mechanical Circulatory Support
Development of mechanical circulatory support systems
Durable left ventricular assist devices
Future directions of mechanical circulatory support
11: Operative Techniques and Intraoperative Management
Principles of device selection
Preoperative assessment and preparation
Considerations in the operating room relevant to subsequent ICU care
Early postimplantation ICU care
Early postimplantation medical management in the ICU
Pharmacologic management in the ICU
13: Adverse Events and Mitigation Strategies
Time-related occurrence, contributing factors, and causation
Adverse event burden and era effect
Adverse events contributing to death
14: Right Heart Failure in Patients With Mechanical Circulatory Support
Physiology and anatomy of the right ventricle
Right ventricular failure in patients with chronic heart failure after lvad
Right venticular afterload sensitivity and adaptation
Preoperative evaluation and predictive risk scores
Pulmonary artery pulsatility index
Perioperative management of right ventricular function
Mechanical circulatory support for right ventricular dysfunction
Delayed right ventricular failure
15: Clinical Trial Results in Mechanical Circulatory Support
Overview of clinical trials of mechanical circulatory support devices
Quality of life, functional status, and adverse events
16: Psychosocial and Quality of Life Issues in Mechanical Circulatory Support
Preimplantation considerations
Psychosocial outcomes during mechanical circulatory support
Psychosocial predictors of clinical outcomes during mechanical circulatory support
Postimplantation and end-of-life considerations
Conclusions and future clinical and research directions
17: Left Ventricular Assist Device in Special Population of Patients
Modification in surgical technique
18: Mechanical Circulatory Support in Pediatrics
Current devices for pediatric cardiac support
Management of pediatric patients receiving cardiac assist device therapy
Other topics in pediatric mechanical circulatory support
19: Facilitating Myocardial Recovery
History of recovery and device explantation
Possible explanations of the low rate of myocardial recovery
Optimizing myocardial recovery
Surgery for myocardial recovery
Quality of life after left ventricular assist device explantation
Summary and next steps to enhance rate of recovery
20: The Critical Role of MCS Registries
Evolving intent of durable mcs placement
Registry comparison to alternative therapies
Impact of registry data on clinical use of vads
Globalization of mcs registries
21: Regulatory and Reimbursement Landscape for Mechanical Circulatory Support
History of medical device regulations
Regulatory pathways for mechanical circulatory support devices
Reimbursement pathways for mechanical circulatory support devices
Mechanical circulatory support device total product life cycle
Creating reimbursement for left ventricular assist devices
Postmarket studies/surveillance
Mechanical circulatory support device registries
Mechanical circulatory support device corrections and removals (recalls)
22: The Future of Mechanical Circulatory Support
I. The trail blazed and the pathway ahead
II. The future is leveraging the past
III. The future is optimizing the present