Table of Contents

Cover image

Title page

Copyright

Dedication

Contributors

Preface

Braunwald’s Heart Disease Family of Books

1: Historical Aspects of Mechanical Circulatory Support

Abstract

Early mechanical circulatory support devices and technology development

Ongoing technology developments and devices

Current state of MCS

Disclosure

Funding

2: Advanced Heart Failure and Cardiogenic Shock

Abstract

Introduction

Definition

Etiology of cardiogenic shock

Hemodynamic effects of cardiogenic shock

Neurohormonal response to cardiogenic shock

Inflammatory pathways

End organ injury

Conclusion

3: Risk Stratification in Advanced Heart Failure

Abstract

Introduction

Acute versus chronic heart failure

Heart failure with preserved ejection fraction

Sudden cardiac death versus progressive heart failure

Elderly versus transplant referral populations

Renal dysfunction

Biomarkers

Physical capacity and mortality risk in heart failure

Exercise hemodynamics

Frailty

Multivariable risk stratification in heart failure

Conclusion

4: Candidate Selection and Decision Making in Mechanical Circulatory Support

Abstract

Introduction

Indications for mechanical circulatory support

Contraindications to MCS—medical, cardiac

Contraindications to MCS—Medical, Noncardiac

Contraindications to MCS—nonmedical

Temporary support to assess candidacy

Formal evaluation protocols

Shared decision making

Summary

5: Acute Circulatory Support

Abstract

Introduction

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

Conclusions/summary

Disclosures

6: The Role of Extracorporeal Membrane Oxygenation in Cardiac Support

Abstract

Background

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

Conclusion

7: Understanding the Principles of Continuous-Flow Rotary Left Ventricular Assist Devices

Abstract

Introduction

Historical perspective

General pump design

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

Flow estimation

Limitations in flow control with cf rotary pumps

Conclusion

8: Hemocompatibility in Mechanical Circulatory Support

Abstract

Introduction

Biological Factors

Hemocompatibility-Related Engineering Aspects

Conclusions

9: The Biological Response to Ventricular Unloading

Abstract

Introduction

Cardiac hypertrophy-atrophy

Contractile dysfunction, calcium handling, and cytoskeletal proteins

Cardiac metabolism and bioenergetics

Cell death and stress

Natriuretic peptides and neurohormones

Inflammatory markers

Extracellular matrix and fibrosis

Gene expression, rna, and proteomic profiling

Endothelium and vasculature

Studies on angiogenesis

Future directions

Summary

10: Current Types of Devices for Durable Mechanical Circulatory Support

Abstract

Development of mechanical circulatory support systems

Durable left ventricular assist devices

Evaheart LVAS

Future directions of mechanical circulatory support

Summary

11: Operative Techniques and Intraoperative Management

Historical note

Principles of device selection

Preoperative assessment and preparation

Implant operation

Intraoperative considerations

Postoperative care

12: Postoperative VAD Management: Operating Room to Discharge and Beyond: Surgical and Medical Considerations

Abstract

Perioperative management

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

Preparing for home discharge

Standard outpatient visit

13: Adverse Events and Mitigation Strategies

Introduction

Definitions

Time-related occurrence, contributing factors, and causation

Adverse event burden and era effect

Adverse events contributing to death

Perioperative bleeding

Surgical wound infections

Pump-related infection

Gastrointestinal bleeding

Neurologic dysfunction

Renal failure

Device failure

Pump thrombosis

Other thromboembolic events

Right Heart Failure

Aortic Insufficiency

14: Right Heart Failure in Patients With Mechanical Circulatory Support

Abstract

Introduction

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

Abstract

Disclosure

Overview of clinical trials of mechanical circulatory support devices

Pulsatile flow

Continuous flow—axial

Continuous flow—centrifugal

Quality of life, functional status, and adverse events

Total artificial hearts

Conclusion

16: Psychosocial and Quality of Life Issues in Mechanical Circulatory Support

Abstract

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

Abstract

Case presentation

Introduction

Modification in surgical technique

Potential patient population

Summary

18: Mechanical Circulatory Support in Pediatrics

Abstract

Introduction

Heart failure in children

Current devices for pediatric cardiac support

Bridge-to-transplantation

Management of pediatric patients receiving cardiac assist device therapy

Other topics in pediatric mechanical circulatory support

Conclusion

19: Facilitating Myocardial Recovery

History of recovery and device explantation

Possible explanations of the low rate of myocardial recovery

Optimizing myocardial recovery

Harefield protocol

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

Origins of Intermacs/Pedimacs

Intermacs Patient profiles

Evolving intent of durable mcs placement

Overall outcomes

Adverse events

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

Abstract

Introduction

History of medical device regulations

Global reimbursement

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

Device tracking

Mechanical circulatory support device registries

Mechanical circulatory support device corrections and removals (recalls)

Obsolescence

Lessons learned

Conclusions

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

IV. The future requires organization

V. The future is now

Index