Advertisement

History of Durable Mechanical Circulatory Assist Devices

  • Ambar Afshar Andrade
  • Roxanne Siemeck
  • Tisha Suboc
Chapter

Abstract

Cardiac transplant has been a widely accepted therapy for end-stage heart failure; unfortunately, the supply of donor hearts does not meet the ongoing demand. Patients with end-stage heart failure can now safely undergo durable left ventricular assist device (LVAD) implantation. Furthermore, LVAD therapy has now expanded beyond patients who are not transplant candidates. About 50% of patients who undergo VAD implantation in the current era are implanted as destination therapy (DT). The modern era of cardiac surgery began with the use of the cardiopulmonary bypass (CPB) machine. The advent of CPB and open heart surgery thus allowed for the development of mechanical support of the failing heart. The inability to wean some patients from CPB sparked an interest in prolonged mechanical assistance to promote myocardial recovery. From the first implantable ventricular assist device, to the first human heart transplant, the field of mechanical circulatory support has been rapidly evolving. First generation ventricular assist devices were pulsatile in nature with a variety of designs and placement and were approved for use as a bridge to transplant and/or post-cardiotomy shock. The second generation LVADs include axial flow devices and the third generation devices are centrifugal flow devices. To date, the most utilized second generation pump is the HM II, with over 17,000 implants worldwide. The two main centrifugal flow pumps that are available today are the HeartWare HVAD and the HeartMate 3. Improvements in outcomes with mechanical circulatory support (MCS) for patients requiring LVADs have been universally recognized during the past decade. The 1- and 2-year survival with continuous flow pumps is currently 80% and 70%, respectively. Unfortunately, neurologic events, right heart failure, and multisystem organ failure are the predominant causes of death early after LVAD implantation. Infection, multiorgan system failure and neurologic events are the major causes of late mortality. The choice of which pump to implant comes down to implant indication, and unique patient conditions. Further device evolution will continue to shift the paradigm of LVAD therapy, possibly to implanting LVADs in less sick individuals in need of lower cardiovascular support. The basics of LVAD therapy will remain the same, and warrant continual knowledge seeking by clinicians involved in the care of patients with Stage D heart failure.

Keywords

Mechanical circulatory support Heart failure Cardiogenic shock Post cardiotomy shock LVAD HeartMate II Heartmate 3 HeartWare HVAD Total artificial heart Heart transplant Myocardial recovery Right ventricular failure History of mechanical circulatory support 

References

  1. 1.
    Colsvin MSJM, Skeans MA, Edwards LB, Uccellini K, Snyder JJ, Israni AK, Kasiske BL. OPTN/SRTR 2015 annual data report: heart. Am J Transplant. 2017;17(Suppl 1):286–356. https://doi.org/10.1111/ajt.14128.CrossRefGoogle Scholar
  2. 2.
    Kirklin JK, Naftel DC, Pagani FD, et al. Sixth INTERMACS annual report: a 10,000-patient database. J Heart Lung Transplant. 2014;33:555–64.CrossRefPubMedGoogle Scholar
  3. 3.
    Liotta D, Hall CW, Henly WS, Cooley DA, Crawford ES, DeBakey ME. Prolonged assisted circulation during and after cardiac or aortic surgery: prolonged partial left ventricular bypass by means of intracorporeal circulation. Am J Cardiol. 1963;12:399–405.CrossRefPubMedGoogle Scholar
  4. 4.
    Gibbon JH Jr. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med. 1954;37:171.PubMedGoogle Scholar
  5. 5.
    Kirklin JW, DuShane J, Patrick R, et al. Intracardiac surgery with the aid of a mechanical pump-oxygenator system (gibbon type): report of eight cases. Proc Staff Meet Mayo Clin. 1955;30:201–6.PubMedGoogle Scholar
  6. 6.
    Goldstein DJ, Oz MC, Rose EA. Implantable left ventricular assist devices. N Engl J Med. 1998;339:1522–33.CrossRefPubMedGoogle Scholar
  7. 7.
    Hogness J, VanAntwerp M. The artificial heart program: current status and history. Washington, DC: National Academy Press; 1991.Google Scholar
  8. 8.
    DeBakey ME. Left ventricular bypass pump for cardiac assistance: clinical experience. Am J Cardiol. 1971;27:3–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Stewart GC, Givertz MM. Mechanical circulatory support for advanced heart failure patients and technology in evolution. Circulation. 2012;125:1304–15.CrossRefPubMedGoogle Scholar
  10. 10.
    Portner PM, Oyer PE, Pennington DG, et al. Implantable electrical left ventricular assist systems: bridge to transplantation and future. Ann Thorac Surg. 1989;47:142–50.CrossRefPubMedGoogle Scholar
  11. 11.
    Norman J, Cooley D, Kahan B, et al. Total support of the circulation of a patient with post-cardiotomy stone-heart syndrome by a partial artificial heart (ALVAD) for 5 days followed by heart and kidney transplantation. Lancet. 1978;311:1125–7.CrossRefGoogle Scholar
  12. 12.
    Portner P, Oyer P, McGregor C, et al. First human use of an electrically powered implantable ventricular assist system. Artif Organs. 1985;9:36.Google Scholar
  13. 13.
    Slaughter MS, Tsui SS, El-Banayosy A, et al. Results of a multicenter clinical trial with the Thoratec implantable ventricular assist device. J Thorac Cardiovasc Surg. 2007;133:1573–80. e2CrossRefPubMedGoogle Scholar
  14. 14.
    Tsukui H, Teuteberg JJ, Murali S, et al. Biventricular assist device utilization for patients with morbid congestive heart failure. Circulation. 2005;112:I-65–72.Google Scholar
  15. 15.
    Slaughter MS, Sobieski MA, Koenig SC, Pappas PS, Tatooles AJ, Silver MA. Left ventricular assist device weaning: hemodynamic response and relationship to stroke volume and rate reduction protocols. ASAIO J. 2006;52:228–33.CrossRefPubMedGoogle Scholar
  16. 16.
    Mancini D, Colombo PC. Left ventricular assist devices: a rapidly evolving alternative to transplant. J Am Coll Cardiol. 2015;65:2542–55.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    JoNhn R. Current axial-flow devices—the HeartMate II and Jarvik 2000 left ventricular assist devices. Semin Thorac Cardiovasc Surg. 2008;20(3):264–72.CrossRefGoogle Scholar
  18. 18.
    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.CrossRefPubMedGoogle Scholar
  19. 19.
    Slaughter MS, Pagani FD, Rogers JG, et al. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant. 2010;29:S1–S39.CrossRefPubMedGoogle Scholar
  20. 20.
    Wampler R, Baker B, Wright W. Circulatory support of cardiac interventional procedures with the HemopumpTM cardiac assist system. Cardiology. 1994;84:194–201.CrossRefPubMedGoogle 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.CrossRefPubMedGoogle Scholar
  22. 22.
    Kirklin JK, Naftel DC, Kormos RL, et al. Third INTERMACS annual report: the evolution of destination therapy in the United States. J Heart Lung Transplant. 2011;30:115–23.CrossRefPubMedGoogle 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.CrossRefPubMedGoogle Scholar
  24. 24.
    Lim HS, Howell N, Ranasinghe A. The physiology of continuous-flow left ventricular assist devices. J Card Fail. 2017;23:169–80.CrossRefPubMedGoogle Scholar
  25. 25.
    Moazami N, Fukamachi K, Kobayashi M, et al. Axial and centrifugal continuous-flow rotary pumps: a translation from pump mechanics to clinical practice. J Heart Lung Transplant. 2013;32:1–11.CrossRefPubMedGoogle Scholar
  26. 26.
    Thoratec. HeartMate II LVAS instructions for use featuring GoGear system components (105747.B) (Technical report). Thoratec: Pleasanton; 2013.Google Scholar
  27. 27.
    LaRose JA, Tamez D, Ashenuga M, Reyes C. Design concepts and principle of operation of the HeartWare ventricular assist system. ASAIO J. 2010;56:285–9.PubMedGoogle Scholar
  28. 28.
    HeartWare® Ventricular Assist System. Instructions for use. Miami Lakes, FL: Medtronic; 2015.Google Scholar
  29. 29.
    Capoccia M. Mechanical circulatory support for advanced heart failure: are we about to witness a new “gold standard”? J Cardiovasc Dev Dis. 2016;3:35.CrossRefPubMedCentralGoogle Scholar
  30. 30.
    Kirklin JK, Naftel DC, Pagani FD, et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant. 2015;34:1495–504.CrossRefPubMedGoogle Scholar
  31. 31.
    Goldstein DJ, John R, Salerno C, et al. Algorithm for the diagnosis and management of suspected pump thrombus. J Heart Lung Transplant. 2013;32(7):667–70. https://doi.org/10.1016/j.healun.2013.05.002.CrossRefPubMedGoogle Scholar
  32. 32.
    Meineri M, Van Rensburg AE, Vegas A. Right ventricular failure after LVAD implantation: prevention and treatment. Best Pract Res Clin Anaesthesiol. 2012;26:217–29.CrossRefPubMedGoogle Scholar
  33. 33.
    McMurray JJ, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur J Heart Fail. 2012;14:803–69.CrossRefPubMedGoogle Scholar
  34. 34.
    Patlolla B, Beygui R, Haddad F. Right-ventricular failure following left ventricle assist device implantation. Curr Opin Cardiol. 2013;28:223–33.CrossRefPubMedGoogle Scholar
  35. 35.
    Jessup M, Goldstein D, Ascheim D, et al. 5 risk for bleeding after MCSD implant: an analysis of 2358 patients in INTERMACS. J Heart Lung Transplant. 2011;30:S9.CrossRefGoogle Scholar
  36. 36.
    Crow S, Milano C, Joyce L, et al. Comparative analysis of von Willebrand factor profiles in pulsNatile and continuous left ventricular assist device recipients. ASAIO J. 2010;56:441–5.CrossRefPubMedGoogle Scholar
  37. 37.
    Uriel N, Pak S-W, Jorde UP, et al. Acquired von Willebrand syndrome after continuous-flow mechanical device support contributes to a high prevalence of bleeding during long-term support and at the time of transplantation. J Am Coll Cardiol. 2010;56:1207–13.CrossRefPubMedGoogle Scholar
  38. 38.
    Vincentelli A, Susen S, Le Tourneau T, et al. Acquired von Willebrand syndrome in aortic stenosis. N Engl J Med. 2003;349:343–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Suarez J, Patel CB, Felker GM, Becker R, Hernandez AF, Rogers JG. Mechanisms of bleeding and approach to patients with axial-flow left ventricular assist devices. Circ Heart Fail. 2011;4:779–84.CrossRefPubMedGoogle Scholar
  40. 40.
    Demirozu ZT, Radovancevic R, Hochman LF, et al. Arteriovenous malformation and gastrointestinal bleeding in patients with the HeartMate II left ventricular assist device. J Heart Lung Transplant. 2011;30:849–53.CrossRefPubMedGoogle Scholar
  41. 41.
    Adzic A, Patel SR, Maybaum S. Impact of adverse events on ventricular assist device outcomes. Curr Heart Fail Rep. 2013;10:89–100.CrossRefPubMedGoogle Scholar
  42. 42.
    Holman WL, Pae WE, Teutenberg JJ, et al. INTERMACS: interval analysis of registry data. J Am Coll Surg. 2009;208:755–61.CrossRefPubMedGoogle Scholar
  43. 43.
    Hannan MM, Husain S, Mattner F, et al. Working formulation for the standardization of definitions of infections in patients using ventricular assist devices. J Heart Lung Transplant. 2011;30:375–84.CrossRefPubMedGoogle Scholar
  44. 44.
    Topkara VK, Kondareddy S, Malik F, et al. Infectious complications in patients with left ventricular assist device: etiology and outcomes in the continuous-flow era. Ann Thorac Surg. 2010;90:1270–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Pedrotty DM, Rame JE, Margulies KB. Management of ventricular arrhythmias in patients with ventricular assist devices. Curr Opin Cardiol. 2013;28:360–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ambar Afshar Andrade
    • 1
  • Roxanne Siemeck
    • 2
  • Tisha Suboc
    • 3
  1. 1.Department of CardiologyAdvocate Christ Medical CenterOakLawnUSA
  2. 2.Department of Heart Transplant and Ventricular Assist DevicesAdvocate Christ Medical CenterOakLawnUSA
  3. 3.Department of CardiologyRush UniversityChicagoUSA

Personalised recommendations