Examination of Native Hearts with Implantable Mechanical Circulatory Support Systems

Abstract

Mechanical circulatory support systems (MCS) are widely accepted as a safe short and long-term treatment option for terminal heart failure. There is a growing number of MCS patients bridged to heart transplantation and those, in which MCS are used as long term support in destination therapy. During the last decades, various surgical techniques were used to install a wide variety of different generations’ fully implantable MCS systems in all four heart chambers. Due to development of devices with increased durability the number of adverse events increases significantly with enhanced survival time. Structural changes of the tissues, directly affected by device therapy, are becoming more evident. Therefore, nowadays in the routine diagnostic setting the pathologists encounter a growing amount of surgically removed tissues affected by device therapy and entire hearts explanted at time of heart transplantation. In addition, examination of the patient’s mechanically unloaded hearts and all affected organs at autopsy takes a prominent role in quality assurance of MCS therapy. As pathologists are becoming part not only in the diagnostic workup but their diagnoses impacts on improvement measures of therapy, knowledge of the different generations MCS is vital to secure accurate diagnosis. In this chapter we stress on the importance of carefully dissecting a mechanically unloaded heart.