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Ventricular Assist Systems: Clinical Application

  • O. H. Frazier

Summary

The ideal therapy for chronic end-stage heart failure must be reliable, cost effective, easy to implement and maintain, and capable of providing a physiologic level of circulatory support. The therapy most likely to have these characteristics within the next 10 years will probably be one more of the ventricular assist systems. Systems currently used primarily as intermediate or long-term bridges to transplantation include the HeartMate implantable left ventricular assist system (Thermo Cardiosystems, Woburn, MA) and the Novacor left ventricular assist system (Baxter Healthcare, Novacor Division, Oakland, CA). These devices not only support the circulation but may also enable a patient’s ventricle to recover before transplantation. Many patients who receive these devices become self-sufficient and can resume their normal activities. As experience accumulates, the future for heart failure patients may include long-term implantation of one of these systems as an alternative to transplantation. In fact, the US Food and Drug Administration has approved a clinical trial for use of the vented electric HeartMate as an alternative to transplantation. It may also one day be possible to implant such a system, rest the heart, and then remove the system when the patient’s heart has adequately recovered. The future may also bring clinical application of smaller assist systems now being tested experimentally. The J-2000 (Jarvik Research, New York, NY), for example, is a valveless, miniaturized, intraventricular, axial-flow left ventricular assist system with blood-immersed bearings, currently under investigation at the Texas Heart Institute. The device, which is powered transcutaneously, is implanted within the left ventricle, and ongoing experimental results are promising.

Keywords

Blood Pump Mechanical Circulatory Support Heart Lung Transplant Total Artificial Heart Pulsatile Pump 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Schuler S, Parnt R, Warnecke H, Matheis G, Hetzer R. (1988) Extended donor criteria for heart transplantation. J Heart Transplant 7:326–330PubMedGoogle Scholar
  2. 2.
    Copeland JG, Emery RW, Levinson MM, Copeland J, McAleer MJ, Riley JE (1985) The role of mechanical support and transplantation in treatment of patients with end-stage cardiomyopathy. Circulation 72(Suppl II): 7–12Google Scholar
  3. 3.
    Barker LE, DeVries WC (1993) Total artificial heart. In: Quaal S (ed) Cardiac mechanical assistance beyond balloon pumping. Mosby Year Book, St. Louis, Mo USA, pp 167–180Google Scholar
  4. 4.
    Frazier OH, Short HD, Wampler RK, Noon GP, Myers TJ, Parnis SM, Coleman CL, Macris MP (1996) Mechanical circulatory support in the transplant population. In: Frazier OH (ed) Support and replacement of the failing heart. Lippincott-Raven, Philadelphia, PA, USAGoogle Scholar
  5. 5.
    Shinn JA, Oyer PE (1993) Novacor ventricular assist system. In: Quaal SJ (ed) Cardiac mechanical assistance beyond balloon pumping. Mosby Year Book, St. Louis, MO, USA, pp 99–115Google Scholar
  6. 6.
    Loisance D, Deleuze PH, Mazzucotelli JP, Abe Y, LeBesnerais P, Dubois-Rande JL (1994) The initial experience with the wearable Baxter Novacor venticular assist system. J Thorac Cardiovasc Surg 108:176–177PubMedGoogle Scholar
  7. 7.
    Miller PJ, Billich TJ, LaForge DH, Lee J, Naegeli A, Ramasamy N, Jassawalla JS, Portner PM (1994) Initial clinical experience with a wearable controller for the Novacor left ventricular assist system. ASAIO J 40:M465–M470PubMedCrossRefGoogle Scholar
  8. 8.
    Reedy JE, Swartz MT, Termuhlen DF, Pennington DG, McBride LR, Miller LW, Ruzevich SA (1990) Bridge to heart transplantation: importance of patient selection. J Heart Transplant 9:473–480PubMedGoogle Scholar
  9. 9.
    Pennington DG, Swartz MT (1995) Mechanical circulatory support: patient and device selection. In: Lewis T, Graham TR (eds) Mechanical circulatory support. Edward Arnold, London, p 159–168Google Scholar
  10. 10.
    Frazier OH (1997) Long-term mechanical circulatory support. In: Edmunds LH (ed) Cardiac surgery in the adult. McGraw-Hill, New York, 1477–1490Google Scholar
  11. 11.
    Burnett CM, Duncan JM, Frazier OH, Sweeney MS, Vega JD, Radovancevic B (1993) Improved multiorgan function after prolonged univentricular support. Ann Thorac Surg 55:65–71PubMedCrossRefGoogle Scholar
  12. 12.
    Shinn JA (1991) Novacor left ventricular assist system. AACN Clinical Issues 2:575–586Google Scholar
  13. 13.
    Korfer R, El-Banayosy A, Posival H, Minami K, Korner MM, Arusoglu L, Breymann T, Kizner L, Seifert D, Kortke H, et al. (1995) Mechanical circulatory support: the Bad Oeynhausen experience. Ann Thorac Surg 59:S56–62PubMedCrossRefGoogle Scholar
  14. 14.
    Frazier OH, Rose EA, McCarthy P, Burton NA, Tector A, Levin H, Kayne HL, Poirier VL, Dasse KA (1995) Improved mortality and rehabilitation of transplant candidiates treated with a long-term implantable left ventricular assist system. Ann Surg 222:327–336PubMedCrossRefGoogle Scholar
  15. 15.
    Mehta SM, Aufiero TX, Pae WE, Jr., Miller CA, Pierce WS (1995) Combined registry for the clinical use of mechanical ventricular assist pumps and the total artificial heart in conjunction with heart transplantation: sixth official report — 1994. J Heart Lung Transplant 14:585–593PubMedGoogle Scholar
  16. 16.
    Farrar DJ, Lawson JH, Litwak P, Cederwall G (1990) Thoratec VAD system as a bridge to heart transplantation. J Heart Lung Transplant 9:415–422Google Scholar
  17. 17.
    Pennington DG, Kanter KR, McBride LR, Kaiser GC, Barner HB, Miller LW, Naunheim KS, Fiore AC, Willman V (1988) Seven years’ experience with the Pierce-Donachy ventricular assist device. J Thorac Cardiovasc Surg 96:901–911PubMedGoogle Scholar
  18. 18.
    Reedy JE, Ruzevich SA, Noedel NR, Vitale LJ, Merkle EJ (1990) Nursing care of the ambulatory patient with a mechanical assist device. J Heart Transplant 9:97–105PubMedGoogle Scholar
  19. 19.
    Portner PM, Oyer PE, Pennington DG, Baumgartner WA, Griffith BP, Frist WR, Magilligan DJ Jr., Noon GP, Ramasamy N, Miller PJ, et al. (1989) Implantable electrical left ventricular assist system: bridge to transplantation and the future. Ann Thorac Surg 47:142–150PubMedCrossRefGoogle Scholar
  20. 20.
    Frazier OH, Rose EA, Macmanus Q, Burton NA, Lefrak EA, Poirier VL, Dasse KA (1992) Multicenter clinical evaluation of the HeartMate 1000 IP left ventricular assist device. Ann Thorac Surg 53:1080–1090PubMedCrossRefGoogle Scholar
  21. 21.
    Kormos RL, Borovetz HS. Gasior T, Antaki JF, Armitage JM, Pristas JM, Hardesty RL, Griffith BP (1990) Experience with univentricular support in mortally ill cardiac transplant candidates. Ann Thorac Surg 49:261–271PubMedCrossRefGoogle Scholar
  22. 22.
    Pennington DG (1996) Extended support with permanent systems: percutaneous versus totally implantable. Ann Thorac Surg 61:403–406PubMedCrossRefGoogle Scholar
  23. 23.
    Frazier OH, Duncan JM, Radovancevic B, Vega JD, Baldwin RT, Burnett CM, Lonquist JL (1992) Successful bridge to heart transplantation with a new left ventricular assist device. J Heart Lung Transplant 11:530–537PubMedGoogle Scholar
  24. 24.
    Frazier OH, Baldwin RT, Eskin SJ, Duncan JM (1993) Immunochemical identification of human endothelial cells on the lining of a ventricular assist device. Tex Heart Inst J 20:78–82PubMedGoogle Scholar
  25. 25.
    Graham TR, Dasse K, Coumbe A, Salih V, Marrinan MT, Frazier OH, Lewis CT (1990) Neointimal development on textured biomaterial surfaces during clinical use of an implantable left ventricular assist device. Eur J Cardiothorac Surg 4:182–190PubMedCrossRefGoogle Scholar
  26. 26.
    Dasse KA, Chapman SD, Sherman CN, Levine AH, Frazier OH (1987) Clinical experience with textured blood contacting surfaces in ventricular assist devices. ASAIO Trans 33:418–425PubMedGoogle Scholar
  27. 27.
    Pennington DG, McBride LR, Peigh LS, Peigh PS, Miller LW, Swartz MT (1994) Eight years’ experience with bridging to cardiac transplantation. J Thorac Cardiovasc Surg 107:472–480PubMedGoogle Scholar
  28. 28.
    Reedy JE, Pennington DG, Miller LW, McBride LR, Lohmann DP, Noedel NR, Swartz MT (1992) Status I heart transplant patients — conventional vs ventricular assist device support. J Heart Lung Transplant 11:246–252PubMedGoogle Scholar
  29. 29.
    Birovljev S, Radovancevic B, Burnett CM, Vega JD, Bennink G, Lonquist JL, Duncan JM, Frazier OH (1992) Heart transplantation after mechanical circulatory support: four years’ experience. J Heart Lung Transplant 11:240–245PubMedGoogle Scholar
  30. 30.
    Pifarre R, Sullivan H, Montoya, Montoya A, Bakhos M, Grieco J, Foy BK, Blakeman B, Costanzo-Nordin MR, Altergott R, Lonchyna V, et al. (1992) Comparison of results after heart transplantation: mechanically supported versus nonsupported patients. J Heart Lung Transplant 11:235–239PubMedGoogle Scholar
  31. 31.
    Pennington DG, Portner PM, Swartz MT (1995) Clinical experience with the Novacor left ventricular assist system. In: Lewis T, Graham TR (eds) Mechanical circulatory support. Edward Arnold, London, UK, pp 225–228Google Scholar
  32. 32.
    Myers TJ, Dasse KA, Macris MP, Poirier VL, Cloy MJ, Frazier OH (1994) Use of a left ventricular assist device in an outpatient setting. ASAIO J 40:M471-M475.PubMedCrossRefGoogle Scholar
  33. 33.
    Levin HR, Chen JM, Oz MC, Catanese KA, Krum H, Goldsmith RL, Packer M, Rose EA (1994) Potential of left ventricular assist devices as outpatient therapy while awaiting transplantation. Ann Thorac Surg 58:1515–1520PubMedCrossRefGoogle Scholar
  34. 34.
    Frazier OH, Benedict CR, Radovancevic B, Bick RJ, Capek P, Springer WE, Macris MP, Delgado R, Buja (1996) Improved left ventricular function after chronic left ventricular unloading. Ann Thorac Surg 62:675–681PubMedCrossRefGoogle Scholar
  35. 35.
    Frazier OH (1996) Cardiac devices. Transplant Proc 28:2039–2041PubMedGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 1998

Authors and Affiliations

  • O. H. Frazier
    • 1
  1. 1.Departments of Cardiothoracic Surgery and Cardiovascular Surgical ResearchTexas Heart Institute at St. Luke’s Episcopal HospitalHoustonUSA

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