Ventricular Assist Devices (VAD) Therapy: New Technology, New
                        Hope?

Rodríguez, Limael E.; Suarez, Erik E.; Loebe, Matthias; Bruckner, Brian A.

doi:10.14797/mdcj-9-1-32

Cited by 58 publications

(40 citation statements)

References 37 publications

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“…The first generation of VADs used a pulsatile pump and valve technology. The second generation of VADs is largely based on a continuous, valveless, axial flow technology (17,18), and the third generation employs continuous flow pumps that use magnetic levitation technology and contactless bearings (18).…”

Section: Introductionmentioning

confidence: 99%

Soft robotic sleeve supports heart function

et al. 2017

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(C.J.W); frank.pigula@ulp.org (F.A.P.) Overline: Cardiovascular diseaseOne Sentence Summary: A soft robotic sleeve modeled on the structure of the human heart assists cardiovascular function in an ex vivo and in vivo porcine model of heart failure. Abstract:There is much interest in form-fitting, low modulus, implantable devices or soft robots that can mimic or assist in complex biological functions such as the contraction of heart muscle. Here we present a soft robotic sleeve that is implanted around the heart and actively compresses and twists to act as a cardiac ventricular assist device. The sleeve does not contact blood, obviating the need for anticoagulation therapy or blood thinners, and reduces complications with current ventricular assist devices such as clotting and infection. Our approach used a biologically inspired design to orient individual contracting elements or actuators in a layered helical and circumferential fashion, mimicking the orientation of the outer two muscle layers of the mammalian heart. The resulting implantable soft robot mimicked the form and function of the native heart, with a stiffness value of the same order of magnitude as native heart tissue. We demonstrated feasibility of this soft sleeve device for supporting heart function in a porcine model of acute heart failure. The soft robotic sleeve can be customized to patient-specific needs and may have the potential to act as a bridge to transplant for patients with heart failure.

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Section: Introductionmentioning

confidence: 99%

Soft robotic sleeve supports heart function

et al. 2017

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“…These changes give the advantage of longer battery life, decreased risk of infections, reduced hemolysis, reduced pump failure and increased durability [26]. The third generation devices, also continuous flow, have magnetically levitated noncontact bearings, which decrease friction and reduce heat generation, consequently continuing the increase in durability and efficiency [27]. The first generation devices showed a 48 % reduction in the risk of death when compared to OMM [12].…”

Section: Device Design and Evolutionmentioning

confidence: 99%

“…Recent data show the number of patients ''crashing onto VAD'' is decreasing [5,15]. Prognostically, the destination therapy risk score was devised for risk stratification, though it was originally developed from pulsatile device use ( Currently, two ongoing trials, the REVIVE-IT and ROADMAP trials, are investigating LVAD implantation in less ill patients earlier in heart failure treatment [27]. Both trials will evaluate placement of the HeartMate II VAD prior to inotrope dependency and other organ dysfunction in an attempt to further prolong survival and increase quality of life [63].…”

Section: Future Progressmentioning

confidence: 99%

Current Options and Practices in Long-Term Ventricular Assist Devices

2014

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End-stage heart failure poses a significant problem for patients and a burden on the healthcare system. With a lack of available hearts for transplant, mechanical circulatory support has emerged as a viable treatment option. The first generation ventricular assist device (VAD) showed superior outcomes to optimal medical management. Now with second and third generation continuous-flow VADs available, outcomes have continued to improve. Patients who undergo VAD implantation have superior survival and increased quality of life; however, they also have a significant risk of adverse events. These adverse events are decreasing as newer devices are developed, surgical experience increases, postoperative care improves and patient selection trends toward less critically ill patients. Future progress of the VAD will continue to improve survival and decrease adverse events.

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“…While heart transplantation (HTX) represents the ultimate option for cure of these patients who developed end-stage heart disease, left ventricular assist devices (LVAD) have emerged as an established therapy for patients with end-stage heart failure [1,2]. The two main reasons for this development are the shortage of appropriate donor organs on one hand and the increasing number of patients waiting for heart transplantation (HTX) on the other hand [3,4].…”

Section: Introductionmentioning

confidence: 99%

Pathological Findings in Cardiac Apex Removed during Implantation of Left Ventricular Assist Devices (LVAD) are Non-Specific. A 13-Year-Experience at a German Heart Center

Strecker

Agaimy

Roesch

et al. 2015

Thorac cardiovasc Surg

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Background and aim: Ventricular assist devices (VAD) have become an established therapy for patients with end-stage heart failure. The two main reasons for this development are the shortage of appropriate donor organs and the increasing number of patients waiting for heart transplantation (HTX). Furthermore, the enormous advances in the technical equipment and the rising clinical experience have improved the implantation technique, the durability and the long-term patient outcomes. Methods: We reviewed all cases of left ventricular assist device (LVAD) implantation at our Erlangen Heart Center during January 2000-July 2013. The main aim of this study was to analyze the underlying pathology from the cardiac apex removed during the implantation. From all patients, we created a follow-up, analyzed the pathological features with the clinical diagnoses and described the overall outcome. Results: VAD implantation was performed in 266 cases at our center in the last 13 years (2.2% of the total of 12254 cardiac surgical operations in that period). From these patients, 223 underwent LVAD or biventricular (BVAD) implantation; the remaining received a right (RVAD) implantation. The most frequent underlying clinical diagnoses were dilated (n = 84, 37.7%, DCM) or ischemic (n = 61, 27.4%, ICM) cardiomyopathy. The pathological findings in the apex biopsy were generally non-specific and showed variable interstitial myocardial fibrosis with evidence of fibre loss, fatty degeneration and variable irregular atrophy of muscle fibres, consistent with dilated and ischemic cardiomyopathies as the most frequent causes of heart failure in these patients. Only a few cases showed other specific features such as myocarditis and AL-amyloidosis. Conclusions: Pathological findings in cardiac apex removed during LVAD implantation are rather non-specific and they generally reflect the late stage or consequences of chronic myocardial damage in cases of dilated or ischemic cardiomyopathies. Variable patchy chronic inflammatory changes may be observed in cardiomyopathies as a non-specific reaction caused by myocardial fiber damage and should not lead to misinterpretation as evidence of myocarditis or revision of original diagnosis.

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Ventricular Assist Devices (VAD) Therapy: New Technology, New Hope?

Cited by 58 publications

References 37 publications

Soft robotic sleeve supports heart function

Soft robotic sleeve supports heart function

Current Options and Practices in Long-Term Ventricular Assist Devices

Pathological Findings in Cardiac Apex Removed during Implantation of Left Ventricular Assist Devices (LVAD) are Non-Specific. A 13-Year-Experience at a German Heart Center

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