State of the Art of Mechanical Circulatory Support

Abstract

Mechanical circulatory support of the failing heart has become an important means of treating end-stage heart disease. This rapidly growing therapeutic field has produced impressive clinical outcomes and has great potential to help thousands of otherwise terminal patients worldwide. In this review, we examine the state of the art of mechanical circulatory support: current practice, totally implantable systems of the future, evolving biventricular support mechanisms, the potential for myocardial recovery and adjunctive treatment methods, and miniaturized devices with expanded indications for therapy.

The future of mechanical circulatory support for advanced heart failure

“…The TAH relies on two pneumatically driven polyurethane ventricles with two unidirectional mechanical valves that operate in a pulsatile fashion. The durability of these pulsatile devices limits the majority of patients to receive relatively short-term support of less than 1 year as a result of the many moving parts and finite endurance of the flexible membranes [17]. The focus of new technology for long-term total heart replacement therapy is to design a device that is compact, highly durable yet powerful enough to replace native cardiac function.…”

“…The BiVACOR Total Artificial Heart (BiVACOR, Houston, Texas, USA) is a magnetically powered, biventricular, continuous flow support device. The unique feature is that it utilizes a zero-power magnetic suspension that levitates a single, double-sided impeller, which automatically balances pulmonary and systemic blood flow in response to differences between left and right atrial pressure [17] (Fig. 3a).…”

Clinical Osteopathic Observation of Patients with Left-Ventricular Assistance Device

“…When heart failure is in an advanced stage and the clinical condition allows, the patient can be put on the transplant list. However, the number of organs available for transplant is lower than the demand [4,5]. Another treatment option in advanced heart failure is mechanical ventricular support, which can be offered to patients who meet pre-determined criteria for inclusion [6].…”

“…The patient must learn to manage the device and its management, thanks to the training provided by specialists. Since the system is carried out with the ultimate aim of having a transplant, it is referred to as "bridge therapy", while if the use of L-VAD becomes a definitive therapeutic solution, it is described as a "destination therapy" [5,8], (Figure 1). …”

“…These patients have to undergo strict medical supervision and can access the cardiovascular rehabilitation programs; the results of functional recovery are very slow but verifiable [6,[9][10][11]. The patient with L-VAD system is subject to a number of complications both during the hospital stay, and at home, in particular anemia, respiratory problems, recurrent infections in the insertion of the VAD cable, and on rare occasions, thrombosis [5][6][7]. In this study we evaluated the presence of osteopathic dysfunctions in patients with L-VAD, as we have verified that a text citing osteopathic issues is missing from the existing literature.…”