This book is a detailed practical guide to the use of ventricular assist devices and total artificial hearts to provide mechanical circulatory support (MCS) in patients with end-stage heart failure. It explains why MCS may be indicated, which patients require MCS, when and how to implant ventricular assist devices or a total artificial heart, and how to avoid potential complications of MCS. Management throughout the period of care is described, from preimplantation to follow-up, and both typical and atypical cases are discussed. The text features numerous helpful tips and tricks relating to surgical and nonsurgical management and is supported by a wealth of high-quality illustrations that document the preoperative evaluation and implantation techniques. Heart transplantation remains the gold standard for the treatment of patients suffering from end-stage heart failure, but the shortage of donors has led to an increase in the use of MCS. This book will assist all physicians, and especially cardiologists and anesthesiologists, who are involved in the care of these patients.
PART I: PREOPERATIVE EVALUATION - 1 Physiopathology and Fate of End-Stage Cardiac Heart Failure in the era of Mechanical Circulatory Support.- 2 The Advantage of Mechanical Solution: Results of Clinical Trials to Date.- 3 Mechanical Circulatory Support Candidate Selection Criteria.- 4 Preoperative Assessment and Clinical Optimization.- 5 Preoperative Evaluation of Right Ventricular Function.- 6 High INTERMACS profiles: Medical vs. Mechanical Circulatory Support treatment.- 7 Low INTERMACS Profiles: which Strategies? (Temporary ECMO or TAH support; Temporary mid-term Paracorporeal Ventricular Assisted Device Support; Primary long-term Ventricular Assisted Device placement).- 8 From BTT to DT Strategy: USA and Europe views.- 9 Mechanical Circulatory Support as a Bridge to Recovery.- 10 Mechanical Circulatory Support as a Bridge to Candidacy.- PART II: INTRAOPERATIVE TIPS AND PITFALLS - 11 Pulsatile vs. Continuous Flow pumps: Engineering and Clinical Considerations.- 12 Which Approach? Traditional vs. MICS.- 13 To Pump or not to Pump: the Role of Cardio-Pulmonary Bypass or ECMO.- 14 Techniques for Inflow Cannula Placement.- 15 Techniques for Outflow Cannula Placement.- 16 Techniques for Driveline Positioning.- 17 Percutaneous Devices: Options.- 18 Paracorporeal Biventricular Devices.- 19 Biventricular Implantable Continuous flow pumps.- 20 The Total Artificial Heart.- 21 Mechanical Circulatory Support in Pediatric Population.- 22 Concomitant Cardiac Surgery during Ventricular Assisted Device Placement: When is It too Much?.- 23 Pump Removal after Recovery.- 24 Intraoperative anesthesiological monitoring and management.- 25 Intraoperative right ventricular failure management.- PART III: POSTOPERATIVE RECOMMENDATIONS - 26 Physiotherapy and Rehabilitation Management in Ventricular Assisted Device Patients.- 27 Coagulation Monitoring.- 28 Adverse events management: Ischemic and Haemorragic Stroke.- 29 Adverse events management: Gastro-intestinal Bleeding.- 30 Adverse events management: Pump Thrombosis.- 31 Adverse events management: Infectious Complications.- 32 Adverse events management: AVW Syndrome.- 33 Adverse events management: Concomitant non-Cardiac Surgery during MCS: Management of Therapy.- 34 Pump and Equipment Failure: How to Behave.- 35 The Outpatient Care: The Role of Ventricular Assisted Device coordinator and the Remote Monitoring.- PART IV: MISCELLANEA - 36. Miniaturization and Future Technologies.- 37 ReliantHeart - Forward Compatibility and TET.- 38 The BIVACOR project.- 39 Potential of CARMAT in the Future.- 40 The ReinHeart Solution.- 41 Ethical and Psychological aspects of long-term MCS.- 42 Health-Economic Aspects of Mechanlical Circulatory Support Therapy.- 43 The Mechanical Circulatory Support Registries: Role and Perspectives.- 44 Conclusions.