Mechanical Circulatory Support in End-Stage Heart Failure: A Practical Manual

Description

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

Key Features

• ​Explains when and how to implant ventricular assist devices or a total artificial heart
• Provides clear guidance on patient selection and evaluation
• Includes numerous surgical and nonsurgical tips and tricks
• Describes how to avoid and manage complications

Table of Contents

1. 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
2. PART II: INTRAOPERATIVE TIPS AND PITFALLS 
   1. Pulsatile vs. Continuous Flow pumps: Engineering and Clinical Considerations
   2. Which Approach? Traditional vs. MICS
   3. To Pump or not to Pump: the Role of Cardio-Pulmonary Bypass or ECMO
   4. Techniques for Inflow Cannula Placement
   5. Techniques for Outflow Cannula Placement
   6. Techniques for Driveline Positioning
   7. Percutaneous Devices: Options
   8. Paracorporeal Biventricular Devices
   9. Biventricular Implantable Continuous flow pumps
   10. The Total Artificial Heart
   11. Mechanical Circulatory Support in Pediatric Population
   12. Concomitant Cardiac Surgery during Ventricular Assisted Device Placement: When is It too Much?
   13. Pump Removal after Recovery
   14. Intraoperative anesthesiological monitoring and management
   15. Intraoperative right ventricular failure management
3. PART III: POSTOPERATIVE RECOMMENDATIONS 
   1. Physiotherapy and Rehabilitation Management in Ventricular Assisted Device Patients
   2. Coagulation Monitoring
   3. Adverse events management: Ischemic and Haemorragic Stroke
   4. Adverse events management: Gastro-intestinal Bleeding
   5. Adverse events management: Pump Thrombosis
   6. Adverse events management: Infectious Complications
   7. Adverse events management: AVW Syndrome
   8. Adverse events management: Concomitant non-Cardiac Surgery during MCS: Management of Therapy
   9. Pump and Equipment Failure: How to Behave
   10. The Outpatient Care: The Role of Ventricular Assisted Device coordinator and the Remote Monitoring
4. PART IV: MISCELLANEA
   1. . Miniaturization and Future Technologies
   2. ReliantHeart – Forward Compatibility and TET
   3. The BIVACOR project
   4. Potential of CARMAT in the Future
   5. The ReinHeart Solution
   6. Ethical and Psychological aspects of long-term MCS
   7. Health-Economic Aspects of Mechanlical Circulatory Support Therapy
   8. The Mechanical Circulatory Support Registries: Role and Perspectives
5. Conclusions

Editors Biography

Dr. Antonio Loforte, MD, PhD

Dr. Antonio Loforte received his Medical Degree from Catania University School of Medicine, Italy, and completed his cardiothoracic surgery residency at the University of Bologna, S. Orsola-Malpighi Hospital, Italy, after a period of training at St. Antonius Ziekenhuis, Nieuwegein, Utrecht, The Netherlands. He completed a two-year cardiothoracic and transplantation surgery fellowship at the Deutsches Herzzentrum Berlin, Germany, and then joined the  Michael E. DeBakey Department of Surgery, Division of Tranplant  and Assist Devices, Baylor College of Medicine, Houston, Texas, USA, and the Klinic fur Herzchirurgie, Universitat Leipizig, Herzzentrum, Leipizig.

Dr. Cristiano Amarelli, MD

Dr. Amarelli, is a cardiac nonacademic surgeon involved in the field of heart transplantation during the last 15 years with a strong scientific activity in the field of transplantation, mechanical valve and mechanical circulatory support.

Born in Naples he graduated in Naples at the Second University of Naples where he completed in 2003 his training in cardiovascular surgery.

Dr. Andrea Montalto, MD.

Dr. Andrea Montalto obtained his Medical Degree at “Federico II” University  School of Medicine in Neaples, Italy.

After completed the  residency  in cardiac surgery at the University Federico II, he moved to Rome to complete the training by attending the cardiac surgery center at  S. Camillo Hospital.

Since 2006 he became permanent staff surgeon  at S. Camillo Hospital, Department of Cardiac Surgery and Transplantation, Rome, Italy,

Prof. HC. Dr. med. habil. Thomas Krabatsch

Thomas Krabatsch, MD, PhD is Senior Cardiac Surgeon at Deutsches Herzzentrum Berlin. Dr. Krabatsch has expertise in the surgical treatment of a variety of cardiovascular diseases in adults including severe diffuse coronary artery disease, valvular heart diseases, mechanical circulatory support and transplantation.