Heart disease is a leading cause of death worldwide. When the heart is damaged, it may not pump blood as well as it should. This condition is known as heart failure. For those suffering from end-stage heart failure, cardiac assist devices can be a lifesaver. Let's take a deeper look into these innovative medical devices.
What are Cardiac Assist Devices?
Cardiac assist devices, also known as mechanical circulatory support devices, are mechanical pumps that are implanted in the body to help the heart pump blood. There are various types of devices that assist different chambers of the heart and fulfill different functions. Some cardiac assist devices are intended for short-term use, while others can be used permanently or for many years.
The main types of cardiac assist devices include:
- Left Ventricular Assist Devices (LVADs): LVADs are pumps placed inside the chest to help the left ventricle pump blood to the rest of the body. They are meant for long-term use in patients awaiting a heart transplant or as a permanent solution for those who are not transplant candidates.
- Right Ventricular Assist Devices (RVADs): Similar to an LVAD but designed to help the right ventricle pump blood to the lungs. They are often used in combination with an LVAD.
- Biventricular Assist Devices (BIVADs): As the name suggests, BIVADs support both sides of the heart through separate pumps on the right and left ventricles.
- Extracorporeal Membrane Oxygenation (ECMO): ECMO systems have an external pump that takes over the function of both sides of the heart and lungs. They are short-term support often used in surgery recoveries or cardiogenic shock.
Benefits of Cardiac Assist Devices
Cardiac assist devices offer many advantages over pharmacological therapy alone for patients with advanced heart failure:
- Increased survival: Mechanical circulatory support significantly reduces the risk of death while waiting for a heart transplant by sustaining blood circulation. Devices also prolong survival compared to drug treatment alone.
- Improved quality of life: By boosting cardiac output and restoring end-organ function, these devices relieve symptoms like fatigue, edema, and shortness of breath. This enables patients to resume normal daily activities.
- Bridge to transplantation: LVADs in particular allow transplant-eligible patients to stabilize medically and wait in better condition for a donor organ to become available.
- Destination therapy: For those considered too sick or old for a heart transplant, an LVAD offers the possibility of lifelong assistance without needing further intervention.
- Recovery potential: Some patient hearts recover partially or fully after getting initial mechanical support from devices like LVADs, potentially obviating the need for long-term support or transplant.
Device Implantation and Ongoing Management
The surgical procedure to implant these Cardiac Assist Devices requires opening the chest and connecting the external pump section to pumps placed within the heart or blood vessels. Post-operative care and management involves:
- Monitoring of pump function and therapy optimization by specialized cardiologists and nurses.
- Maintenance of adequate hydration and blood thinning to reduce clotting risks.
- Care of driveline exit site from the pump through the skin to external components.
- Potential for device-related complications like bleeding, infection and pump thrombosis that need prompt intervention.
- Post-operative rehabilitation to help patients regain strength.
- Long-term follow-up through dedicated heart failure centers.
The Future of Mechanical Circulatory Support
As technology advances, new generations of smaller, more durable, and easier to use cardiac assist devices are being developed. Some areas that hold promise include:
- Wireless, entirely implantable LVADs for a more natural feeling and freedom from drivelines or external controllers.
- Pediatric and neonatal-sized devices to expand life-saving options for children.
- Artificial hearts as an alternative to transplantation for permanent complete cardiac support.
- Wearable miniaturized devices for temporary support during high-risk procedures or as a bridge to recovery.
- Adaptive algorithms using sensors to automatically adjust pump speed based on patient activity levels and physiologic need.
Cardiac assist devices represent a major milestone in the treatment of end-stage heart failure. They are transforming lives by extending longevity, allowing for an active existence, and providing hope for patients who would otherwise have no options. As the technology continues advancing rapidly, these life-extending inventions have an exciting future ahead.
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