IMPLANT INFORMATION about Heart / Vessel

   
What … for? (Indications for implants)  
 Implants for the heart serve at
  1. Structural Heart Diseases as
    1.1 Partial Heart Substitutes,

    1.2 Hybrid Heart Assistive Devices,
    1.3 Total Artificial Heart,
    1.4 Vessels, and at
  2. Abnormal heart rhythms (artificial pacemaker).

Different distinction criteria:
Pulsatile heart supporting Systems
– Non-pulsatile heart supporting Systems

 1. Structural Heart Diseases

1.1 Partial Heart Substitutes (VHD=Valvular Heart Disease)-   Severe aortic stenosis (AS)
–   Aortic Dissection (AD)
–   Bicuspid Aortic Valve
–   Rheumatic MS (mitral Stenosis)
–   MR (mitral regurgitation)
–   TR (Tricuspid Valve Disease)
–   Pulmonic Valve Disease
–   Mixed Valve Disease
–   Patients with prosthetic valves
–   Symptomatic heart disease due to either severe native  calcific aortic stenosis or failure
–   Dilated ascending aorta in combination with valve pathology
–   Left ventricular dysfunction
–   Aortic valve disease causing hemodynamic burden sufficient to affect left ventricular structure or function
–   Enlargement of left ventricle (parachute implant)

Patients who cannot tolerate surgery for aortic valve replacement may be candidates for a less invasive approach called TAVI or TAVR (Transcatheter Aortic Valve Replacement).

Summary of recommendations for prosthetic valve choice (Nishimura)

A bioprosthesis is recommended in patients of any age for whom anticoagulant therapy is contraindicated, cannot be managed appropriately, or is not desired.

A mechanical prosthesis is reasonable for AVR or MVR in patients <60 y of age who do not have a contraindication to anticoagulation.

A bioprosthesis is reasonable in patients >70 y of age. Either a bioprosthetic or mechanical valve is reasonable in patients between 60 y and 70 y of age.

1.2 Hybrid Heart Assistive Devices
To bridge the time to heart transplantation or to permanently replace the heart in case heart Transplantation is not possible
Left Ventricular Assist Device (LVAD)
Right Ventricular Assist Device (RVAD)
Biventricular Assist Device (BiVAD)

1.3 Total Artificial Heart
To bridge the time to heart transplantation or to permanently replace the heart in case heart transplantation is not possible
Total artificial heart (TAH), Prototypes, Single Case Experiences

1.4 Vessels
–   Intracranial aneurysms
–  Reduced vessel (e.g. coronary, carotid) Diameter
–   Closed vessels
–   AS (Aortic Stenosis)
–   AR (Aortic Regurgitation)

Replacement of the aortic valve by a pulmonary autograft (the Ross procedure), may be considered in young patients when VKA anticoagulation is contraindicated or undesirable (Nishimura).

2) Abnormal heart rhythms (artificial pacemaker)
Bradycardia, arrhythmia, heart block, congenital heart diseases.
If heartbeat is too slow or irregular.
May be combined with an internal cardioverter defibrillator (ICD).

   heart 01
Stent angioplasty procedure on a black background
 
 heart 04 vascular stent
  Oberkörper, männlich mit implantiertem Herzschrittmacher
Generally a multidisciplinary approach by a specialized team is recommendable.
Numbers
American Heart Association (USA): – 1.313 million PCI procedures (2006) – 2.200 Heart transplants (2006) – 106.000 Valve replacements (2006)
Pacemakers worldwide (2009): 1,002,664 (737,840 new, 264,824 replacements)
LVADs worldwide about 4,000 implanted (total until 2000)1 of every 2.9 deaths in the United States is related to heart diseases (AHA, 2011)
Times
Structural therapies: very different acc. to type and scope of the surgery.
Pacemaker: hospital stay several hours until days.
Contraindications behavioral Missing, low compliance
  medical Comorbidities precluding the expected benefit, Frailty
Mortality Scores . eg Euroscore (STS risk estimate) Procedure specific impediments
Heart infections
Low life expectancy
 
during surgery n/a
Risks during surgery Impracticability, problems with general anesthesia, death
short term No benefit
long term No benefit
restrictions Accompanying medical treatment, Control regiment.
Artificial pacemaker: Avoid intense magnetic fields, contact sports, electric interference may occur (e.g. at magnetic resonance imaging MRI, radiofrequencies, transcutaneous electrical nerve stimulation TENS, therapeutic radiation, diathermy, electric tools)
Failures n/a, many varieties
Material Artificial heart Pump titanium-aluminum-vanadium alloy
    polyester
  polyurethan
porcine
Battery  
Tubes  
Structural implants (valves, widener, opener…..)
autologous Pulmonal valve e.g. “Ross” operation
allogenic Human valves
xenogenous Bovine pericardium Sorin pericardial valves

Tissue heart valves

 
Collagen
alloplastic Stents after coronary, peripheral angioplasty (balloon angioplasty) leaving a stent Stainless steel, gold, cobalt-chromium, tantalum
 
Nitinol (55%Ni, 45%Ti)
Nitinol-composite with platinum core
Silicone
Shape-memory polymers
biodegradable Polyorthoester
Polyanhydrids
Polyester (biodegradable)
Implantable pacing systemes (pacemaker, defibrillator, cardioverter, CRT Cardiac resynchronization therapy, CRT-D, implantable cardioverter defibrillator (ICD)
alloplastic Generator (resistors, diodes, capacitors, semiconductors) wired titanium
wireless titanium
battery lithium, iodine
electrodes
Statistics Aortic valve operations: 80% of patients had a predicted risk of mortality (PROM) of <4% and actual mortality rate of 1.4%, the remaining 20% had a higher risk (2002 – 2010).
 
Literature – Basic 2014 AHA/ACC guideline for the Management of Patients with Valvular Heart Disease (find more guidelines, recommendations on page e63)
Pocket Guides of the Canadian Cardiovascular Society
The German Aortic Valve Registry (GARY): in-Hospital outcome
Problems Pacemaker problems
Prosthetic heart valves problems
– Science/Future Artificial Heart Pump
Medical societies see here
Criticism Heart stents still overused (NYT, 2013)
 
Selected Patient informations Angioplasty Patient Center
Artificial Pacemaker (1)
Artificial Pacemaker (2)
Atrial Fibrillation
Carotid Artery Stent (Medline)
Cholesterol (AHA)
Heart Failure Matters (multilingual)
Heart Valve Disease (University of Michigan)
Implantation eines ICD- oder CRT-Systems (german)
Risks of having a stent (NIH)
Sudden cardiac death (AHA)
 
Register for patients International pacemaker patient identification cards carry information such as patient data (among others, symptom primary, ECG, aetiology), pacemaker center (doctor, hospital), IPG (rate, mode, date of implantation, manufacturer, type) and lead type
 
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