IMPLANT INFORMATION about Cardiovascular System

 

 

    
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 and blood circulation

 

 

 

 

heart with implanted pacemaker

 

 

 

 

 

 

 

 

 

 

 
  
Stent angioplasty procedure

 

 

 

 

 

 

 
 
  
  
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.
 
ContraindicationsbehavioralMissing, low compliance 
 medicalComorbidities precluding the expected benefit, Frailty
Mortality Scores . eg Euroscore (STS risk estimate) Procedure specific impediments
Heart infections
Low life expectancy
 
  
during surgeryn/a 
Risksduring surgeryImpracticability, problems with general anesthesia, death 
 short termNo benefit 
long termNo benefit 
restrictionsAccompanying 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)
 
Failuresn/a, many varieties 
MaterialArtificial heartPumptitanium-aluminum-vanadium alloy 
   polyester 
  polyurethan 
 porcine 
Battery  
Tubes  
Structural implants (valves, widener, opener…..) 
autologousPulmonal valvee.g. “Ross” operation 
allogenicHuman valves  
xenogenousBovine pericardiumSorin pericardial valves

 

Tissue heart valves

 
   
Collagen 
alloplasticStents after coronary, peripheral angioplasty (balloon angioplasty) leaving a stentStainless steel, gold, cobalt-chromium, tantalum 
  
Nitinol (55%Ni, 45%Ti) 
Nitinol-composite with platinum core 
 Silicone 
Shape-memory polymers 
biodegradablePolyorthoester 
 Polyanhydrids 
Polyester (biodegradable) 
Implantable pacing systemes (pacemaker, defibrillator, cardioverter, CRT Cardiac resynchronization therapy, CRT-D, implantable cardioverter defibrillator (ICD) 
alloplasticGenerator (resistors, diodes, capacitors, semiconductors)wiredtitanium 
 wirelesstitanium 
batterylithium, iodine 
electrodes  
StatisticsAortic 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– Basic2014 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
 
 ProblemsPacemaker problems
Prosthetic heart valves problems
 
– Science/FutureArtificial Heart Pump 
Medical societiessee here

Use the information button or the doctor-finder in the medical societies section. If available you´ll find information in your language and according to the region you live. 
CriticismHeart stents still overused (NYT, 2013) 
  
Selected Patient informationsAngioplasty 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 patientsInternational 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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