|What … for? (Indications for implants)|
| Implants for the heart serve at
Different distinction criteria:
1. Structural Heart Diseases
1.1 Partial Heart Substitutes (VHD=Valvular Heart Disease)- Severe aortic stenosis (AS)
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
1.3 Total Artificial Heart
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)
|Generally a multidisciplinary approach by a specialized team is recommendable.|
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)
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
Low life expectancy
|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|
|Structural implants (valves, widener, opener…..)|
|autologous||Pulmonal valve||e.g. “Ross” operation|
|xenogenous||Bovine pericardium||Sorin pericardial valves|
|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|
|Implantable pacing systemes (pacemaker, defibrillator, cardioverter, CRT Cardiac resynchronization therapy, CRT-D, implantable cardioverter defibrillator (ICD)|
|alloplastic||Generator (resistors, diodes, capacitors, semiconductors)||wired||titanium|
|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)
Carotid Artery Stent (Medline)
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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