IMPLANT INFORMATION about Cardiovascular System

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

Tissue heart valves