Mechanical Circulatory Assistance
2002; Lippincott Williams & Wilkins; Volume: 106; Issue: 16 Linguagem: Inglês
10.1161/01.cir.0000035281.97319.a2
ISSN1524-4539
AutoresDiego Delgado, Vivek Rao, Heather J. Ross, Subodh Verma, Nicholas G. Smedira,
Tópico(s)Cardiac Arrest and Resuscitation
ResumoHomeCirculationVol. 106, No. 16Mechanical Circulatory Assistance Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBMechanical Circulatory AssistanceState of Art Diego H. Delgado, Vivek Rao, Heather J. Ross, Subodh Verma and Nicholas G. Smedira Diego H. DelgadoDiego H. Delgado From the Divisions of Cardiology (D.H.D., H.J.R.) and Cardiovascular Surgery (V.R., S.V.), Toronto General Hospital, Toronto, Canada; and Kaufman Heart Failure Center (N.G.S.), Cleveland Clinic Foundation, Cleveland, Ohio. , Vivek RaoVivek Rao From the Divisions of Cardiology (D.H.D., H.J.R.) and Cardiovascular Surgery (V.R., S.V.), Toronto General Hospital, Toronto, Canada; and Kaufman Heart Failure Center (N.G.S.), Cleveland Clinic Foundation, Cleveland, Ohio. , Heather J. RossHeather J. Ross From the Divisions of Cardiology (D.H.D., H.J.R.) and Cardiovascular Surgery (V.R., S.V.), Toronto General Hospital, Toronto, Canada; and Kaufman Heart Failure Center (N.G.S.), Cleveland Clinic Foundation, Cleveland, Ohio. , Subodh VermaSubodh Verma From the Divisions of Cardiology (D.H.D., H.J.R.) and Cardiovascular Surgery (V.R., S.V.), Toronto General Hospital, Toronto, Canada; and Kaufman Heart Failure Center (N.G.S.), Cleveland Clinic Foundation, Cleveland, Ohio. and Nicholas G. SmediraNicholas G. Smedira From the Divisions of Cardiology (D.H.D., H.J.R.) and Cardiovascular Surgery (V.R., S.V.), Toronto General Hospital, Toronto, Canada; and Kaufman Heart Failure Center (N.G.S.), Cleveland Clinic Foundation, Cleveland, Ohio. Originally published15 Oct 2002https://doi.org/10.1161/01.CIR.0000035281.97319.A2Circulation. 2002;106:2046–2050Case presentation 1: Patient 1 is a 24-year-old woman with a 3-day history of a flu-like syndrome who presented with cardiogenic shock. The patient has persistent cardiogenic shock without end-organ dysfunction despite appropriate hemodynamic support. Which type of mechanical assist device is indicated in this case?Case presentation 2: Patient is a 47-year-old man with a 12-year history of chronic heart failure due to idiopathic dilated cardiomyopathy. He now presents with New York Heart Association class IV symptoms that are refractory to medical therapy. At what point should we consider this patient for mechanical circulatory support?Mechanical circulatory support (MCS) is an important adjunct to the management of the patient with severe heart failure. This article describes the current clinically available mechanical support devices, their indications for use, and the specific advantages and disadvantages associated with each device.Indications for SupportMCS is life saving in patients who fail to improve or stabilize with intravenous inotropes or vasodilators, intra-aortic balloon pump support, and mechanical ventilation.1 Patients requiring mechanical support generally fall into 4 categories: those with (1) cardiogenic shock resulting from acute myocardial infarction (AMI); (2) postsurgical myocardial dysfunction; (3) acute cardiac failure from myocarditis (case presentation 1); and (4) decompensated chronic heart failure (case presentation 2).Patients who present in cardiogenic shock after an AMI are excellent candidates for either short- or long-term mechanical support because they have not developed the systemic organ dysfunction seen with chronic end-stage heart failure and have the potential for myocardial recovery. In our experience, however, temporary support is likely futile in patients with massive MI (peak creatine kinase ≥10 000, peak troponin I ≥300, or loss of QRS complexes in the precordial leads), as the probability of myocardial recovery is low. Urgent transplantation evaluation and consideration of long-term support should be initiated for these patients.For patients with the potential for recovery, temporary short-term support should be considered for a period of 5 to 7 days. Patients who fail to demonstrate myocardial recovery within 7 days should be considered for conversion to a long-term device. In transplantation-ineligible patients, device withdrawal should be considered if destination therapy with a long-term implantable device is not an option.Patients with postsurgical shock can be divided into those with preexisting ventricular dysfunction and therefore a low chance of recovery and those who had normal ventricular function before surgery and may recover with short-term support.An Abiomed BVS 5000 may be the most appropriate choice for the patient with previously normal cardiac function, while immediate use of an implantable left ventricular assist device (LVAD) may be the wisest choice in patients with preexisting severe myocardial dysfunction.2,3 In any case, early insertion (before leaving the operating room) is associated with a substantial survival benefit when compared with late (ICU) initiation of MCS.Acute myocarditis is another common indication for cardiac mechanical support (case presentation 1). Short-term support is indicated in patients who have persistent hemodynamic instability despite maximal medical therapy. Failure to demonstrate adequate myocardial recovery should prompt evaluation for conversion to a long-term device.Decompensation of chronic heart failure is the most common indication for long-term MCS (case presentation 2). At this stage, most patients have undergone transplantation eligibility screening, which includes ruling out primary systemic disease that may limit long-term survival (chronic renal failure and severe hepatic or pulmonary disease); significant peripheral and/or symptomatic cerebrovascular disease; recent malignancy (≤5 years); significant blood dyscrasias; active infection; and diabetes mellitus with end-organ damage. Evidence of permanent central nervous system injury is also a contraindication to mechanical support. Psychosocial issues such as active smoking, drug and/or alcohol abuse, unstable and chronic psychiatric disorders, and documented life-threatening noncompliance are additional contraindications. It should be noted that many of these factors would be considered relative contraindications by individual transplant centers.Goals of Mechanical Circulatory SupportThe majority of experience with MCS has occurred in patients who are being supported temporarily as a bridge to transplantation. One important observation during the bridge to transplantation experience was that some hearts recovered sufficient function to have the device removed. Given the shortage of donor organs, all patients undergoing MCS should be systematically evaluated for evidence of myocardial recovery.4,5 The bridge to recovery will be most successful in patients with postsurgical cardiac failure, acute myocarditis, and AMI. The likelihood for recovery in patients with chronic ventricular dysfunction is unknown, but it is likely to be less than 20% of supported patients.The use of LVADs as an alternative to heart transplantation (destination therapy) is at the threshold of the clinical arena. The Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial compared medical treatment with the electrically driven HeartMate device (Thoratec Corp) in functional class IV patients who were not heart transplantation candidates. The use of LVADs in patients with advanced heart failure resulted in a clinically meaningful survival benefit and an improved quality of life at 1 year.6Ventricular Assist DevicesThere are currently 5 Food and Drug Administration (FDA)–approved ventricular assist devices (VADs), in addition to the intra-aortic balloon pump. All assist devices cause common device-related events, although the rates of each vary among the VADs. The most common complications include bleeding, infection, thromboembolism, and device malfunction.Extracorporeal devices include the Abiomed BVS 5000 and Thoratec, which are both capable of biventricular assistance. Implantable devices designed for left ventricular support are the Novacor N1000PC (World Heart Corp), the HeartMate Pneumatic (Thoratec Corp), and the Vented Electric LVADs.The next generation of devices consists of axial flow pumps with nonpulsatile flow, totally implantable LVADs (Arrow LionHeart, WorldHeart Heart Saver) with transcutaneous energy transfer, and the Total Artificial Heart (CardioWest, ABIOCOR).Extracorporeal DevicesAbiomed BVS 5000The Abiomed BVS 5000 is an external, pulsatile, mechanical support system that can be used for univentricular or biventricular support. The advantages of this support system are its ease of use and availability. Thromboembolic, bleeding, and infectious complications limit support periods generally to ≤14 days.ThoratecThe Thoratec paracorporeal pump is a pneumatically driven, polyurethane sac designed for long-term use (Figure 1) The Thoratec VAD system is indicated as a bridge to transplantation and a bridge to recovery. Download figureDownload PowerPointFigure 1. The Thoratec extracorporeal pump.The pump is positioned on the external abdominal wall with cannulae tunneled subcostally into the mediastinum. The Thoratec VAD provides univentricular or biventricular support. For left ventricular support, the inflow cannula is placed either in the left ventricular apex or the left atrium; the outflow cannula is anastomosed to the ascending aorta. For right ventricular support, the inflow cannula is placed in the right atrium or ventricle and the outflow cannula in the main pulmonary artery.7 These cannulae are connected to an external pump (one for each ventricle), consisting of a rigid housing chamber containing a polyurethane blood sac. An external drive console sends pressurized air to the pump, compressing the blood sac and ejecting blood through mechanical valves.The external position of the pump allows device exchange in cases of malfunction, thrombus, or infection. Furthermore, this also allows use in smaller patients who are poor candidates for implantable devices. Patients require systemic anticoagulation for the duration of the Thoratec VAD implantation.Continuous Flow PumpsAxial or rotatory blood pumps have been developed with the goal of intermediate-term and long-term ventricular assistance. These nonpulsatile-flow systems have shown some advantages in contrast to pulsatile systems, including smaller size, higher efficiency, fewer infections, lower incidence of thromboembolic events, and lower cost.8,9 Early clinical experience has shown that long-term nonpulsatile blood flow is well tolerated.Centrifugal PumpsThese devices can be used for short-term left, right, or biventricular support. They use rotating cones or impellers to generate energy that is recovered in the form of pressure/flow work. Insertion of centrifugal pumps requires a sternotomy and, if the patient is unstable, placement on cardiopulmonary bypass. There are several disadvantages to the use of centrifugal pumps, including the need for systemic anticoagulation, the limited duration of support, the development of interstitial edema due to increased capillary permeability, and the inability of patients to ambulate or exercise with the device in place.The use of extracorporeal membrane oxygenation (ECMO) in conjunction with a centrifugal blood pump has been widely reported to have excellent results as a life support in newborns, infants, and children.10 ECMO technology is simple to use, is rapidly initiated under local anesthesia, is applicable to patients of all sizes, and can rapidly reverse ischemia and anoxia. Hemolysis and infection rates increase as assist duration is prolonged.Intracorporeal DevicesHeartMateThe HeartMate LVAD is implanted in a preperitoneal pocket, anterior to the posterior rectus sheath and just below the left costal margin (Figure 2) The inflow cannula is connected to the apex of the left ventricle and the outflow cannula is anastomosed to the ascending aorta. There are 2 types of HeartMate devices. The Implantable Pneumatic LVAD (IP-LVAD, Throatec Corp) is powered and controlled by an external pneumatic drive console that rests on a wheeled cart. The Vented Electric LVAD (VE-LVAD) contains an electric motor within the blood pump housing. It receives external power and control signals from an external microprocessor via a vented driveline. Both systems have porcine valves and textured blood-contacting surfaces that become covered by a "pseudoneointimal" layer. This results in a very low incidence of thromboembolic events, and therefore patients do not require systemic anticoagulation. An increasing number of patients are being discharged from hospital after implantation of the VE-HeartMate. Download figureDownload PowerPointFigure 2. The HeartMate left ventricular assist device.The main drawback of the implantable LVADs is their large size and the need for an exterior driveline. Insertion of the HeartMate is difficult in patients with a body surface area (BSA) less than 1.5 m2 because of anatomical constraints. The major complications occur early and include hemorrhage and right heart failure. The incidence of perioperative bleeding is significant. Early reports have noted a 50% incidence of reoperation for bleeding. However, this incidence has diminished. After LVAD placement, as many as 20% to 30% of patients develop significant right ventricular dysfunction refractory to pharmacological support. Infection remains a common complication (30% to 50%) with prolonged use and is the biggest impediment to long-term success.NovacorThe Novacor is an implantable, electric, dual pusher plate device designed for long-term cardiac support. The pump housing is constructed of a smooth polyurethane pump sac with gelatin-sealed inflow and outflow polyester grafts containing porcine bioprosthetic valves.The Novacor shares many similarities with the HeartMate system, including an external drive system with a portable power pack option. The device is implanted via sternotomy with an inflow conduit to the left ventricular apex and an outflow conduit to the ascending aorta. The pump itself is positioned in an abdominal subfascial plane or intraperitoneally with the tunneled driveline exiting the abdominal wall. A console or portable system regulates the pumping rate. The Novacor LVAD device requires systemic anticoagulation to prevent thromboembolism. Despite systemic anticoagulation, the risk of thromboembolic complications with the Novacor LVAD remains high (20% to 25%). This complication has been dramatically reduced (5% to 7%) with modifications in the inflow and outflow cannula design. The incidence of primary device failure is very rare.CardioWest Total Artificial HeartThe CardioWest is currently the only total artificial heart (TAH) approved for use in the United States under an FDA investigational device exemption. This device is pneumatically driven and is implanted in the orthotopic position. The pump consists of a rigid pump housing that contains dual spherical polyurethane chambers. The dual ventricular chambers are anastomosed to native atrial cuffs and the outflow conduit is anastomosed to the great vessels. Dual pneumatic drivelines exit transcutaneously to a console control system that monitors pump pressures and performance. Antiplatelet and systemic anticoagulation are needed.This device is used as bridge to transplantation in patients with biventricular failure. Patient selection is important, as the pump does not fit all patients and basic size criteria must be met.11 Major limitations include the lack of a portable control unit and the need for anticoagulation.AbioCor TAHThe AbioCor TAH is the first fully implantable replacement heart. It has been approved by the FDA as an investigational new device to be tested on selected patients.12 The AbioCor consists of an internal thoracic unit, an internal rechargeable battery, an internal miniaturized electronics package, and an external battery pack. The thoracic unit, weighing approximately 1 kg, is equipped with an internal motor that is able to move blood through the lungs and the rest of the body. The use of transcutaneous energy transmission eliminates the need for the patient to be immobilized permanently by tubes or wires connected to an external power source, thus possibly reducing risk of infections.Devices in clinical trials include the HeartMate II, the Micromed DeBakey VAD, and the Jarvik 2000. The DeBakey pump has already been successfully implanted in a small number of patients in Europe.13,14 The HeartMate II and the Jarvik 2000 have also been successfully implanted in humans.15 Unfortunately, there are few options or backup mechanisms other than replacement. Additionally, because these devices have no valves, if a malfunction occurs, the patient may develop the equivalent of wide-open aortic insufficiency.Short-term support provided by centrifugal pumps has been shown to be a safe and simple cardiac support system, with an overall wean rate of 50% to 60% and a survival to discharge rate of 25% to 40%.16–18 The use of short-term devices in selected high-risk patients as a bridge to long-term devices has shown survival rates not significantly different from the survival rate after long-term support alone.19Successful transplantation is accomplished in 60% to 65% of patients who receive a long-term device. Between 28% and 38% of all supported patients are discharged from hospital and managed as outpatients.20,21 Patients with LVADs have a higher survival to transplantation rate than the non-LVAD patients.22CardioWest TAH provided a survival to transplantation rate of 75% and a survival rate posttransplantation ≥80%.23–25 There are limited published data regarding axial flow pumps, AbioCor TAH, and other LVADs; however, early results have shown safety, efficacy, and reliability.26Device SelectionDevice selection depends not only on specific patient characteristics and the pathology of the patient's heart failure, but also on device characteristics, device availability, and the experience of the surgical team.27,28Patients in profound postsurgical cardiogenic shock require support to avoid permanent end-organ dysfunction and increase their chances of survival. The preferred devices are the Abiomed BVS 5000, Thoratec device, and ECMO. These devices may provide full biventricular support, reestablishing near normal hemodynamics while awaiting myocardial recovery. If prolonged support is expected, conversion to a longer-term device such as an implantable LVAD or TAH should be considered. The Thoratec device has the advantage of providing long-term, extracorporeal support.Device selection for long-term support is much more complicated and often is subjective and based on the surgeons' experience and bias. For smaller patients (BSA <1.5 m2), the Thoratec device and eventually a continuous flow pump are the only options. For the larger patient, all devices are potential options. An implantable LVAD is used most frequently, but the CardioWest is useful for severe biventricular failure. The role of the continuous flow pump remains to be defined. Currently, there is no approved device to provide permanent MCS, although an FDA advisory panel has recommended conditional approval for the HeartMate VE LVAD.SummaryMechanical circulatory systems have been shown to be effective as short-term therapy, as a bridge to transplantation, and as permanent cardiac support. Device design and function will continue to improve and will undoubtedly become more reliable, more patient friendly, and hopefully less costly. The next generation of mechanical assist devices will provide hope for the burgeoning number of patients with end-stage heart failure, regardless of their eligibility for transplantation.FootnotesCorrespondence to Vivek Rao, MD, PhD, FRCS (C), 14 EN 222, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, Canada, M5G 2C4. E-mail [email protected] References 1 Norman JC, Cooley DA, Igo SR, et al. Prognosis indices for survival during postcardiotomy intraaortic balloon pumping. J Thorac Cardiovasc Surg. 1977; 74: 709–720.CrossrefMedlineGoogle Scholar2 DeRose JJ, Umana JP, Argenziano M, et al. Improved results for postcardiotomy cardiogenic shock with the use of implantable left ventricular assist devices. Ann Thorac Surg. 1997; 64: 1757–1763.CrossrefMedlineGoogle Scholar3 Smedira N, Blackstone EH. Postcardiotomy mechanical support: risk factors and outcomes. Ann Thorac Surg. 2001; 71: S60–66.CrossrefMedlineGoogle Scholar4 El-Banayosy A, Korfwr R, Morshuis M, et al. Bridging to cardiac transplantation with the Thoratec ventricular assist device. Thorac Cardiovasc Surg. 1999; 47 (suppl 2): 307–310.CrossrefMedlineGoogle Scholar5 Zafeiridis A, Jeevanandam V, Houser SR, et al. Regression of cellular hypertrophy after ventricular assist device support. Circulation. 1998; 98: 656–662.CrossrefMedlineGoogle Scholar6 Rose E A, Gelijns A C, Moskowitz AJ, et al. Long-term left ventricular assistance for end-stage heart failure. N Engl J Med. 2001; 345: 1435–1443.CrossrefMedlineGoogle Scholar7 Rao V, Oz MC, Edwards NM, et al. A new off-pump technique for Thoratec right ventricular assist device insertion. Ann Thorac Surg. 2001; 71: 1719–1720.CrossrefMedlineGoogle Scholar8 Nose Y, Tsutsui T, Butler K, et al. Rotary pumps: new developments and future perspectives. ASAIO. 1998; 44: 234–237.CrossrefMedlineGoogle Scholar9 Takami Y, Ohtsuka G, Mueller J, et al. Current progress in the development of a totally implantable gyro centrifugal artificial heart. ASAIO. 1998; 44: 207–211.CrossrefMedlineGoogle Scholar10 Barlett RH, Roloff DW, Custer JR, et al. Extracorporeal life support: the University of Michigan experience. JAMA. 2000; 283: 904–908.CrossrefMedlineGoogle Scholar11 Copeland J Arabia F, Smith R, et al. Intracorporeal support: the CardioWest total artificial heart.In Goldstein DJ, Oz MC, eds. Cardiac Assist Devices. Armonk, NY: Futura Publishing Company Inc; 2000:341–355.Google Scholar12 Zareba KM. The artificial heart: past, present and future. Med Sci Monit. 2002; 8: 72–77.Google Scholar13 Wieselthaler GM, Schima H, Hiesmayr M, et al. First clinical experience with the DeBakey VAD continuous-axial-flow pump for bridge to transplantation. Circulation. 2000; 101: 356–359.CrossrefMedlineGoogle Scholar14 Potapov EV, Loebe M, Nasseri BA, et al. Pulsatile flow in patients with a novel nonpulsatile implantable ventricular assist device. Circulation. 2000; 102 (suppl 3): III183–III187.CrossrefMedlineGoogle Scholar15 Westaby S, Banning AP, Jarvik R, et al. First permanent implant of the Jarvik 2000 Heart. Lancet. 2000; 356: 900–903.CrossrefMedlineGoogle Scholar16 Neon GP, Lafuente JA, Irwin S. Acute and temporary ventricular support with BioMedicus centrifugal pump. Ann Thorac Surg. 1999; 68: 650–654.CrossrefMedlineGoogle Scholar17 Samuels LE, Holmes EC, Thomas MP, et al. Management of acute cardiac failure with mechanical assist: experience with the ABIOMED BVS 5000. Ann Thorac Surg. 2002;S67–72.Google Scholar18 Dekkers RJ, FitzGerald DJ, Couper GS. Five-year clinical experience with ABIOMED BVS 5000 as a ventricular device for cardiac failure. Prefusion. 2001; 16: 8–13.Google Scholar19 Pagani FD, Aaronson KD, Swaniker F, et al. The use of extracorporeal life support in adult patients with primary cardiac failure as a bridge to implantable left ventricular assist device. Ann Thorac Surg. 2001; 71: S77–S81.CrossrefMedlineGoogle Scholar20 Muraly S. Mechanical circulatory support with the Novacor LVAS: world wide clinical results. Thorac Cardiovasc Surg. 1999; 47 (suppl 2): 321–325.CrossrefMedlineGoogle Scholar21 Frazier O, Myers T, Radovancevic B. The HeartMate left ventricular assist system: overview and 12-year experience. Tex Heart Inst J. 1998; 25: 265–271.MedlineGoogle Scholar22 Frazier O, Rose E, McCarthy P, et al. Improved mortality and rehabilitation of transplant candidates treated with a long-term implantable left ventricular assist system. Ann Surg. 1995; 222: 327–336.CrossrefMedlineGoogle Scholar23 Copeland JG, Smith RG, Arabia FA, et al. Comparison of the CardioWest total artificial heart, the Novacor left ventricular assist system and the Thoratec ventricular assist system in bridge to transplantation. Ann Thorac Surg. 2001; 71;: S92–S97.CrossrefMedlineGoogle Scholar24 Arabia FA, Copeland JG, Smith RG, et al. CardioWest total artificial heart: a retrospective controlled study. Artif Organs. 1999; 23: 204–207.CrossrefMedlineGoogle Scholar25 Copeland JG, Arabia FA, Smith RG, et al. Arizona experience with CardioWest total artificial heart bridge to transplantation. Ann Thorac Surg. 1999; 68: 756–760.CrossrefMedlineGoogle Scholar26 Mehta SM, Pae WE, Rosemberg G, et al. The LionHeart LVD-2000: a completely implanted left ventricular assist device for chronic circulatory support. Ann Thorac Surg. 2001; 71: S156–S161.CrossrefMedlineGoogle Scholar27 D'Alessandro DA, Rao V, DiGiorgi PL, et al. Current options for mechanical heart technology. J Card Surg. 2002; 17:81–88.Google Scholar28 Goldstein DJ, Oz MC, Rose EA. Implantable left ventricular assist devices. N Engl J Med. 1998; 339: 1522–1533.CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Jorge A, Filho D, Ribeiro S, Miyagi P and Junqueira F (2018) Human Blood Circulatory System Modeling based on Hybrid Systems 2018 13th IEEE International Conference on Industry Applications (INDUSCON), 10.1109/INDUSCON.2018.8627226, 978-1-5386-7995-1, (770-774) Khorsandi M, Dougherty S, Sinclair A, Buchan K, MacLennan F, Bouamra O, Curry P, Zamvar V, Berg G and Al-Attar N (2016) A 20-year multicentre outcome analysis of salvage mechanical circulatory support for refractory cardiogenic shock after cardiac surgery, Journal of Cardiothoracic Surgery, 10.1186/s13019-016-0545-5, 11:1, Online publication date: 1-Dec-2016. Khorsandi M, Shaikhrezai K, Prasad S, Pessotto R, Walker W, Berg G and Zamvar V (2016) Advanced mechanical circulatory support for post-cardiotomy cardiogenic shock: a 20-year outcome analysis in a non-transplant unit, Journal of Cardiothoracic Surgery, 10.1186/s13019-016-0430-2, 11:1, Online publication date: 1-Dec-2016. Choudhri O, Shah A, Basarab-Tung J, Jaffe R and Steinberg G Extracorporeal membrane oxygenation for cardiac arrest during moyamoya cerebral revascularization surgery: case report, Journal of Neurosurgery, 10.3171/2014.11.JNS141054, 123:3, (693-698) Fargnoli A, Mu A, Katz M, Williams R, Margulies K, Weiner D, Yang S and Bridges C (2014) Anti-inflammatory loaded poly-lactic glycolic acid nanoparticle formulations to enhance myocardial gene transfer: an in-vitro assessment of a drug/gene combination therapeutic approach for direct injection, Journal of Translational Medicine, 10.1186/1479-5876-12-171, 12:1, (171), . Lafçı G, Budak A, Yener A and Cicek O (2014) Use of Extracorporeal Membrane Oxygenation in Adults, Heart, Lung and Circulation, 10.1016/j.hlc.2013.08.009, 23:1, (10-23), Online publication date: 1-Jan-2014. Rao V (2013) Invited Commentary, The Annals of Thoracic Surgery, 10.1016/j.athoracsur.2012.10.017, 95:2, (499), Online publication date: 1-Feb-2013. Bellumkonda L and Bonde P (2012) Ventricular Assist Device Therapy for Heart Failure—Past, Present, and Future, International Anesthesiology Clinics, 10.1097/AIA.0b013e31826233a9, 50:3, (123-145), . Thunberg C, Gaitan B, Arabia F, Cole D and Grigore A (2010) Ventricular Assist Devices Today and Tomorrow, Journal of Cardiothoracic and Vascular Anesthesia, 10.1053/j.jvca.2009.11.011, 24:4, (656-680), Online publication date: 1-Aug-2010. Hullin R (2010) Treatment of Left Ventricular Failure Current Best Practice in Interventional Cardiology, 10.1002/9781444314441.ch12, (152-160) Hobbs R and Boyle A (2010) Heart Failure Current Clinical Medicine, 10.1016/B978-1-4160-6643-9.00026-6, (171-179.e1), . Sidebotham D, McGeorge A, McGuinness S, Edwards M, Willcox T and Beca J (2009) Extracorporeal Membrane Oxygenation for Treating Severe Cardiac and Respiratory Disease in Adults: Part 1—Overview of Extracorporeal Membrane Oxygenation, Journal of Cardiothoracic and Vascular Anesthesia, 10.1053/j.jvca.2009.08.006, 23:6, (886-892), Online publication date: 1-Dec-2009. Alba A and Delgado D (2014) The future is here: ventricular assist devices for the failing heart, Expert Review of Cardiovascular Therapy, 10.1586/erc.09.86, 7:9, (1067-1077), Online publication date: 1-Sep-2009. Morales Pérez C (2009) Bombas centrífugas como asistencia ventricular: estado actual, Cirugía Cardiovascular, 10.1016/S1134-0096(09)70156-1, 16:2, (119-124), Online publication date: 1-Apr-2009. Khan N, Butany J, Zhou T, Ross H and Rao V (2008) Pathological findings in explanted prosthetic heart valves from ventricular assist devices, Pathology, 10.1080/00313020801911504, 40:4, (377-384), Online publication date: 1-Jun-2008. Delgado D, Ross H and Rao V (2007) The dilemma of a left ventricular assist device explantation: A decision analysis, Canadian Journal of Cardiology, 10.1016/S0828-282X(07)70228-3, 23:8, (657-661), Online publication date: 1-Jun-2007. Kilic A, Nolan T, Li T, Yankey G, Prastein D, Cheng G, Jarvik R, Wu Z and Griffith B (2007) Early In Vivo Experience With the Pediatric Jarvik 2000 Heart, ASAIO Journal, 10.1097/MAT.0b013e318038fc1f, 53:3, (374-378), Online publication date: 1-May-2007. Camus J, Campomar G, D'Attellis C, Silvestrini M, Varela L and De Forteza E (2018) In Vitro Evaluation of an Axial Flow Pump: Mock-Pump Interaction and an Approach to Control, The International Journal of Artificial Organs, 10.1177/039139880703000106, 30:1, (34-43), Online publication date: 1-Jan-2007. Beca J, Willcox T and Hall R (2007) Mechanical Cardiac Support Cardiothoracic Critical Care, 10.1016/B978-075067572-7.50025-4, (342-364), . Nieminen M (2006) Key issues of European Society of Cardiology guidelines on acute heart failure, European Heart Journal Supplements, 10.1093/eurheartj/sul024, 8:suppl_E, (E6-E11), Online publication date: 1-Sep-2006. Редакционная С (2006) Острая сердечная недостаточность: рекомендациипо диагностике и лечению, PULMONOLOGIYA, 10.18093/0869-0189-2006-1-19-56:1, (19-56) Zimpfer D, Wieselthaler G, Czerny M, Fakin R, Haider D, Zrunek P, Roethy W, Schima H, Wolner E and Grimm M (2006) Neurocognitive Function in Patients with Ventricular Assist Devices: A Comparison of Pulsatile and Continuous Blood Flow Devices, ASAIO Journal, 10.1097/01.mat.0000191334.51375.7e, 52:1, (24-27), Online publication date: 1-Jan-2006. Fujita Y, Fujino Y, Matsumiya G, Sawa Y, Mashimo T, Matsuda H and Nishimura M (2005) Postoperative hyperbilirubinemia after implantation of left ventricular assist device is associated with poor postoperative liver perfusion, Journal of Artificial Organs, 10.1007/s10047-004-0276-6, 8:1, (28-33), Online publication date: 30-May-2005. Fedak P, Verma S, Weisel R, Skrtic M and Li R (2005) Cardiac remodeling and failure, Cardiovascular Pathology, 10.1016/j.carpath.2005.03.004, 14:3, (109-119), Online publication date: 1-May-2005. (2005) Guías de Práctica Clínica sobre el diagnóstico y tratamiento de la insuficiencia cardíaca aguda. Versión resumida, Revista Española de Cardiología, 10.1157/13073896, 58:4, (389-429), Online publication date: 1-Apr-2005. (2005) Guías de Práctica Clínica sobre el diagnóstico y tratamiento de la insuficiencia cardíaca aguda. Versión resumida, Revista Española de Cardiología (English Edition), 10.1016/S1885-5857(06)60670-1, 58:4, (389-429), Online publication date: 1-Apr-2005. Rao V, Oz M, Flannery M, Idrissi K, Argenziano M, Edwards N and Naka Y (2004) Changing Trends in Mechanical Circulatory Assistance:. Experience With 131 Consecutive HeartMate VE Left Ventricular Assist Devices, Journal of Cardiac Surgery, 10.1111/j.0886-0440.2004.4074_11.x, 19:4, (361-366), Online publication date: 1-Jul-2004. October 15, 2002Vol 106, Issue 16 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000035281.97319.A2PMID: 12379571 Originally publishedOctober 15, 2002 PDF download Advertisement
Referência(s)