Transcript Spinal Cord Injury

Ventricular Assist Devices
Topics in Bioengineering
Increasing use of VADs as bridge to
transplantation
Klotz et al. (2008) Prog Biophys Mol Biol
Overview of VAD types
Klotz et al. (2008) Prog Biophys Mol Biol;
http://my.clevelandclinic.org/heart/disorders/heartfailure/lvad_devices.aspx
http://texasheart.org/Research/Devices/abiocor.cfm
http://medgadget.com/2007/07/pediaflow_ventricular_assist_device.html
The HeartMate II VAD
Miller et al. (2007) NEJM. Figure 1
Griffith et al. (2001) Ann Thorac Surg. Figure 2
Flow visualization around inlet stator and rotor
Griffith et al. (2001) Ann Thorac Surg. Figure 3
Tethered and untethered configurations
Griffith et al. (2001) Ann Thorac Surg. Figures 4 and 5
Pressure-flow relationships for HeartMate II
Griffith et al. (2001) Ann Thorac Surg. Figure 6
Baseline characteristics of the patients (1)
2.6-4.2
9-18
Normal:
55-70%
Miller et al. (2007) NEJM. Table 1
Baseline characteristics of the patients (2)
N
N
N
N
N
H - renal
H - liver
H - liver
N
H – tissue breakdown, various
Miller et al. (2007) NEJM. Table 1
Baseline characteristics of the patients (3)
Increase contraction
Edema
Hypertension
Hypertension, HF
Arrhythmia
Arrhythmia, HF
Hypertension
Arrhythmia (ventricular)
Anticoagulant
Anticoagulant
Anticoagulant
Miller et al. (2007) NEJM. Table 1
Blood clotting cascade
http://www.biosbcc.net/doohan/sample/htm/Hemostasis.htm
NYHA Heart Failure Class
http://www.abouthf.org/questions_stages.htm
Functional status and quality of life
Miller et al. (2007) NEJM. Table 2
Functional status and quality of life
Plot on graph?
Miller et al. (2007) NEJM. Table 2
Outcomes of the patients
Miller et al. (2007) NEJM. Table 3
Outcomes of the patients
Miller et al. (2007) NEJM. Figure 2
Adverse events in the study
Miller et al. (2007) NEJM. Table 4
Adverse events in the study
Miller et al. (2007) NEJM. Table 4
Testimony from a patient
http://www.youtube.com/watch?v=_dj
ouz093Us&feature=endscreen
Questions for discussion
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Is it worth the risk?
What major issues still need to be addressed?
What can BMEs do to improve VAD design?
What about for other patient populations (eg,
women and children)?
• Other thoughts, ideas, critiques?
http://medgadget.com/2007/07/pediaflow_ven
tricular_assist_device.html