Do we really need an Artificial Heart? No!! John V. Conte, MD, Professor of Surgery Johns Hopkins University School of Medicine Division of Cardiac Surgery The Johns Hopkins Medical Institutions
Conflict of Interest Statement No Financial Interests Investigator Thoratec: Heartmate 2 LVAD Heartware: HVAD LVAD Abiomed : Abiocor TAH
Really Francisco? Really?
The concept of the Artificial Heart is exciting!. Artificial Heart is sexy!
Artificial Heart Images : 1960 s, President Kennedy, Hope, Optimism Space flight We will put a man on the moon by the end of the decade Artificial Heart Artificial Heart Program created by the National Heart Institute (NHI) with a national mission to reduce death and disability from heart disease through the development and use of a variety of safe,effective and reliable cardiac assist and total replacement systems.
Artificial Hearts
Artificial Heart Images
Artificial Heart Images
Artificial Heart
Mechanical Circulatory Support Heart pump Ventricular Assist Device
Ventricular Assist Devices Implantable Pump Percutaneous Lead Controller Batteries
Mechanical Circulatory Support Images No Rock Stars here! Sexy?
Image Problem? We don t need an Artificial Heart!
Why don t we need artificial Heart? Results not better TAH more complicated to implant to care for Indications sketchy at best Less convenient for patient More expensive Good alternatives, applicable for all patients
J Copeland. J Thorac Cardiovasc Surg2012;143:727-34
TAH Survival 16 yrs 93-2009 101 pts Mean support 87 days J Copeland. Thorac Cardiovasc Surg2012;143:727-34
Strokes in 7.9% of cases Take-back for hemorrhage in 24.7% of cases 68% survived to transplant J Copeland. Thorac Cardiovasc Surg2012;143:727-34
Competing Outcomes Analysis (n=281) Pagani F, Miller L, Russell S, JAAC: Vol 54, No 4, 2009. 18
383 patients between 2000 and 2010 French multicentricgroupe de Réflexion sur l Assistance Mécanique (GRAM) registry. 66% paracorporealbivad, 24% TAH, 10% implantable BiVADor 63% successful bridgeor wean Kirsch M. J Heart Lung Transplant 2012
Survival while on support and after heart transplantation did not differ significantly in patients supported with paracorporealbivads, implantable BiVADs, or the TAH. Kirsch M. J Heart Lung Transplant 2012
Outcomes 9% of BiVADsweaned off support! You can t be weaned off support if your heart is in a bucket!
June 2006 June 2009
Only 3.6% of devices inserted were TAH! All investigational devices excluded in INTERMACS so. % actually much lower than 3.6%
Cleveland J. J Heart Lung Transplant 2011;30:862-9
Pulsatile vs Continuous Flow Cleveland J. J Heart Lung Transplant 2011;30:862-9
June 2006-June 2011
99 TAH /4366 Implants 2.13 % of Implants! 1.17 % of Implants
Ease of Implant -TAH Won t fit all patients- too large Abiofit Algorithm Big operation 4 suture lines Full sternotomy Cardiopulmonary bypass
Ease of implant -LVAD Small enough for nearly all adults Some advertise No pump pocket 2 rather than 4 potential bleeding sites One suture line and apical cannulation Can be put in without cpb Minimally invasive approach
Non Sternotomy LVAD Insertion
Patient ease of use
Patient ease of use s
Patient ease of use Implanted Battery Thoracic Unit Implanted TET Coil Implanted Controller
Magnetically Coupled Resonators Magnetic Resonance to wirelessly transfer energy Based on work of Nikola Tesla early 20 th century Presented at STS 2012
J Copeland. J Thorac Cardiovasc Surg2012;143:727-34
Discussion There really are no data presented to convince the reader that in fact these patients weren t eligible for an LVAD In general, our experience has -DrHariMallidi, shown that patients Stanford with elevated PAP for the most part need LVAD therapy alone. Right Their RV atrial can pressure be managed was 20 with mm inotropes Hg, pulmonary or a temporary artery assist systolic device with pressure (later) was removal 55 mmhg, of the and device wedge or pressure weaning was from the 30 inotropes. mm Hg. DrHannah -DrHariMallidi, Copeland Stanford
If we don t need an artificial heart.. What do we need?
New TAH = Creative VAD Adaptation
Thank you!