Page 655 - Cardiac Nursing

CHAPTER 26 / Mechanical Circulatory Assist Devices 631

n Figure 26-11 The HeartMate II LVAD is composed of an inflow cannula inserted into the apex of the left
ventricle, an outflow cannula that is anastomosed to the ascending aorta and a pump that is placed within the
abdominal wall or peritoneal cavity. A percutaneous lead carries the electrical cable to an electronic controller
and battery packs, which are worn on a belt and shoulder holster, respectively. (From Figure 1, Miller, L.,
Pagani, F., Russell, S., et al. [2007]. Use of a continuous-flow device in patients awaiting heart transplantation.
The New England Journal of Medicine, 357, 885–896.)

Cardiovascular, Inc., Houston, TX) and the Jarvik 2000 (Jarvik
Heart Inc., New York, NY). In Europe, the InCorBerlinHeart
(Berlin Heart, Inc., Berlin, FR, German), and in Australia the
VentrAssist are available. These axial flow pumps are capable of
generating upward of 10 L/min of continuous flow, which more
effectively rests the left ventricle. 41,42

Total Artificial Heart
Total artificial hearts are devices that are placed in the chest after
the patient’s native heart has been removed. Complications such
as thromboembolism, infection, and bleeding have limited their
development. The CardioWest total artificial heart (SynCardia
Systems, Tucson, AZ) is a pneumatic total artificial heart that has
been studied as a bridge to transplant. In a nonrandomized
prospective, multicenter trial using historical controls, 81 patients
who received the device were followed after implantation. The
rate of survival to transplantation was 79% (95% confidence in-
terval, 68 to 87%). Of the 35 control patients who met the same
entry criteria but did not receive the artificial heart, 46% survived
to transplantation. Overall, the 1-year survival rate among the pa-
tients who received the artificial heart was 70%, as compared with
31% percent among the controls. One- and 5-year survival rates
after transplantation among patients who had received a total ar-
tificial heart as a bridge to transplantation were 86% and 64%, re- n Figure 26-12 The CardioWest total artificial heart (From Figure 1,
43
spectively. This device is depicted in Figure 26-12. Copeland, J. G., Smith, R. G., Arabia, F. A., et al. [2004]. Cardiac
The AbioCor total artificial heart (Abiomed, Inc., Danvers, replacement with a total artificial heart as a bridge to transplantation.
MA) is uniquely designed to use low-viscosity oil that is shunted The New England Journal of Medicine, 351, 859–867.)