Cardiovascular Care
Cardiovascular Care
Cardiovascular Care
Heart Failure
Heart Failure
Heatr Failure
The heart, the seat of our soul and the perennial pump of our body, has its own idiosyncrasies which keeps us mere mortals on our toes. Heart failure can occur due to a multitude of causes ranging from ischemic heart disease to poorly treated diabetes and hypertension.
The heart, the seat of our soul and the perennial pump of our body, has its own idiosyncrasies which keeps us mere mortals on our toes. Heart failure can occur due to a multitude of causes ranging from ischemic heart disease to poorly treated diabetes and hypertension.
The heart, the seat of our soul and the perennial pump of our body, has its own idiosyncrasies which keeps us mere mortals on our toes. Heart failure can occur due to a multitude of causes ranging from ischemic heart disease to poorly treated diabetes and hypertension.
Understanding Heart Failure
Heart failure occurs when the heart muscle doesn't pump blood as well as it should. This can happen due to various conditions that damage or overwork the heart muscle. Understanding the type and severity of heart failure is crucial for proper treatment and management.
Understanding Heart Failure
Heart failure occurs when the heart muscle doesn't pump blood as well as it should. This can happen due to various conditions that damage or overwork the heart muscle. Understanding the type and severity of heart failure is crucial for proper treatment and management.
Understanding Heart Failure
Heart failure occurs when the heart muscle doesn't pump blood as well as it should. This can happen due to various conditions that damage or overwork the heart muscle. Understanding the type and severity of heart failure is crucial for proper treatment and management.
Types of Heart Failure
Types of Heart Failure
Types of Heart Failure
Systolic Heart Failure
When the heart muscle weakens and fails to pump blood efficiently. This affects circulation, oxygen delivery, and organ function. Common causes include: Ischemic heart disease Diabetic cardiomyopathy Leaky heart valves Chronic alcohol use Amyloidosis Viral myocarditis Drug abuse (e.g., cocaine)
Systolic Heart Failure
When the heart muscle weakens and fails to pump blood efficiently. This affects circulation, oxygen delivery, and organ function. Common causes include: Ischemic heart disease Diabetic cardiomyopathy Leaky heart valves Chronic alcohol use Amyloidosis Viral myocarditis Drug abuse (e.g., cocaine)
Systolic Heart Failure
When the heart muscle weakens and fails to pump blood efficiently. This affects circulation, oxygen delivery, and organ function. Common causes include: Ischemic heart disease Diabetic cardiomyopathy Leaky heart valves Chronic alcohol use Amyloidosis Viral myocarditis Drug abuse (e.g., cocaine)
Diastolic Heart Failure
When the heart muscle stiffens and cannot relax properly to fill. It limits blood volume and raises internal pressure. Common causes include: Uncontrolled hypertension Restrictive cardiomyopathy HOCM (hypertrophic type) Aging-related fibrosis Obesity-related changes Diabetes-induced stiffness Chronic inflammation
Diastolic Heart Failure
When the heart muscle stiffens and cannot relax properly to fill. It limits blood volume and raises internal pressure. Common causes include: Uncontrolled hypertension Restrictive cardiomyopathy HOCM (hypertrophic type) Aging-related fibrosis Obesity-related changes Diabetes-induced stiffness Chronic inflammation
Diastolic Heart Failure
When the heart muscle stiffens and cannot relax properly to fill. It limits blood volume and raises internal pressure. Common causes include: Uncontrolled hypertension Restrictive cardiomyopathy HOCM (hypertrophic type) Aging-related fibrosis Obesity-related changes Diabetes-induced stiffness Chronic inflammation
Symptoms of Heart Failure
🩺 What Do You Feel or Present With? Shortness of breath Swelling in the feet (pitting pedal edema) Inability to lie flat (orthopnea) Persistent cough while lying down (fluid in lungs) Wheezing or noisy breathing Abdominal swelling (ascites)
Symptoms of Heart Failure
🩺 What Do You Feel or Present With? Shortness of breath Swelling in the feet (pitting pedal edema) Inability to lie flat (orthopnea) Persistent cough while lying down (fluid in lungs) Wheezing or noisy breathing Abdominal swelling (ascites)
Symptoms of Heart Failure
🩺 What Do You Feel or Present With? Shortness of breath Swelling in the feet (pitting pedal edema) Inability to lie flat (orthopnea) Persistent cough while lying down (fluid in lungs) Wheezing or noisy breathing Abdominal swelling (ascites)
Classification of Heart Failure
Classification of Heart Failure
Classification of Heart Failure
Virtual Care
NYHA Functional Classification
Class I No limitation is experienced in any activities; there are no symptoms from ordinary activities.
Class I No limitation is experienced in any activities; there are no symptoms from ordinary activities.
Class I No limitation is experienced in any activities; there are no symptoms from ordinary activities.
Class II Slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion.
Class II Slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion.
Class II Slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion.
Class III Marked limitation of any activity; the patient is comfortable only at rest.
Class III Marked limitation of any activity; the patient is comfortable only at rest.
Class III Marked limitation of any activity; the patient is comfortable only at rest.
Class IV Any physical activity brings on discomfort and symptoms occur at rest.
Class IV Any physical activity brings on discomfort and symptoms occur at rest.
Class IV Any physical activity brings on discomfort and symptoms occur at rest.
Total Wellness
ACC/AHA Stages
Stage A Patients at high risk for developing HF in the future but no functional or structural heart disorder.
Stage A Patients at high risk for developing HF in the future but no functional or structural heart disorder.
Stage A Patients at high risk for developing HF in the future but no functional or structural heart disorder.
Stage B A structural heart disorder but no symptoms at any stage.
Stage B A structural heart disorder but no symptoms at any stage.
Stage B A structural heart disorder but no symptoms at any stage.
Stage C Previous or current symptoms of heart failure in the context of an underlying structural heart problem, but managed with medical treatment.
Stage C Previous or current symptoms of heart failure in the context of an underlying structural heart problem, but managed with medical treatment.
Stage C Previous or current symptoms of heart failure in the context of an underlying structural heart problem, but managed with medical treatment.
Stage D Advanced disease requiring hospital-based support, a heart transplant or palliative care.
Stage D Advanced disease requiring hospital-based support, a heart transplant or palliative care.
Stage D Advanced disease requiring hospital-based support, a heart transplant or palliative care.
Services
Services
Services
Investigations - What Tests to Do?
Management - I Have Heart Failure, What Do I Do?
Management - I Have Heart Failure, What Do I Do?
Management - I Have Heart Failure, What Do I Do?
Lifestyle Management
The first step is disciplined lifestyle changes: •Fluid restriction •Salt restriction •Daily weight check •Regular walks
Lifestyle Management
The first step is disciplined lifestyle changes: •Fluid restriction •Salt restriction •Daily weight check •Regular walks
Lifestyle Management
The first step is disciplined lifestyle changes: •Fluid restriction •Salt restriction •Daily weight check •Regular walks
Therapies
Therapies
Therapies
Medical Therapy
Cornerstone of heart failure treatment that improves quality of life and prolongs survival: ACE inhibitors Mainstay of therapy - reduce afterload burden and help forward flow. May cause dry cough. Diuretics (Lasix/Furosemide) Aid in reducing fluid burden by ensuring good urine output. Beta-blockers Reduce heart rate and prevent rhythm disturbances common in heart failure. Aldactone Potassium sparing diuretic - great adjunct and helps improve left ventricular function. Digitalis Improves cardiac contractility and slows heart rate, giving the heart rest and support. Nitrates Useful for ischemic heart disease patients - improve coronary blood flow.
Medical Therapy
Cornerstone of heart failure treatment that improves quality of life and prolongs survival: ACE inhibitors Mainstay of therapy - reduce afterload burden and help forward flow. May cause dry cough. Diuretics (Lasix/Furosemide) Aid in reducing fluid burden by ensuring good urine output. Beta-blockers Reduce heart rate and prevent rhythm disturbances common in heart failure. Aldactone Potassium sparing diuretic - great adjunct and helps improve left ventricular function. Digitalis Improves cardiac contractility and slows heart rate, giving the heart rest and support. Nitrates Useful for ischemic heart disease patients - improve coronary blood flow.
Medical Therapy
Cornerstone of heart failure treatment that improves quality of life and prolongs survival: ACE inhibitors Mainstay of therapy - reduce afterload burden and help forward flow. May cause dry cough. Diuretics (Lasix/Furosemide) Aid in reducing fluid burden by ensuring good urine output. Beta-blockers Reduce heart rate and prevent rhythm disturbances common in heart failure. Aldactone Potassium sparing diuretic - great adjunct and helps improve left ventricular function. Digitalis Improves cardiac contractility and slows heart rate, giving the heart rest and support. Nitrates Useful for ischemic heart disease patients - improve coronary blood flow.
Advanced Therapies
Minimally invasive and surgical therapies for advanced heart failure: AICD (Automatic Internal Cardiac Defibrillator) Protects from sudden death due to arrhythmias in severe left ventricular dysfunction patients. CRT (Cardiac Resynchronization Therapy) Helps patients with enlarged hearts and dysynchrony. Can improve ejection fraction by 5-10%. ECMO Used in acute decompensated heart failure and cardiac arrest (E-CPR). Last resort therapy. Ventricular Assist Devices (VAD) Mechanical devices that work as your failed ventricle - bridge to transplant or destination therapy. Heart Transplantation Final frontier for end-stage heart failure. Requires height, weight, and blood group match.
Advanced Therapies
Minimally invasive and surgical therapies for advanced heart failure: AICD (Automatic Internal Cardiac Defibrillator) Protects from sudden death due to arrhythmias in severe left ventricular dysfunction patients. CRT (Cardiac Resynchronization Therapy) Helps patients with enlarged hearts and dysynchrony. Can improve ejection fraction by 5-10%. ECMO Used in acute decompensated heart failure and cardiac arrest (E-CPR). Last resort therapy. Ventricular Assist Devices (VAD) Mechanical devices that work as your failed ventricle - bridge to transplant or destination therapy. Heart Transplantation Final frontier for end-stage heart failure. Requires height, weight, and blood group match.
Advanced Therapies
Minimally invasive and surgical therapies for advanced heart failure: AICD (Automatic Internal Cardiac Defibrillator) Protects from sudden death due to arrhythmias in severe left ventricular dysfunction patients. CRT (Cardiac Resynchronization Therapy) Helps patients with enlarged hearts and dysynchrony. Can improve ejection fraction by 5-10%. ECMO Used in acute decompensated heart failure and cardiac arrest (E-CPR). Last resort therapy. Ventricular Assist Devices (VAD) Mechanical devices that work as your failed ventricle - bridge to transplant or destination therapy. Heart Transplantation Final frontier for end-stage heart failure. Requires height, weight, and blood group match.
Advanced Life Support
Advanced Life Support
Advanced Life Support
Extracorporeal Membrane Oxygenation(ECMO)
Extracorporeal Membrane Oxygenation(ECMO)
Extracorporeal Membrane Oxygenation(ECMO)
ECMO or extracorporeal life support (ECLS) is an external technique of providing heart and lung support to persons whose organs are unable to provide adequate gas exchange to sustain life.
ECMO or extracorporeal life support (ECLS) is an external technique of providing heart and lung support to persons whose organs are unable to provide adequate gas exchange to sustain life.
ECMO or extracorporeal life support (ECLS) is an external technique of providing heart and lung support to persons whose organs are unable to provide adequate gas exchange to sustain life.
Understanding ECMO Technology
How ECMO Works
ECMO works by removing oxygen-deprived blood from the body and artificially removing carbon dioxide while adding oxygen to the blood. It performs the work of lungs with an external oxygenator or artificial lung.
Similar to a heart-lung machine but with minimal cellular destruction, ECMO can be used for days to weeks with minimal damage to cells and organs.
Understanding ECMO Technology
How ECMO Works
ECMO works by removing oxygen-deprived blood from the body and artificially removing carbon dioxide while adding oxygen to the blood. It performs the work of lungs with an external oxygenator or artificial lung.
Similar to a heart-lung machine but with minimal cellular destruction, ECMO can be used for days to weeks with minimal damage to cells and organs.
Understanding ECMO Technology
How ECMO Works
ECMO works by removing oxygen-deprived blood from the body and artificially removing carbon dioxide while adding oxygen to the blood. It performs the work of lungs with an external oxygenator or artificial lung.
Similar to a heart-lung machine but with minimal cellular destruction, ECMO can be used for days to weeks with minimal damage to cells and organs.
Key Benefits
NOW
• Low cellular destruction compared to traditional methods
• Can support patients for weeks
• Therapy of choice for young patients
• Bridge to recovery or transplantation
Applications
Extensively used in children and increasingly in adults with cardiac and respiratory failure.
Key Benefits
NOW
• Low cellular destruction compared to traditional methods
• Can support patients for weeks
• Therapy of choice for young patients
• Bridge to recovery or transplantation
Applications
Extensively used in children and increasingly in adults with cardiac and respiratory failure.
Key Benefits
NOW
• Low cellular destruction compared to traditional methods
• Can support patients for weeks
• Therapy of choice for young patients
• Bridge to recovery or transplantation
Applications
Extensively used in children and increasingly in adults with cardiac and respiratory failure.
Types of ECMO
Types of ECMO
Types of VADs
Veno-Arterial (VA) ECMO
Used mainly in cardiorespiratory failure where the heart is significantly affected. Blood is drained from the femoral vein and returned via the artery, acting as a temporary artificial heart and lung system. Duration: 2–4 weeks safely.
Veno-Arterial (VA) ECMO
Used mainly in cardiorespiratory failure where the heart is significantly affected. Blood is drained from the femoral vein and returned via the artery, acting as a temporary artificial heart and lung system. Duration: 2–4 weeks safely.
Veno-Arterial (VA) ECMO
Used mainly in cardiorespiratory failure where the heart is significantly affected. Blood is drained from the femoral vein and returned via the artery, acting as a temporary artificial heart and lung system. Duration: 2–4 weeks safely.
Veno-Venous (VV) ECMO
Used mainly in severe respiratory failure when the heart is functioning normally. Blood is drained from the femoral vein and returned through the internal jugular vein to support oxygenation. Duration: 2–4 weeks safely.
Veno-Venous (VV) ECMO
Used mainly in severe respiratory failure when the heart is functioning normally. Blood is drained from the femoral vein and returned through the internal jugular vein to support oxygenation. Duration: 2–4 weeks safely.
Veno-Venous (VV) ECMO
Used mainly in severe respiratory failure when the heart is functioning normally. Blood is drained from the femoral vein and returned through the internal jugular vein to support oxygenation. Duration: 2–4 weeks safely.
Indications for ECMO
Hypoxemic respiratory failure - Lung failure due to inability to transfer oxygen Hypercapnic respiratory failure with arterial pH <7.20 Refractory cardiogenic shock not responding to standard therapy Failure to wean from heart-lung machine after cardiac surgery Bridge to heart transplantation or assist device placement
Indications for ECMO
Hypoxemic respiratory failure - Lung failure due to inability to transfer oxygen Hypercapnic respiratory failure with arterial pH <7.20 Refractory cardiogenic shock not responding to standard therapy Failure to wean from heart-lung machine after cardiac surgery Bridge to heart transplantation or assist device placement
Indications for ECMO
Hypoxemic respiratory failure - Lung failure due to inability to transfer oxygen Hypercapnic respiratory failure with arterial pH <7.20 Refractory cardiogenic shock not responding to standard therapy Failure to wean from heart-lung machine after cardiac surgery Bridge to heart transplantation or assist device placement
Relative Contraindications
Conditions incompatible with normal life if patient recovers Pre-existing conditions affecting quality of life Age and size considerations Futility - patients too sick or with fatal diagnosis Note: There are no absolute contraindications for ECMO
Relative Contraindications
Conditions incompatible with normal life if patient recovers Pre-existing conditions affecting quality of life Age and size considerations Futility - patients too sick or with fatal diagnosis Note: There are no absolute contraindications for ECMO
Relative Contraindications
Conditions incompatible with normal life if patient recovers Pre-existing conditions affecting quality of life Age and size considerations Futility - patients too sick or with fatal diagnosis Note: There are no absolute contraindications for ECMO
Important Information for Patients & Families
Important Information for Patients & Families
Important Information for Patients & Families
ECMO Process Overview
ECMO Process Overview
ECMO Process Overview
Initiation
The patient is anticoagulated with Heparin to prevent clotting, and cannulae are inserted into large blood vessels by experienced clinicians under ultrasound or surgical guidance.
Initiation
The patient is anticoagulated with Heparin to prevent clotting, and cannulae are inserted into large blood vessels by experienced clinicians under ultrasound or surgical guidance.
Initiation
The patient is anticoagulated with Heparin to prevent clotting, and cannulae are inserted into large blood vessels by experienced clinicians under ultrasound or surgical guidance.
Monitoring
Vital signs, organ function, and fluid balance are continuously monitored during ECMO support. Adjustments are made as needed to maintain oxygenation, circulation, and hemodynamic stability.
Monitoring
Vital signs, organ function, and fluid balance are continuously monitored during ECMO support. Adjustments are made as needed to maintain oxygenation, circulation, and hemodynamic stability.
Monitoring
Vital signs, organ function, and fluid balance are continuously monitored during ECMO support. Adjustments are made as needed to maintain oxygenation, circulation, and hemodynamic stability.
Weaning
ECMO is gradually reduced based on the patient’s recovery. Lung function and cardiac output are closely evaluated through trials off support before complete discontinuation is considered.
Weaning
ECMO is gradually reduced based on the patient’s recovery. Lung function and cardiac output are closely evaluated through trials off support before complete discontinuation is considered.
Weaning
ECMO is gradually reduced based on the patient’s recovery. Lung function and cardiac output are closely evaluated through trials off support before complete discontinuation is considered.
Advanced Cardiac Support
Advanced Cardiac Support
Advanced Cardiac Support
Ventricular Assist Devices (VADs)
Ventricular Assist Devices (VADs)
Ventricular Assist Devices (VADs)
Electromechanical circulatory devices that partially or completely replace the function of a failing heart, providing life-saving support for patients with advanced heart failure.
Electromechanical circulatory devices that partially or completely replace the function of a failing heart, providing life-saving support for patients with advanced heart failure.
Electromechanical circulatory devices that partially or completely replace the function of a failing heart, providing life-saving support for patients with advanced heart failure.
Understanding VADs
What is a VAD?
A ventricular assist device (VAD) is an electromechanical circulatory device that is used to partially or completely replace the function of a failing heart. VADs differ from artificial cardiac pacemakers and are distinct from artificial hearts.
Key Distinctions
• VADs assist the heart rather than replace it completely
• Can support left (LVAD), right (RVAD), or both ventricles (BiVAD)
• Available for short-term or long-term use
• Bridge to transplantation or destination therapy
Understanding VADs
What is a VAD?
A ventricular assist device (VAD) is an electromechanical circulatory device that is used to partially or completely replace the function of a failing heart. VADs differ from artificial cardiac pacemakers and are distinct from artificial hearts.
Key Distinctions
• VADs assist the heart rather than replace it completely
• Can support left (LVAD), right (RVAD), or both ventricles (BiVAD)
• Available for short-term or long-term use
• Bridge to transplantation or destination therapy
Understanding VADs
What is a VAD?
A ventricular assist device (VAD) is an electromechanical circulatory device that is used to partially or completely replace the function of a failing heart. VADs differ from artificial cardiac pacemakers and are distinct from artificial hearts.
Key Distinctions
• VADs assist the heart rather than replace it completely
• Can support left (LVAD), right (RVAD), or both ventricles (BiVAD)
• Available for short-term or long-term use
• Bridge to transplantation or destination therapy
Clinical Applications
NOW
• Bridge to transplantation
• Destination therapy (permanent support)
• Bridge to recovery
• Bridge to candidacy
Recent Improvements
VADs have improved significantly in recent years, providing better survival rates and quality of life among recipients with advanced heart failure.
Clinical Applications
NOW
• Bridge to transplantation
• Destination therapy (permanent support)
• Bridge to recovery
• Bridge to candidacy
Recent Improvements
VADs have improved significantly in recent years, providing better survival rates and quality of life among recipients with advanced heart failure.
Clinical Applications
NOW
• Bridge to transplantation
• Destination therapy (permanent support)
• Bridge to recovery
• Bridge to candidacy
Recent Improvements
VADs have improved significantly in recent years, providing better survival rates and quality of life among recipients with advanced heart failure.
Types of VADs
Types of VADs
Types of VADs
LVAD (Left Ventricular Assist Device)
Most commonly used device that assists the left ventricle in pumping blood to the body — supports systemic circulation, commonly used long-term, and is the most preferred ventricular assist device.
LVAD (Left Ventricular Assist Device)
Most commonly used device that assists the left ventricle in pumping blood to the body — supports systemic circulation, commonly used long-term, and is the most preferred ventricular assist device.
LVAD (Left Ventricular Assist Device)
Most commonly used device that assists the left ventricle in pumping blood to the body — supports systemic circulation, commonly used long-term, and is the most preferred ventricular assist device.
RVAD (Right Ventricular Assist Device)
Assists the right ventricle when pulmonary artery resistance is high — often used temporarily, inserted via a percutaneous approach, and primarily supports the pulmonary circulation in acute settings.
RVAD (Right Ventricular Assist Device)
Assists the right ventricle when pulmonary artery resistance is high — often used temporarily, inserted via a percutaneous approach, and primarily supports the pulmonary circulation in acute settings.
RVAD (Right Ventricular Assist Device)
Assists the right ventricle when pulmonary artery resistance is high — often used temporarily, inserted via a percutaneous approach, and primarily supports the pulmonary circulation in acute settings.
BiVAD (Biventricular Assist Device)
Supports both ventricles in patients with biventricular failure — used for advanced heart failure, often as a bridge to transplant, and offers circulatory support to both sides of the heart.
BiVAD (Biventricular Assist Device)
Supports both ventricles in patients with biventricular failure — used for advanced heart failure, often as a bridge to transplant, and offers circulatory support to both sides of the heart.
BiVAD (Biventricular Assist Device)
Supports both ventricles in patients with biventricular failure — used for advanced heart failure, often as a bridge to transplant, and offers circulatory support to both sides of the heart.
VAD Design & Technology
VAD Design & Technology
VAD Design & Technology
1st Generation – Pulsatile Pumps
Mimic the natural pulsing action of the heart using positive displacement pumps — first generation VADs, larger in size, may require vent tube, and maintain pulsatile flow throughout the support period.
1st Generation – Pulsatile Pumps
Mimic the natural pulsing action of the heart using positive displacement pumps — first generation VADs, larger in size, may require vent tube, and maintain pulsatile flow throughout the support period.
1st Generation – Pulsatile Pumps
Mimic the natural pulsing action of the heart using positive displacement pumps — first generation VADs, larger in size, may require vent tube, and maintain pulsatile flow throughout the support period.
2nd Generation – Continuous Flow Pumps
Smaller and more durable pumps that provide continuous blood flow — centrifugal or axial flow, smaller size, greater reliability, and typically produce no pulse or significantly reduced pulsation.
2nd Generation – Continuous Flow Pumps
Smaller and more durable pumps that provide continuous blood flow — centrifugal or axial flow, smaller size, greater reliability, and typically produce no pulse or significantly reduced pulsation.
2nd Generation – Continuous Flow Pumps
Smaller and more durable pumps that provide continuous blood flow — centrifugal or axial flow, smaller size, greater reliability, and typically produce no pulse or significantly reduced pulsation.
3rd Generation – Magnetic Levitation
Advanced pumps using electromagnetic or hydrodynamic suspension — only one moving part, no mechanical bearings, reduced wear and tear, and designed to provide enhanced long-term durability.
3rd Generation – Magnetic Levitation
Advanced pumps using electromagnetic or hydrodynamic suspension — only one moving part, no mechanical bearings, reduced wear and tear, and designed to provide enhanced long-term durability.
3rd Generation – Magnetic Levitation
Advanced pumps using electromagnetic or hydrodynamic suspension — only one moving part, no mechanical bearings, reduced wear and tear, and designed to provide enhanced long-term durability.
Technical Innovations
NOW
Rotor Suspension Methods
• Solid bearings: Early versions with mechanical contact
• Electromagnetic suspension: "Maglev" technology
• Hydrodynamic suspension: Fluid-based levitation
Power Innovations
• Transcutaneous induction: Wireless power transmission
• Reduced infection risk: No percutaneous cables
• Improved cosmetics: Better patient experience
Technical Innovations
NOW
Rotor Suspension Methods
• Solid bearings: Early versions with mechanical contact
• Electromagnetic suspension: "Maglev" technology
• Hydrodynamic suspension: Fluid-based levitation
Power Innovations
• Transcutaneous induction: Wireless power transmission
• Reduced infection risk: No percutaneous cables
• Improved cosmetics: Better patient experience
Technical Innovations
NOW
Rotor Suspension Methods
• Solid bearings: Early versions with mechanical contact
• Electromagnetic suspension: "Maglev" technology
• Hydrodynamic suspension: Fluid-based levitation
Power Innovations
• Transcutaneous induction: Wireless power transmission
• Reduced infection risk: No percutaneous cables
• Improved cosmetics: Better patient experience
Historical Development
Historical Development
1966
1966
First Successful LVAD Implantation
First Successful LVAD Implantation
Dr. Michael E. DeBakey performed the first successful implantation in a 37-year-old woman, providing 10 days of mechanical support.
Significance: Proof of concept
Dr. Michael E. DeBakey performed the first successful implantation in a 37-year-old woman, providing 10 days of mechanical support.
Significance: Proof of concept
Dr. Michael E. DeBakey performed the first successful implantation in a 37-year-old woman, providing 10 days of mechanical support.
Significance: Proof of concept
1988
1988
1988
First Long-term LVAD
First Long-term LVAD
First Long-term LVAD
Dr. William F. Bernhard conducted the first successful long-term implantation with HeartMate device under NIH contract.
Significance: Long-term viability demonstrated
Dr. William F. Bernhard conducted the first successful long-term implantation with HeartMate device under NIH contract.
Significance: Long-term viability demonstrated
Dr. William F. Bernhard conducted the first successful long-term implantation with HeartMate device under NIH contract.
Significance: Long-term viability demonstrated
1994
1994
FDA Approval
FDA Approval
HeartMate IP LVAS received FDA approval, marking the first commercially available VAD in the US.
Significance: Commercial availability
HeartMate IP LVAS received FDA approval, marking the first commercially available VAD in the US.
Significance: Commercial availability
HeartMate IP LVAS received FDA approval, marking the first commercially available VAD in the US.
Significance: Commercial availability
2000s
2000s
2000s
Continuous Flow Era
Continuous Flow Era
Continuous Flow Era
Development of second-generation continuous flow pumps with improved reliability and smaller size.
Significance: Technology advancement
Development of second-generation continuous flow pumps with improved reliability and smaller size.
Significance: Technology advancement
Development of second-generation continuous flow pumps with improved reliability and smaller size.
Significance: Technology advancement
Notable Patient Story
NOW
Peter Houghton was the longest surviving recipient of a VAD for permanent use. He received an experimental Jarvik 2000 LVAD in June 2000 and lived for 7 years until 2007. During this time, he completed a 91-mile charity walk, published two books, lectured widely, hiked in the Swiss Alps and American West, flew in an ultra-light aircraft, and traveled extensively around the world.
Notable Patient Story
NOW
Peter Houghton was the longest surviving recipient of a VAD for permanent use. He received an experimental Jarvik 2000 LVAD in June 2000 and lived for 7 years until 2007. During this time, he completed a 91-mile charity walk, published two books, lectured widely, hiked in the Swiss Alps and American West, flew in an ultra-light aircraft, and traveled extensively around the world.
Notable Patient Story
NOW
Peter Houghton was the longest surviving recipient of a VAD for permanent use. He received an experimental Jarvik 2000 LVAD in June 2000 and lived for 7 years until 2007. During this time, he completed a 91-mile charity walk, published two books, lectured widely, hiked in the Swiss Alps and American West, flew in an ultra-light aircraft, and traveled extensively around the world.
Clinical Studies & Outcomes
Clinical Studies & Outcomes
Clinical Studies & Outcomes
HeartMate II Pivotal Study
Multicenter study (2005–2007) with 113 patients demonstrated significant improvements in survival, NYHA functional class, exercise tolerance, and quality of life — with 68% survival at 12 months, establishing strong clinical evidence for durable LVAD therapy.
HeartMate II Pivotal Study
Multicenter study (2005–2007) with 113 patients demonstrated significant improvements in survival, NYHA functional class, exercise tolerance, and quality of life — with 68% survival at 12 months, establishing strong clinical evidence for durable LVAD therapy.
HeartMate II Pivotal Study
Multicenter study (2005–2007) with 113 patients demonstrated significant improvements in survival, NYHA functional class, exercise tolerance, and quality of life — with 68% survival at 12 months, establishing strong clinical evidence for durable LVAD therapy.
REMATCH Trial
Randomized trial comparing LVAD therapy vs optimal medical management for end-stage heart failure — 81% improvement in 2-year survival, 23% vs 8% survival at 2 years, pivotal in securing FDA approval and reshaping advanced heart failure treatment.
REMATCH Trial
Randomized trial comparing LVAD therapy vs optimal medical management for end-stage heart failure — 81% improvement in 2-year survival, 23% vs 8% survival at 2 years, pivotal in securing FDA approval and reshaping advanced heart failure treatment.
REMATCH Trial
Randomized trial comparing LVAD therapy vs optimal medical management for end-stage heart failure — 81% improvement in 2-year survival, 23% vs 8% survival at 2 years, pivotal in securing FDA approval and reshaping advanced heart failure treatment.
HARPS Study
Harefield Recovery Protocol Study evaluating myocardial recovery with VAD support — 73% achieved device explantation, 100% freedom from recurrent HF at 1 year, 64% average ejection fraction at 59 months post-therapy, confirming reversibility in select patients.
HARPS Study
Harefield Recovery Protocol Study evaluating myocardial recovery with VAD support — 73% achieved device explantation, 100% freedom from recurrent HF at 1 year, 64% average ejection fraction at 59 months post-therapy, confirming reversibility in select patients.
HARPS Study
Harefield Recovery Protocol Study evaluating myocardial recovery with VAD support — 73% achieved device explantation, 100% freedom from recurrent HF at 1 year, 64% average ejection fraction at 59 months post-therapy, confirming reversibility in select patients.
Recent Developments (2009-2015)
NOW
•HeartMate III first human implant in 2014 at Hannover Medical School
•Evidence of heart regeneration with long-term LVAD use (2015 study)
•Wireless VAD power systems reducing infection risk
•Development of total artificial hearts using dual VADs
•Miniaturization of devices for women and children
Recent Developments (2009-2015)
NOW
•HeartMate III first human implant in 2014 at Hannover Medical School
•Evidence of heart regeneration with long-term LVAD use (2015 study)
•Wireless VAD power systems reducing infection risk
•Development of total artificial hearts using dual VADs
•Miniaturization of devices for women and children
Recent Developments (2009-2015)
NOW
•HeartMate III first human implant in 2014 at Hannover Medical School
•Evidence of heart regeneration with long-term LVAD use (2015 study)
•Wireless VAD power systems reducing infection risk
•Development of total artificial hearts using dual VADs
•Miniaturization of devices for women and children
Complications & Management
Complications & Management
Complications & Management
Bleeding – High Risk
Most common postoperative complication, requiring reoperation in up to 60% of recipients. Management: adequate blood evacuation, prevent chest tube clogging, manage coagulopathy with timely correction and transfusion support to stabilize the patient effectively.
Bleeding – High Risk
Most common postoperative complication, requiring reoperation in up to 60% of recipients. Management: adequate blood evacuation, prevent chest tube clogging, manage coagulopathy with timely correction and transfusion support to stabilize the patient effectively.
Bleeding – High Risk
Most common postoperative complication, requiring reoperation in up to 60% of recipients. Management: adequate blood evacuation, prevent chest tube clogging, manage coagulopathy with timely correction and transfusion support to stabilize the patient effectively.
Infection – High Risk
VAD-related infections are caused by various organisms and often difficult to eradicate. Management: initiate broad-spectrum antibiotics, obtain culture samples promptly, follow appropriate prophylactic protocols, and monitor for driveline or pocket-site complications.
Infection – High Risk
VAD-related infections are caused by various organisms and often difficult to eradicate. Management: initiate broad-spectrum antibiotics, obtain culture samples promptly, follow appropriate prophylactic protocols, and monitor for driveline or pocket-site complications.
Infection – High Risk
VAD-related infections are caused by various organisms and often difficult to eradicate. Management: initiate broad-spectrum antibiotics, obtain culture samples promptly, follow appropriate prophylactic protocols, and monitor for driveline or pocket-site complications.
Anticoagulation Issues – Medium Risk
Anticoagulation is essential due to non-biologic surfaces but poses bleeding and clotting risks. Management: carefully monitor INR levels, adjust dosing, balance thrombotic and hemorrhagic risks, and apply device-specific anticoagulation protocols for optimal outcomes.
Anticoagulation Issues – Medium Risk
Anticoagulation is essential due to non-biologic surfaces but poses bleeding and clotting risks. Management: carefully monitor INR levels, adjust dosing, balance thrombotic and hemorrhagic risks, and apply device-specific anticoagulation protocols for optimal outcomes.
Anticoagulation Issues – Medium Risk
Anticoagulation is essential due to non-biologic surfaces but poses bleeding and clotting risks. Management: carefully monitor INR levels, adjust dosing, balance thrombotic and hemorrhagic risks, and apply device-specific anticoagulation protocols for optimal outcomes.
Common Infectious Organisms
Staphylococcus aureus
Enterococci
Pseudomonas aeruginosa
Enterobacter species
Klebsiella species
Candida species
Note: VAD-related infections are exceedingly difficult to treat and many patients may die despite optimal treatment. Early culture and appropriate antibiotic therapy are crucial.
Common Infectious Organisms
Staphylococcus aureus
Enterococci
Pseudomonas aeruginosa
Enterobacter species
Klebsiella species
Candida species
Note: VAD-related infections are exceedingly difficult to treat and many patients may die despite optimal treatment. Early culture and appropriate antibiotic therapy are crucial.
Common Infectious Organisms
Staphylococcus aureus
Enterococci
Pseudomonas aeruginosa
Enterobacter species
Klebsiella species
Candida species
Note: VAD-related infections are exceedingly difficult to treat and many patients may die despite optimal treatment. Early culture and appropriate antibiotic therapy are crucial.
Risk Mitigation
NOW
Patient Education
Comprehensive patient education about risks and lifestyle modifications is essential before VAD implantation.
Monitoring
Regular monitoring for signs of infection, bleeding, and device malfunction is critical for successful outcomes.
Support Resources
Internet-based patient resources and physician consultation help patients make informed decisions about VAD therapy.
Risk Mitigation
NOW
Patient Education
Comprehensive patient education about risks and lifestyle modifications is essential before VAD implantation.
Monitoring
Regular monitoring for signs of infection, bleeding, and device malfunction is critical for successful outcomes.
Support Resources
Internet-based patient resources and physician consultation help patients make informed decisions about VAD therapy.
Risk Mitigation
NOW
Patient Education
Comprehensive patient education about risks and lifestyle modifications is essential before VAD implantation.
Monitoring
Regular monitoring for signs of infection, bleeding, and device malfunction is critical for successful outcomes.
Support Resources
Internet-based patient resources and physician consultation help patients make informed decisions about VAD therapy.
Current VAD Devices
Current VAD Devices
Current VAD Devices
HeartMate III – Thoratec
Continuous-flow VAD with magnetically suspended rotor. Status: Clinical trials started in 2014. Key Features: magnetic levitation, enhanced durability, advanced design, low shear stress, and latest-generation VAD technology. Status: Approved.
HeartMate III – Thoratec
Continuous-flow VAD with magnetically suspended rotor. Status: Clinical trials started in 2014. Key Features: magnetic levitation, enhanced durability, advanced design, low shear stress, and latest-generation VAD technology. Status: Approved.
HeartMate III – Thoratec
Continuous-flow VAD with magnetically suspended rotor. Status: Clinical trials started in 2014. Key Features: magnetic levitation, enhanced durability, advanced design, low shear stress, and latest-generation VAD technology. Status: Approved.
HeartMate II – Thoratec
Continuous axial-flow device with proven clinical utility. Status: FDA approved for both Bridge to Transplant (BTT) and Destination Therapy (DT). Key Features: ball-and-cup bearings, long-term use, wide adoption, high survival rates. Status: Approved.
HeartMate II – Thoratec
Continuous axial-flow device with proven clinical utility. Status: FDA approved for both Bridge to Transplant (BTT) and Destination Therapy (DT). Key Features: ball-and-cup bearings, long-term use, wide adoption, high survival rates. Status: Approved.
HeartMate II – Thoratec
Continuous axial-flow device with proven clinical utility. Status: FDA approved for both Bridge to Transplant (BTT) and Destination Therapy (DT). Key Features: ball-and-cup bearings, long-term use, wide adoption, high survival rates. Status: Approved.
HVAD – HeartWare
Miniature centrifugal-flow device designed for intrapericardial placement. Status: FDA approved. Key Features: smaller pump size, hydromagnetic suspension, ease of implantation, and limited post-market availability. Status: Limited Approval.
HVAD – HeartWare
Miniature centrifugal-flow device designed for intrapericardial placement. Status: FDA approved. Key Features: smaller pump size, hydromagnetic suspension, ease of implantation, and limited post-market availability. Status: Limited Approval.
HVAD – HeartWare
Miniature centrifugal-flow device designed for intrapericardial placement. Status: FDA approved. Key Features: smaller pump size, hydromagnetic suspension, ease of implantation, and limited post-market availability. Status: Limited Approval.
Jarvik 2000 – Jarvik Heart
Continuous axial-flow VAD with compact design. Status: CE marked in Europe, undergoing clinical trials in the U.S. Key Features: ceramic bearings, bridge to transplant use, portable controller, and lifetime use approval granted in European Union.
Jarvik 2000 – Jarvik Heart
Continuous axial-flow VAD with compact design. Status: CE marked in Europe, undergoing clinical trials in the U.S. Key Features: ceramic bearings, bridge to transplant use, portable controller, and lifetime use approval granted in European Union.
Jarvik 2000 – Jarvik Heart
Continuous axial-flow VAD with compact design. Status: CE marked in Europe, undergoing clinical trials in the U.S. Key Features: ceramic bearings, bridge to transplant use, portable controller, and lifetime use approval granted in European Union.
Important Considerations
Device Selection Factors
• Patient size and body surface area
• Underlying heart disease etiology
• Pulmonary arterial resistance
• Intended duration of support
• Bridge to transplant vs destination therapy
Recent Advances
• Smaller devices suitable for women and children
• Magnetic levitation technology
• Wireless power transmission systems
• Improved biocompatibility
• Enhanced durability and reliability
Important Considerations
Device Selection Factors
• Patient size and body surface area
• Underlying heart disease etiology
• Pulmonary arterial resistance
• Intended duration of support
• Bridge to transplant vs destination therapy
Recent Advances
• Smaller devices suitable for women and children
• Magnetic levitation technology
• Wireless power transmission systems
• Improved biocompatibility
• Enhanced durability and reliability
Important Considerations
Device Selection Factors
• Patient size and body surface area
• Underlying heart disease etiology
• Pulmonary arterial resistance
• Intended duration of support
• Bridge to transplant vs destination therapy
Recent Advances
• Smaller devices suitable for women and children
• Magnetic levitation technology
• Wireless power transmission systems
• Improved biocompatibility
• Enhanced durability and reliability