Artificial heart

An artificial heart (artificial hearts, ventricular assist device or heart implant) is inserted into the body of patients with incurable heart disease (heart failure ), because the patient's heart is no longer able to maintain the systemic circulation sufficient.

Types

We distinguish between different types of artificial hearts.

• Left ventricular assist device ( LVAD ): This type of artificial heart is inserted into the left ventricle pumps the blood and from there into the aorta. This type of support represents the most common type of artificial hearts

• Right ventricular assist device ( RVAD ): An RVAD implanted into the right ventricle and pumps blood into the pulmonary artery.

• Total artificial heart ( TAH ): The total artificial heart replaces the human heart completely. During the operation of the patient's heart is fully explanted and replaced by a mechanical pump.

Operation

Artificial hearts are used by cardiac surgeons. The operation is performed under general anesthesia and lasts about four hours. In most cases, the operation is performed on the heart-lung machine.

The default access path is via a complete transection of the sternum. Then, the artificial heart is installed in the respective ventricle and connected to the target vessels.

The Hannover Medical School has developed a new minimally invasive technique. In this, only a small part of the sternum is cut and another section is set below the left breast. In this way, the perioperative risk could be reduced.

Treatment goals

There are several treatment goals for Artificial Heart patients:

Bridge to transplant: The artificial heart is used and stabilizes the current health of the patient or improved. Once a suitable donor organ is available, the artificial heart is again explanted and transplanted a human heart.

Bridge to recovery: In a few cases, it may, after artificial heart implantation lead to a relaxation of the heart muscle, so that the artificial heart can be explanted.

Destination therapy: This strategy is applied in patients whose health condition is a heart transplant. Furthermore, many artificial heart patients opt for this strategy, because it perfectly to get right with the system and do not want to take on the risks of a heart transplant. A variation of this strategy represents the "Bridge to Bridge " method If there after a few years of therapy for artificial heart change, in this strategy, a new artificial heart system can be installed, which, compared to the old system has technical improvements.

Life with Artificial Heart

The artificial heart therapy improves the performance of the patients. In addition to the resulting increased quality of life, however, are also drawbacks of this therapy.

• Limited Battery Run Time

• Risk of infection

• Need for anticoagulation

Historical Aspects

The first artificial heart implantation was made on April 4, 1969 at the Texas Heart Institute in Houston, USA by Denton A. Cooley. The 47- year-old patient Haskell Karp was developed by Domingo Liotta artificial heart, which was after 65 hours replaced by a natural heart. Shortly after heart transplantation died Karp.

First permanent implant of the Jarvik -7 heart of Robert Jarvik, the December 2, 1982 in the University Hospital of Utah ( University of Utah ) in Salt Lake City, a retired dentist Barney Clark applies (January 21, 1921 - March 23, 1983 ) in a seven -hour operation was used. The operation resulted in William DeVries, a son of Dutch immigrants from. Clark survived 112 days and suffered multiple thromboses, before he died. On November 25, 1984 the American William J. Schroeder an artificial heart was implanted Jarvik -7 type with which he survived 620 days and died on 6 August 1986 of a stroke.

In Berlin, the German scientists and cardiac surgeon Emil Bücherl researched since the 1960s in the production of artificial hearts. In several animals, the survival time was increased. Thus survived 1981, a calf after a Kunstherzeinpflanzung 268 days and a goat in 1984 about 345 days. In 1979, the Berliner known as artificial heart was implanted in Germany has become a human organ and served short term to support the blood circulation.

Nowadays artificial heart patients can be supplied by means of cardiac support system for more than five years. The current European record were implanted at the Hannover Medical School.

On December 18, 2013 implanted in Paris Georges Pompidou Hospital, a surgical team at Christian Latrémouille an artificial heart with biosynthetic skin. This has the advantage that the risk of rejection is minimized. The artificial heart is a bioprosthesis and thus can replace the biological heart. It is about two fists tall; a smaller version is in development. According to developers, Alain Carpentier is thus a transplant of a biological heart be bridged five years, thanks to built-in battery and sensors. The patient died after 75 days.

The investments for the development amounted to approximately 100 million euros. The support from the Matra Group under its then Director General Jean -Luc Lagardère laid the foundation for funding. Additional funds were contributed by government research funds and investment funds. In particular, the fund has invested 33 million euros Oseo. The price of this artificial heart should be around € 160,000 per copy.

Swell

• Schmitto J. D. et al. " Implantation of a centrifugal pump as a left ventricular assist device through a novel, minimized approach: upper hemisternotomy combined with anterolateral thoracotomy " J Thorac Cardiovasc Surg. February 2012, 143 (2) :511-3