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8/13/2019 Current Advacnces in Heart Transplant
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CURRENTADVANCESINHEART
TRANSPLANT
by Mirajini Manoharan
8/13/2019 Current Advacnces in Heart Transplant
2/21
CONTENT
Introduction
Mechanically Assisted Devices
What is it?
How does it work?
Who is it used for?
Limitations
Stem Cells
Extra cellular Matrix
Decellularization
Recellularization
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INTRODUCTION
Heart transplants:
An allograft is the only definitive treatment for end-
stage heart failure
But: Shortage of organs
Currently, fewer than 3000 donor hearts per year are
available worldwide
vs.
An estimated 12 million new annual diagnoses of heart
failure
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MECHANICALLYASSISTEDDEVICES
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WHATISIT?
o Not an Artificial Heart
o Assist the ventricles in pumping blood to
successfully restore the patients blood flow
o
Reduce the work load of the ventricleso Relieve symptoms of heart failure
o 2 types:
o Left ventricular assisted device (LVAD)
o Right ventricular assisted device (RVAD)
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HOWDOESITWORK?
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WHATISITUSEDFOR?
1. Bridge to transplant
2. Bridge to recovery
3. Destination therapy
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LIMITATIONS
Infection
Thrombus formation
Mechanical breakdown
Right sided heart failure
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STEMCELLS
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STEMCELLS
Cell therapy
Whole organ engineering
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WHOLEORGANENGINEERING
Extracellular Matrix
Decellularization
Recellularization
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EXTRACELLULARMATRIX(ECM)
Consist of protein that are secreted by the cells
These ECM proteins are site specific
Guides organ development, repair and physiologic
regeneration
In cell engineering these proteins provide footprint
of the previous resident cells .
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DECELLULARIZATION
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RECELLULARIZATION
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SUMMARY
Introduction
Mechanically Assisted Devices
What is it?
How does it work?
Who is it used for?
Limitations
Stem Cells
Extra cellular Matrix
Decellularisation
Recellularisation
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QUESTIONS?
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REFERENCES
Kirklin J.K., Naftel D.C., Kormos R.L., Stevenson L.W., Pagani
F.D., Miller M.A. et al. The Fourth INTERMACS Annual Report:
4000 implants and counting. The journal of Heart and Lung
Transplantation2012 Feb; 31: 117-126
Rose E.A., Geljins A.c., Moskowitz A.J., Heitjan D.F., Stevenson
L.W., Dembitsky W. et al. Long- Term use of Left Ventricular Assist
Device for end- stage heart failure. N Engl J Med 2001; 345: 1435-
1443
Maddox T.M., Heart Disease and Left Ventricular Assist Device
(LVAD) [internet]. 2012[updated 2012 Feb 22; cited 2012 Mar 20]
available from: http://www.nhlbi.nih.gov/health/health-
topics/topics/vad/
What is a Ventricular Assist Device [internet] 2012 [ updated 2009
Sep; cited 2012 March 20] available from:
http://www.webmd.com/heart-disease/treating-left-ventricular-
device
http://www.nhlbi.nih.gov/health/health-topics/topics/vad/http://www.nhlbi.nih.gov/health/health-topics/topics/vad/http://www.webmd.com/heart-disease/treating-left-ventricular-devicehttp://www.webmd.com/heart-disease/treating-left-ventricular-devicehttp://www.webmd.com/heart-disease/treating-left-ventricular-devicehttp://www.webmd.com/heart-disease/treating-left-ventricular-devicehttp://www.webmd.com/heart-disease/treating-left-ventricular-devicehttp://www.webmd.com/heart-disease/treating-left-ventricular-devicehttp://www.webmd.com/heart-disease/treating-left-ventricular-devicehttp://www.webmd.com/heart-disease/treating-left-ventricular-devicehttp://www.webmd.com/heart-disease/treating-left-ventricular-devicehttp://www.webmd.com/heart-disease/treating-left-ventricular-devicehttp://www.webmd.com/heart-disease/treating-left-ventricular-devicehttp://www.nhlbi.nih.gov/health/health-topics/topics/vad/http://www.nhlbi.nih.gov/health/health-topics/topics/vad/http://www.nhlbi.nih.gov/health/health-topics/topics/vad/8/13/2019 Current Advacnces in Heart Transplant
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REFERENCES(2)
New York Presbyterian. Artificial Heart- Ventricular Assist Devices(VADs) [internet] 2012 [cited 2012 Mar 20] available from:http://nyp.org/services/ctsurg/vads.html
Crapo M. P., Gilbert W. T., Badylak F. S.. An overview of tissue andwhole organ decellularization processes. Biomaterials - 2011; 32:
3233- 3243 Stubbs L.S, Crook J.M., Wayne A.M., FRACSa.b, Newcomb A.E.,
FRACSb.c. Toward Clinical Application of Stem Cells for CardiacRegeneration. Heart, Lung and Circulation2011; 20:173-179
Ott H.C., Matthiesen T.S., Goh S., Black L.D., Kren S.M., Netoff
T.I., Taylor D.A..Perfusion-decellularized matrix: using naturesplatform to engineer a bioartificial heart.Nature Medicine2008Feb; 14: 213- 221
Iyer R.K., Chiu L. LY., Reis L.A., Radisic M.. Engineered cardiactissues. Current Opinion in Biotechnology2011; 22: 706- 714
http://nyp.org/services/ctsurg/vads.htmlhttp://nyp.org/services/ctsurg/vads.html8/13/2019 Current Advacnces in Heart Transplant
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Makkar R.M., Smith R.R., Cheng K., Malliaras K., Thomson L.E.J.,
Berman D., Czer L.S.C., Marbn L., Mendizabal A., Johnston P.V.,
Russell S.D., Schuleri K.H., Lardo A.L., Gerstenblith G., Marbn E..
Intracoronary cardiosphere-derived cells for heart regeneration after
myocardial infarction (CADUCEUS): a prospective, randomised
phase 1 trial. Lancet2012; 379- 895- 904
Taylor D.A.. From stem cells and cadaveric matrix to engineered
organs. Current Opinion in Biotechnology2009; 20: 598- 605
Song J.J., Ott H.C.. Organ engineering based on decellularized
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424- 432
Ilic D., Polak J., Stem cell based therapywhere are we going.
Lancet2012 Mar; 379; 877- 878