The Mechanical Heart - The future of surgery for Adult CHD ?

Ivan M. Rebeyka University of Alberta

& Stollery Children’s

Hospitals

ACHD Patient Day May 23, 2015

Phoenix, Arizona – July 2011

Number of Heart Transplants Reported by Year

189 318669

1185

21652720

3156 3380

4024 4186 4219 4382 4438 4356 4206 40873769

3436 3314 3219 3107

0

500

1000

1500

2000

2500

3000

3500

4000

4500

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

Num

ber

of T

rans

plan

ts

Ref.: ISHLT, J Heart and Lung Transplant 2004; 23: 796-803

Dr. William DeVries - 1982

Barney Clark - 1982

Current Ventricular Assist Device (VAD) Options

o  Berlin Heart

o HeartWare (HVAD)

o Heartmate II

o  Total Artificial heart (Syncardia)

0

50

100

150

200

250

Feb.1990

Mai.199

1

Jul.1

992

Dez.19

92

Jul.1

993

Apr.19

95

Mai.199

6

Aug.19

97

Mai.199

8

Sep.19

98

Nov.19

99

Mai.200

0

Nov.20

00

Jun.2

001

Mrz.200

2

Jan.2

003

Okt.20

03

Apr.20

04

Aug.20

04

Nov.20

04

Feb.2005

Mai.200

5

Aug.20

05

Nov.20

05

Feb.2006

Mai.200

6

Aug.20

06

Patients

Total Impl.US/Canada

August 2004

Total World-wide Pediatric Berlin Heart Implants

August, 2004

North American Berlin Heart ‘Miles’stone

80 ml

Berlin Heart System

Cannulas Driving Unit Blood Pump

Cannula and Pump Placement

Apex Ao RA PA

Berlin Heart Blood Pump

Berlin Heart Blood Pumps (10 ml – 60 ml)

HeartWare - I

o  Size = 50 cc

o  Centrifugal continuous flow device

HeartWare - II

o  Flow - 3.5-7.0 L/min (max 10 L/min)

o  Long-term device n  Longest current implant – 7 years !!!

Standard (sternotomy) HVAD implant - I

Standard (sternotomy) HVAD implant - II

Standard (sternotomy) HVAD implant - III

Standard (sternotomy) HVAD implant - IV

Standard (sternotomy) HVAD implant - V

Standard (sternotomy) HVAD implant - VI

Standard (sternotomy) HVAD implant - VII

Minimally invasive implant II

o  Superior Hemisternotomy + 5th ICS thoracotomy

o  Aortic arterial / femoral venous cannulae

o  ? Off-pump – Germany / Austria

Heartmate II

Shane L.

Total Artificial Heart (Syncardia TAH)

Total Artificial Heart (Syncardia TAH)

Total Artificial Heart (Syncardia TAH)

What do we do after the mechanical heart is in ?

•  Transplantation

•  Recovery (Bridge To Recovery)

•  Withdrawal of therapy

•  ........

What do we do after the mechanical heart is in ?

•  Transplantation

•  Recovery (Bridge To Recovery)

•  Withdrawal of therapy

•  Implantable VAD (Destination therapy)

Destination Therapy ???

Rebecca N.

Temporary Mechanical Circulatory Support

MVAD vs HVAD