Mechanical circulatory support

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Contents

Background

Mechanical circulatory support refers to any mechanical method used to replace or augment the native circulation. The term as it is commonly used does not usually refer to cardio-pulmonary bypass, but to other, more chronic (days to years) forms of mechanical circulatory support. Cardio-pulmonary bypass is included in this section because of its commonality in development and physiology with more chronic forms of support.

History

Cardiopulmonary bypass in 1966 (Image courtesy of National Institutes Of Health)
In 1953 Dr John Gibbons, working at Jefferson Medical College, Philadelphia, performed the first cardio-pulmonary bypass using a mechanical device, to repair an atrial septal defect in an 18 year old female patient. This pioneering work was the beginning of the modern era of cardiac surgery. The intra-aortic balloon pump was the first mechanical cardiac assist device and is now the most widely used. Because of the growing use of cardio-pulmonary bypass, the need arose to develop means of supporting patients with post cardiotomy shock. In 1970 the National Heart, Lung and Blood Institute in the USA sponsored a program for the development of a left ventricular assist device (LVAD) that could be used for post cardiotomy shock. In 1982 Barney Clark became the first patient to be implanted with a total artificial heart, the Jarvik 7. The increasing prevalence of heart failure and shortage of donor organs for heart transplantation led to the application of ventricular assist devices to patients with end stage heart failure. Technology is rapidly advancing and there is now a multitude of circulatory assist devices in use and in development. Recently there has been a move towards development of small axial flow pumps and devices which use magnetic suspension rather than bearings.




Indications

Device types

Counterpulsation devices

Pulsatile flow devices

Axial flow devices

Magnetic suspension devices

Total artificial hearts

External links

The International Society For Heart And Lung Transplantation maintains a mechanical circulatory support database (MCSD) from which slides are available.

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