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Key points Baseline ECG in any cardiac or extracardiac tumors is mandatory since therapeutic side effects of chemotherapy on heart are proven. Comprehensive understanding of the cardiac effect of anticancer agents is mandatory to predict side effects and prevent irreversible damage. Introduction While life expectancy and quality of life have improved dramatically in this era of new oncology treatments, longer lifespan comes with its own set…
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Key Points Cardiac tumors are being rare, but form an important component of cardio-oncology practice in which diagnosis and management are vital. Tumors encompass a broad set of lesions and/or masses that can be categorized as neoplastic or nonneoplastic. Neoplastic lesions can be further classified into primary and secondary tumors (i.e., metastasis to the heart). Up to 90% of primary neoplastic tumors are benign and may…
Key points Primary cardiac tumors (PCTs) are extremely rare that may be symptomatic or found incidentally. The signs and symptoms of cardiac tumors generally are determined by the location of the tumor in the heart and not by its histopathology. Cardiac myxoma is the most common benign heart tumor. The tumor plop sound is one of the classic and characteristic auscultation findings of cardiac myxoma. The…
I. The trail blazed and the pathway ahead As the field of Mechanical Circulatory Support (MCS) reaches into its sixth decade beyond first laboratory experimentation, it behooves us to reflect on the historical, pioneering advances on which the future will be leveraged. Such reflection is most valuable when it inspires the thoughtful to blaze new trials. Much has been accomplished. The field is tantalizingly close to…
Introduction A regulatory/reimbursement product plan should be created simultaneously, early in the product development cycle, with the concept of developing ongoing evidence to support appropriate device use. If each is treated separately and implemented linearly rather than collectively, significant market access delays and restrictions can be anticipated. Outlining clinical study protocols with regulatory agencies and payers is necessary to demonstrate whether the product is not only…
Origins of Intermacs/Pedimacs In The Artificial Heart: Prototypes, Policies, and Patients: Institute of Medicine Report from 1991, the committee opined that “maintaining a registry of mechanical circulatory support (MCS) recipients should be considered a routine aspect of this care.” With the approval of the HeartMate XVE (Thoratec, Pleasanton, CA) for reimbursement as long-term “destination therapy” (DT) by the Center for Medicare and Medicaid Services (CMS) in…
Heart failure (HF) is characterized by a pathologic process known as remodeling that involves progressive enlargement (See Chapter 9 ) of the ventricle, reduction in contractility, and an increase in intracardiac pressures. These changes are associated with adverse cellular, structural, and functional changes in the myocardium (see Chapter 9 ). Historically, the remodeling process was considered largely irreversible once HF had been present for a period…
Introduction Mechanical circulatory support (MCS) for pediatric patients has advanced enormously, since its first reported use in the 1950s by Gibbon, Kirklin, and Lillehei in the form of a cardiopulmonary bypass machine. Kirklin and others were the first group to develop a pump oxygenator with a much smaller priming volume. The rapid evolution of cardiopulmonary bypass continued for the next 20 years, including the refinement of…
Case presentation A 73-year-old retired psychiatrist presents with advanced congestive heart failure (HF) (New York Heart Association [NYHA] class IV). He was healthy until about 3 years ago. On evaluation, he is found to have restrictive cardiomyopathy (RCM) due to senile cardiac amyloidosis. He also develops acute worsening of his chronic renal dysfunction. He is in atrial fibrillation, and his right heart catheterization reveals severe biventricular…
The use of mechanical circulatory support (MCS) as a long-term therapy for end-stage heart failure is associated with many psychosocial considerations for both patients and their families. These considerations span the process of care: they encompass factors including evaluation, informed consent, and decision-making before implantation; health-related quality of life (HRQOL) and behavioral outcomes during and after MCS implantation; impact of psychosocial factors on clinical outcomes after…
Disclosure Dr. Russell is a consultant for Medtronic and serves on the Data and Safety Monitoring Board for the HeartMate 3 trial sponsored by Abbott. Dr. Teuteberg has industry relationships with Medtronic (advisory board, speaking), Abiomed (advisory board), CareDx (advisory board, speaking), Abbott (HeartMate 3 Clinical Events Committee), and EcoR1 (consulting). Overview of clinical trials of mechanical circulatory support devices Clinical trials of mechanical circulatory support…
Introduction For end-stage heart failure (HF), heart transplantation or implantation of a left ventricular assist device (LVAD) is lifesaving and provides a significant improvement in quality of life. Despite the therapeutic success of LVADs, concomitant right ventricular failure (RVF) and the lack of appropriate long-term, right ventricular (RV) support devices has limited the full potential that mechanical circulatory support (MCS) can offer to patients with biventricular…
Introduction The evolution of ventricular assist devices (VAD) since the year 2000 has allowed patients with end-stage heart failure to survive with increased functional capacity and quality of life (QOL). Since the beginning of randomized clinical trials in the field, survival, QOL, and resource requirements have been limited by adverse events. In the case of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive…
Perioperative management This chapter focuses on the early postoperative care of patients with ventricular assist devices (VADs). Appropriate patient selection and optimal implantation techniques greatly simplify postoperative management. Indeed, some problems created by suboptimal implantation techniques are difficult or impossible to correct, short of a return to the operating room. This chapter commences with a discussion of operative factors that influence the early intensive care unit…
Historical note The first left ventricular assist device (LVAD) was implanted in 1963 by Dr. DeBakey in a patient with postcardiotomy shock. As the incidence of heart failure rose to epidemic proportions, the LVAD emerged as a new solution to this devastating disease, and superiority over medical treatment was demonstrated in the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial.…
Development of mechanical circulatory support systems The methods for providing mechanical circulatory support (MCS) have varied greatly. The evolution of MCS technology has been gradual, as the biological barriers to progress have remained constant and difficult. Clinicians and engineers have collaborated for many years to develop an array of devices that range from very small catheter-mounted devices to fully implantable total cardiac replacement systems ( Table…
Introduction Heart failure (HF) is one of the major medical burdens in our society. Complete recovery of the heart after insult has been an attractive goal for many clinicians and scientists for long time. Mechanical circulatory support (MCS) devices, such as left ventricular assist devices (LVADs), effectively unload the heart by reducing the pressure overload/increased afterload, ultimately resulting in a degree of myocardial reverse remodeling. Currently,…
Introduction Understanding the hemocompatibility of mechanical circulatory support (MCS) devices requires insight into two scientific disciplines: biology and physics Biology related to MCS is only partially understood and at times seems unpredictable. Mother Nature is responsible for unleashing a variety of random and often chaotic situations in life, many of which are not well understood. Tissue and cells are living organisms that follow rules that are…