MECHANICAL CIRCULATORY SUPPORT

A selected history of mechanical circulatory support; the physiology of left ventricular assistance; the biomaterial - blood interface in circulatory support devices - a cardiac surgeon's view; the development of biomaterials for cardiovascular prostheses. Part 1 Advanced respiratory support: the need for advanced respiratory support in the intensive care unit; technical overview of advanced respiratory support; the IVOX intravascular gas-exchange device - current world-wide experience; extracorporeal membrane oxygenation for neonates and older children; adult ECMO. Part 2 Cardiopulmonary bypass: pulsatile and non-pulsatile perfusion in cardiac surgery - the continuing controversy; the choice of blood pump for cardiopulmonary bypass. Part 3 Short-term support: principles of intra-aortic balloon counterpulsation; the development of future of the Hemopump; clinical uses of the Hemopump; development, indications and clinical use of centrifugal blood pumps; mechanical circulatory support - patient and device selection. Part 4 Medium-term support: the Thoratec VAD system - patient selection and clinical results in bridge to transplantation. Part 5 Long-term support: the need for long-term circulatory support - a cardiologist's view; end-organ function with long-term support; development and clinical use of the total artificial heart - a review of the current status of the CardioWest C-70 TAH (Jarvik-7); clinical use of a total artificial heart - overall European experience; the future of TAH; worldwide clinical experience of the Novacor device; worldwide clinical experience of TCI device; the Novacor left ventricular assist system; TCI Heartmate blood pump. Part 6 Biological assist: transplantation; xenotransplantation - current status and future prospects; educating skeletal muscle to do cardiac work; circulatory assistance with skeletal muscle ventricles; clinical use of skeletal muscle counterpulsation; the experimental evidence for skeletal muscle support in cardiomyoplasty; clinical uses of myoplastic techniques. Part 7 Problems: valves in pulsatile devices; bleeding complications in patients requiring mechanical circulatory support; management of bleeding in ECMO; anticoagulants and the artificial heart; linings; cannulation techniques in cardiac support systems; cannulation for ECMO; infectious complications associated with ventricular assist device support; optimizing flow in centrifugal blood pumps; use of aprotinin in mechanical circulatory support. Part 8 General issues: regulatory and informed consent issues in circulatory support; economic evaluation of therapies for end-stage heart failure; ethical considerations for circulatory support; the bridge to transplantation. Appendix: device registry.