Overview | What to Expect | Devices | Mechanical Heart and Lung Support Team
Jarvik 2000
Mechanical heart and lung circulatory support is just one of a spectrum of treatment options offered for patients at the University of Maryland. We offer state-of-the-art care specifically tailored to the individual needs of end-stage heart and lung failure patients requiring mechanical circulatory support.
The Maryland Heart Center currently offers five bridge-to-transplant devices for heart support. Depending on the patient's medical condition and other circumstances, the patient, their family and the mechanical heart and lung support team work together to decide which device is the best option for each individual situation.
In addition, the University of Maryland Medical System is developing a lung support program using an extracorporeal membrane oxygenator ("ECMO") to provide artificial lung support for patients with life threatening lung disease. This approach is being explored as a bridge-to-transplant or for potentialy reversible lung failure.
Bridge-to-transplant devices currently available at the Maryland Heart Center:
Abiomed Device
ABIOMED's BVS® 5000, cardiac support system, provides a patient's failing heart with full circulatory assistance while allowing the heart to rest, heal and recover its function. The BVS 5000 has been approved by the U. S. Food and Drug Administration (FDA) as a bridge-to-recovery device for the treatment of all patients with potentially reversible heart failure.
It is now the most widely used advanced cardiac assist system in the world. It is installed in hundreds of leading medical centers worldwide.
The BVS 5000 is most frequently used with patients whose hearts do not immediately recover their function following heart surgery.
The Abiomed Impella 5.0 is a new type of investigational heart pump designed to give the heart a short-term rest after cardiac surgery. Cardiac surgeons at the University of Maryland Medical Center are the first in the region to implant this new type of investigational heart pump, as part of a seven-center, 20-patient pilot study.
The device has been approved for use in Europe, where more than 250 patients have been treated with it. The pencil-sized pump assists the left ventricle, the heart’s main pumping chamber, for up to seven days. In some cases, it can be deployed without a large incision. The small pump, designed to fit inside a catheter, can be placed through an artery into the heart.
The Impella is the smallest device available for left ventricular pumping. It weighs only eight grams, but can do the work of much larger ventricular assist devices, pumping up to five liters of blood per minute, about three-quarters of a normal heart’s output of seven liters per minute. The respite that the heart pump provides can be enough for the heart to bounce back to normal.
VentrAssist™
VentrAssist™ is a new "third generation" cardiac assist system. Like other "ventricular assist" devices it is a blood pump that connects to the main pumping chamber of the diseased heart, the left ventricle. Such pumps help restore normal circulation, and allow some of the sickest heart patients to experience a better quality of life.
The VentrAssist™ is currently being tested at UM as a "bridge" for heart transplant candidates who require circulatory support while awaiting their new heart. The UM Medical Center was the first in the United States to implant the device in this U.S. pilot study.
VentrAssist™ has only one moving part, a hydrodynamically suspended, magnetically powered "impeller" that pushes blood forward by centrifugal force. It has been designed to have no wearing parts, which reduces the chances for blood damage. It weighs just 298 grams (10 oz) and measures 60 mm (2.5 inches) in diameter, making it potentially suitable for children and small adults. The implanted parts of the VentrAssist™ system use materials which are fully biocompatible including titanium alloys. Its components are light, strong, non-toxic and highly resistant to degradation within the body.
Since it was designed primarily as a permanent alternative to heart transplantation, once sufficient experience demonstrates that the device is reliable in "bridge" patients, UM expects to participate in trials evaluating the VentrAssist™ for "destination therapy."
Thoratec VAD System
The Thoratec VAD System is able to provide left, right or biventricular support to patients of almost any size. It is the only VAD that is approved for use both as a bridge-to-transplant and for postcardiotomy recovery from open-heart surgery.
The Thoratec VAD System includes three major components: Blood pump, Cannulae, and Dual Drive Console or TLC-II® Portable Driver. This system provides partial or total circulatory assistance when the natural heart, with conventional therapy, is unable to maintain adequate circulation to perfuse vital organs. To accomplish support, blood flows from the natural heart to the VAD, which then pumps pulsatile blood flow back to the body.
The Thoratec VAD System is the only system that offers circulatory support for either the left side of the heart, the right side of the heart, or both sides of the heart. As of June 2001, the Thoratec VAD System has been used in more than 1,700 patients, and has been used in over 170 medical centers worldwide. It is FDA approved for bridge-to-cardiac transplantation and postcardiotomy recovery of the natural heart.
Novacor
The Novacor® Left Ventricular Assist System (LVAS) is an electromechanically driven pump, about the size of a human heart, which is implanted within the abdominal wall. The LVAS provides circulatory support by taking over most of the workload of the left ventricle, the heart's main pumping chamber. Blood enters the pump though an inflow conduit connected to the left ventricle and is ejected through an outflow conduit into the body's arterial system.
The system is monitored by an electronic controller and powered by primary and reserve battery packs, worn on a belt around the waist or carried in a shoulder bag, or by a small bedside monitor. The controller is connected to the implanted pump by a percutaneous lead (a small tube containing control and power wires) through the recipient's skin. The device is remarkably reliable in long-term use. Device recipients must take blood thinners to reduce the risk of stroke.
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The system responds instantaneously to the recipient's changing heartbeat and circulatory demands. The Novacor LVAS is commercially approved as a bridge-to-transplantation device in the U.S. and Canada. There have been over 1,350 Novacor LVAS recipients worldwide.
The University of Maryland Medical Center is participating in the first multi-center study to compare this and the HeartMate pump as "destination therapy" for patients who are not eligible for a heart transplant.
The Jarvik 2000 is the smallest and simplest left ventricular assist device (LVAD) available today. This a battery-powered flow pump is about the size of a thumb. The pump fits directly inside the heart's left chamber (ventricle) and continuously pushes oxygen-rich blood throughout the body, assisting the patient's own heart as a booster pump.
Compared to other heart assist devices, the Jarvik 2000 is much smaller, lighter and simpler. The Jarvik's size enables it to be used in small adults and children. It was designed to function reliably for as long as a decade. Although device recipients must take blood thinners, this device is expected to reduce the risk of blood clotting and infection. Those are problems sometimes associated with larger pulsatile pumps.
Right now the Jarvik 2000 is only FDA approved for experimental study as a bridge-to-transplant device. In the future, doctors hope that the pump will be safe and effective as a permanent assist device for a failing heart, and as a temporary implant to facilitate recovery of hearts treated with new medications or gene therapy approaches.
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