Development of a ventricular assist device for out-of-hospital use

Current State and Future Perspectives of Energy Sources for Totally Implantable Cardiac Devices

There is a large population of patients with end-stage congestive heart failure who cannot be treated by means of conventional cardiac surgery, cardiac transplantation, or chronic catecholamine infusions. Implantable cardiac devices, many designated as destination therapy, have revolutionized patient care and outcomes, although infection and complications related to external power sources or routine battery exchange remain a substantial risk. Complications from repeat battery replacement, power failure, and infections ultimately endanger the original objectives of implantable biomedical device therapy - eliminating the intended patient autonomy, affecting patient quality of life and survival. We sought to review the limitations of current cardiac biomedical device energy sources and discuss the current state and trends of future potential energy sources in pursuit of a lifelong fully implantable biomedical device.

From "spongy" and "cold" hearts to cellular cardiomyoplasty: tales of Canadian contribution to global cardiac surgery

Despite the small size of its population and the number of its cardiac surgeons, Canadians have participated actively in the birth and development of cardiac surgery during the past half century, with pioneers such as Arthur Vineberg and Wilfred Bigelow leading the way. New and innovative cardiac surgical techniques and their scientific bases were developed and shared globally over the years. Canadian surgeons continue to be productive and are contributing to advances in this field at the dawn of the twenty-first century. Some of these efforts and achievements are illustrated in this review.

New devices for chronic ventricular support

Congestive heart failure affects 5 million people in the United States with 500,000 new cases diagnosed each year. Medical and surgical therapy have helped many patients but when these options fail, heart transplantation remains the only other treatment available to help improve their condition. Heart transplantation suffers from the lack of a sufficient number of suitable donor organs, the complications of chronic immunosuppression, and many patients die while on the waiting list. A number of pulsatile and nonpulsatile cardiac assist devices are being developed to provide chronic support for patients with heart failure and to be an alternative to heart transplantation. It is estimated that as many as 60,000 patients with heart failure could be helped by mechanical devices used for chronic support. For these devices to be effective they must provide sufficient cardiac output to allow patients to perform their daily activities, have a low risk of thromboemboli, be fully implantable thereby reducing the risk of infection, and have a low incidence of device malfunction requiring part or all of the device to be replaced. In this article, we will review several new devices which have been developed over the past 5 years or so and will be in human clinical trials in the United States soon, either as a bridge or as an alternative to heart transplantation.

Economic impact of mechanical cardiac assistance

In contrast to heart transplantation, little effort has been made to estimate the economic implications of mechanical cardiac assistance from either a procedure- or a program-level perspective. With annual direct and indirect expenditures for the treatment of coronary artery disease and congestive heart failure now exceeding $65 billion in the United States, and the treatment options available for these diseases becoming increasingly diverse, it is important that we begin to better understand how expenditures for various treatment options compare. From a disease management perspective, it is also essential that policymakers have credible estimates of total program expenditures. At this time, program expenditures for heart transplantation in the United States are somewhere between $352 and $700 million. Given the availability of viable long-term mechanical cardiac assistance and the current need for cardiac replacement, total direct annual program expenditures could be as low as $5.4 billion or as high as $24 billion, depending on the expenses associated with device implantation and maintenance. By contrast, in 1996 the United States spent $9.8 billion on the treatment of end-stage renal disease. Clearly, the economics are such that viable mechanical cardiac assistance will likely engender considerable public policy debate.