Do we really need an
Artificial Heart?
No!!
John V. Conte, MD,
Professor of Surgery
Johns Hopkins University School of Medicine
Division of Cardiac Surgery
The Johns Hopkins Medical Institutions
Conflict of Interest Statement
• No Financial Interests
• Investigator
• Thoratec: Heartmate 2 LVAD
• Heartware: HVAD LVAD• Heartware: HVAD LVAD
• Abiomed : Abiocor TAH
Really Francisco?
Really?
Artificial Heart is sexy !
The concept of the Artificial
Heart is exciting! .
Artificial Heart is sexy !
Artificial Heart Images :• 1960’s, President Kennedy, Hope, Optimism
• Space flight
“We will put a man on the moon by the end of the decade”
• Artificial Heart• Artificial Heart
Artificial Heart Program created by the National Heart Institute (NHI) with a national mission “to reduce death and disability from heart disease through the development and use of a variety of safe,effective and reliable cardiac assist and total replacement systems.”
Artificial Hearts
Artificial Heart Images
Artificial Heart Images
Artificial Heart
Mechanical Circulatory
Support
Heart pump
Ventricular Assist Device
Ventricular Assist Devices
Implantable
Pump
Percutaneous
Controller
Percutaneous
Lead
Batteries
Mechanical Circulatory Support Images
Sexy ?No Rock Stars here !
Image Problem ?
We don’t need an We don’t need an
Artificial Heart !
Why don’t we need artificial Heart?
• Results not better
• TAH more complicated
• to implant
• to care for
• Indications sketchy at best• Indications sketchy at best
• Less convenient for patient
• More expensive
• Good alternatives, applicable for all patients
J Copeland. J Thorac Cardiovasc Surg2012;143:727-34
TAH Survival
16 yrs ‘93-2009 101 pts
Mean support 87 days
J Copeland. Thorac Cardiovasc Surg2012;143:727-34
Strokes in 7.9% of cases
Take-back for hemorrhage in 24.7% of cases
68% survived to transplant
J Copeland. Thorac Cardiovasc Surg2012;143:727-34
Competing Outcomes Analysis
(n=281)(n=281)
18
Pagani F, Miller L, Russell S, JAAC: Vol 54, No 4, 2009.
• 383 patients between 2000 and 2010
• French multicentric Groupe de Réflexion sur l’Assistance Mécanique
(GRAM) registry.
• 66% paracorporeal BiVAD, 24% TAH, 10% implantable BiVAD or
• 63% successful bridgeor wean
Kirsch M. J Heart Lung Transplant 2012
“Survival while on support and after
heart transplantation did not differ
significantly in patients supported with
paracorporeal BiVADs, implantable paracorporeal BiVADs, implantable
BiVADs, or the TAH.”
Kirsch M. J Heart Lung Transplant 2012
Outcomes
9% of BiVADs weaned off support !
You can’t be weaned off support
if your heart is in a bucket!if your heart is in a bucket!
June 2006 – June 2009
Only 3.6% of devices inserted were TAH !
All investigational devices excluded in
INTERMACS so….INTERMACS so….
% actually much lower than 3.6%
Cleveland J. J Heart Lung Transplant 2011;30:862-9
Pulsatile vs Continuous Flow
Cleveland J. J Heart Lung Transplant 2011;30:862-9
June 2006-June 2011
99 TAH /4366 Implants
2.13 % of Implants!
1.17 % of Implants
Ease of Implant -TAH
• Won’t fit all patients- too large– Abiofit Algorithm
• Big operation
• 4 suture lines• 4 suture lines
• Full sternotomy
• Cardiopulmonary bypass
Ease of implant -LVAD
• Small enough for nearly all adults
• Some advertise No pump pocket
• 2 rather than 4 potential bleeding sites
• One suture line and apical cannulation
• Can be put in without cpb• Can be put in without cpb
• Minimally invasive approach
Non Sternotomy LVAD Insertion
Patient ease of use
Patient ease of use
s
Patient ease of use
Thoracic UnitImplanted
TET CoilImplanted
Battery
Implanted
Controller
Magnetically Coupled Resonators
Magnetic Resonance to wirelessly transfer energy
Based on work of Nikola Tesla early 20th century
Presented at STS 2012
J Copeland. J Thorac Cardiovasc Surg2012;143:727-34
“There really are no data presented to convince the reader
that in fact these patients weren’t eligible for an LVAD”
- Dr Hari Mallidi, Stanford “ In general, our experience has shown that patients with
elevated PAP for the most part need LVAD therapy alone.
Discussion
“Right atrial pressure was 20 mm Hg, pulmonary artery
systolic pressure was 55 mmHg, and wedge pressure was
30 mm Hg.” – Dr Hannah Copeland
elevated PAP for the most part need LVAD therapy alone.
Their RV can be managed with inotropes or a temporary assist
device with (later) removal of the device or weaning from the
inotropes.” - Dr Hari Mallidi, Stanford
If we don’t need an artificial
heartCC..heartCC..
What do we need?
New TAH = Creative VAD Adaptation
Thank you !
