Evolution and clinical adoption of the Autologs system: An automated analysis for enhanced patient management in MCS.

The Medtronic Autologs System allows real-time clinician review of HeartWare HVAD System logfiles, providing supplemental pump data to aid in patient management. In its first year of availability, Autologs generated a 70% increase in logfile submissions, with 73% of all logfile requests being sent to Autologs. Within a month of its launch, Autologs submissions outnumbered the amount of logfiles submitted for manual review. Following the v1.1 release, there was a 20% increase in logfile submissions, with 77% of all logfile requests being Autologs. With the introduction of v1.2, there was another 35% increase in logfile submissions, with nearly 90% of all logfile requests being Autologs. The widespread adoption and utility of the Autologs System highlights the need for clinician access to real-time data analysis in the field of Mechanical Circulatory Support.

The Hemopump™, The First Intravascular Ventricular Assist Device.

Development of durable left ventricular assist devices (LVADs), based on rotary flow blood pumps, began in earnest after the successful implantation of a catheter-mounted axial flow blood pump via intravascular access in 1988. This device, the Hemopump, successfully supported the circulation of a patient in cardiogenic shock secondary to acute rejection of a transplanted heart. Duration of support was 46 hours, resulting in complete recovery of cardiac function and hospital discharge. In effect, this sentinel event demonstrated that continuous-flow blood pumps could be used to support patients in cardiogenic shock. This held true in spite of many widely held paradigms against rotary blood pumps regarding blood damage, diminished pulsatility, and thrombosis. At this writing, 50,000 patients have been implanted with durable LVADs based on rotary blood pumps as a bridge to cardiac transplantation or destination support as long as 10 years.

Evolutionary Improvements in the Jarvik 2000 Left Ventricular Assist Device.

Mechanical circulatory support devices experience a wide range of operating conditions during patient use. Since its first implant in June 2000, the Jarvik 2000 left ventricular assist device has witnessed systematic stepwise modifications to reduce the risk of serious adverse events and improve patient outcomes. Over time, clinical experience revealed a number of low-incidence failure modes that presented opportunities for improvement. Design changes have included, but are not limited to, a Y cable to permit battery changes without pump stoppage, increased pull strength of external cables from 35 to 200 lbs, an intermittent low-speed controller to improve aortic root washout, sintered titanium microsphere surface on the pump housing to prevent apical thrombus, and novel cone bearings to reduce thrombus formation. In summary, real world conditions challenge devices in ways that laboratory or animal experiments do not. Thorough case reviews have led to many improvements as the Jarvik 2000 continues through its second decade of implants.

Bleeding with the artificial heart: Gastrointestinal hemorrhage in CF-LVAD patients.

Continuous-flow left ventricular assist devices (CF-LVADs) have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or, more recently, as destination therapy. However, its implantations carries a risk of complications including infection, device malfunction, arrhythmias, right ventricular failure, thromboembolic disease, postoperative and nonsurgical bleeding. A significant number of left ventricular assist devices (LVAD) recipients may experience recurrent gastrointestinal hemorrhage, mainly due to combination of antiplatelet and vitamin K antagonist therapy, activation of fibrinolytic pathway, acquired von Willebrand factor deficiency, and tendency to develop small intestinal angiodysplasias due to increased rotary speed of the pump. Gastrointestinal bleeding in LVAD patients remains a source of increased morbidity including the need for blood transfusions, extended hospital stays, multiple readmissions, and overall mortality. Management of gastrointestinal bleeding in LVAD patients involves multidisciplinary approach in stabilizing the patients, addressing risk factors and performing structured endoluminal evaluation with focus on upper gastrointestinal tract including jejunum to find and eradicate culprit lesion. Medical and procedural intervention is largely successful and universal bleeding cessation occurs in transplanted patients.

From Catheters To Ventricular Assist Devices: 60 Years of Cardiovascular Experiences With William L. Winters, JR., M.D.

Automatic typewriters, transistor radios, microfiche, black and white television…while considered high-tech in the 1950s, these technologies seem limited when viewed from the 21st century. The same is true for cardiovascular medicine, which back then relied on electrocardiograms and X-rays for most diagnoses. In the 60 years since, advances in medical capabilities have progressed at a staggering pace. Patient research that once required months poring over paper charts is now reduced to hours using electronic medical record databases. Diagnostic images that once took days to process can now be accessed instantly through ultrasound and magnetic resonance imaging. While a half-century ago no one would have imagined accessing any and all information with a 5-second Google search, so too would noninvasive heart surgery been considered unimaginable. Since the 1950s when he graduated from medical school, William L. Winters, Jr., has been a first-hand witness to breathtaking innovations in cardiovascular medicine-both globally and in Houston. Author of Houston Hearts: A History of Cardiovascular Surgery and Medicine at Houston Methodist DeBakey Heart & Vascular Center and long-time medical editor of the Methodist DeBakey Cardiovascular Journal, Dr. Winters sat down with the journal editors this past April to share his insights from the last half-century of medical practice.

Mechanical circulatory assist device development at the Texas Heart Institute: a personal perspective.

In December 2013, we performed our 1000th ventricular assist device implantation at the Texas Heart Institute. In my professional career, I have been fortunate to see the development of numerous mechanical circulatory support devices for the treatment of patients with advanced heart failure. In fact, most of the cardiac pumps in wide use today were developed in the Texas Heart Institute research laboratories in cooperation with the National Heart, Lung and Blood Institute or device innovators and manufacturers and implanted clinically at our partner St. Luke's Episcopal Hospital. My early involvement in this field was guided by my mentors, Dr Michael E. DeBakey and, especially, Dr Denton A. Cooley. Also, many of the advances are directly attributable to my ongoing clinical experience. What I learned daily in my surgical practice allowed me to bring insights to the development of this technology that a laboratory researcher alone might not have had. Young academic surgeons interested in this field might be well served to be active not only in laboratory research but also in clinical practice.