[Circulatory support with the mechanical heart, "HeartMate"]. / Cirkulationsstøtte med Det mekaniske hjerte, "HeartMate".

Treatment with the mechanical heart, HeartMate, has been introduced in Denmark. Short-term circulatory support can be obtained by intraaortic balloon counterpulsation, an external centrifugal pump and the total artificial heart. Long-term circulatory support can be established by treatment with the HeartMate. The principle of the mechanical heart is simple--a pump is implanted in parallel to the existing heart and connected to external, portable batteries. The patient quickly improves and is brought in an optimal state for transplantation. A few patients have been able to omit the subsequent heart transplantation. The patient's own heart improved during the treatment and the native heart functioned again after the system was explanted. The main complications during treatment are bleeding, infection, thromboembolic events and systemic failure. Permanent, fully implantable mechanical circulatory pumps are under development--which may herald the beginning of a whole new era for treatment of cardiac failure.

[Economic aspects of implementation of the mechanical heart, "HeartMate"]. / Okonomiske betragtninger ved implementering af det mekaniske hjerte, "HeartMate".

This economic evaluation was performed to assess the economic consequences for society and for the Danish health care sector of replacing the traditional treatment with Biomedicus assist device with The Mechanical Heart, HeartMate, as a bridge to transplantation for patients with severe cardiac failure. A cost-effectiveness analysis showed that the use of HeartMate is more cost-effective than the use of Biomedicus assist device. Using HeartMate one life-year gained costs DKK 225,000. Using Biomedicus one life-year gained costs DKK 270,000. The use of HeartMate results in an additional expenditure of DKK 615,000 per patient. By this additional expenditure the patients gain 3.6 extra life-years on average. The marginal expenditure by replacing the Biomedicus treatment with HeartMate is DKK 170,000 per extra life-year gained.

[The first Danish experiences with neonatal extracorporeal membrane oxygenation]. / De første danske erfaringer med neonatal ekstrakorporal membranoxygenering.

In 1995, neonatal extra-corporeal membrane oxygenation (ECMO) was established at the Department of Neonatology, Rigshospitalet, Copenhagen. The indication for ECMO is circulatory or respiratory failure with arterial oxygen tension below 8 kPa despite maximal conventional treatment. During the first two and a half years 17 newborn infants and one child of 21 months have been treated with ECMO at the Rigshospital. Fifteen survived, of 12 followed at least nine months, 11 have normal development and one has cerebral palsy. There were problems including surgical placement of the cannula, technical difficulties or bleeding in 12 patients. During the same two years at least eight newborns in Denmark fulfilled the ECMO indication, but were not treated, half were not transferred to the Rigshospital. Seven of these eight infants died. The need for ECMO treatment in newborn infants is documented but small. We have succeeded in establishing this complicated treatment due to teamwork between different specialities with a good result.