Cardiac Support Device Research Articles

(86) - Myocardial Recovery From Short- and Long-Term Cardiac Support Devices: Results From the UNOS Registry

(86) - Myocardial Recovery From Short- and Long-Term Cardiac Support Devices: Results From the UNOS Registry

Abstract 17953: A Novel Biodegradable Cardiac Support Device for Treating Ischemic Cardiomyopathy in Canine Heart

Introduction: The non-biodegradable material-made “Corecap” type cardiac support device reportedly reduces diastolic wall stress and consequently improves systolic cardiac function. However, the efficacy was inconsistent in the clinical studies possibly due to device-related impairment of diastolic cardiac function. We herein hypothesized that use of biodegradable material for the cardiac support device may contribute to improvement in both systolic and diastolic function of the failing heart. Methods: Polyglycolic acid and Polyethyleneterephtalate were used to prepare biodegradable (n=6) and non-biodegradable (n=5) cardiac support device, respectively. Both cardiac support devices were structurally designed to cover the entire ventricles of the 12-month-aged Beagle canine heart that was subjected to anterior coronary artery ligation at 1 week prior to the implantation. Sham operation was performed in coronary artery-ligated canines for control (n=7). Results: At 12 weeks after coronary artery ligation, the biodegradable group showed a greater recovery of ejection fraction than the non-biodegradable and the control group (39 ± 4% vs. 31 ± 4% vs. 30± 3, respectively, P <0.05), assessed by multi-detector computed tomography. Echocardiographically, diastolic function evaluated by Doppler-derived mitral deceleration time at 12 weeks was significantly greater in the biodegradable group (108 ± 18 msec) than the non-biogradable group (70 ± 13 msec, P<0.05). Thickness of connective tissues around the epicardium was significantly less in the biodegradable groups than the non-biodegradable group at 12 weeks. Histologically, fibrosis in the infarct area was significantly less in the treatment groups than the control group. Conclusions: Implantation of cardiac support device made of biodegradable material was effective in improvement of both systolic and diastolic function of the canine infarct heart for 12 weeks, compared with that of non-biodegradable material, warranting clinical studies using biodegradable cardiac support device.

Automated cardiopulmonary resuscitation using a load-distributing band external cardiac support device for in-hospital cardiac arrest: A single centre experience of AutoPulse-CPR

BackgroundPoor quality cardiopulmonary resuscitation (CPR) predicts adverse outcome. During invasive cardiac procedures automated-CPR (A-CPR) may help maintain effective resuscitation. The use of A-CPR following in-hospital cardiac arrest (IHCA) remains poorly described. Aims & methodsFirstly, we aimed to assess the efficiency of healthcare staff using A-CPR in a cardiac arrest scenario at baseline, following re-training and over time (Scenario-based training). Secondly, we studied our clinical experience of A-CPR at our institution over a 2-year period, with particular emphasis on the details of invasive cardiac procedures performed, problems encountered, resuscitation rates and in-hospital outcome (AutoPulse-CPR Registry). ResultsScenario-based training: Forty healthcare professionals were assessed. At baseline, time-to-position device was slow (mean 59 (±24) s (range 15–96s)), with the majority (57%) unable to mode-switch. Following re-training time-to-position reduced (28 (±9) s, p<0.01 vs baseline) with 95% able to mode-switch. This improvement was maintained over time. AutoPulse-CPR Registry: 285 patients suffered IHCA, 25 received A-CPR. Survival to hospital discharge following conventional CPR was 28/260 (11%) and 7/25 (28%) following A-CPR. A-CPR supported invasive procedures in 9 patients, 2 of whom had A-CPR dependant circulation during transfer to the catheter lab. ConclusionA-CPR may provide excellent haemodynamic support and facilitate simultaneous invasive cardiac procedures. A significant learning curve exists when integrating A-CPR into clinical practice. Further studies are required to better define the role and effectiveness of A-CPR following IHCA.

Aortic Counterpulsation: C-Pulse and Other Devices for Cardiac Support

Heart failure is the leading cause of hospitalization in the USA. Despite major advances in the medical and device-related therapy including chronic resynchronization therapy for management of heart failure, significant number of patients eventually require advanced cardiac therapy including mechanical circulatory support or heart transplant. Heart transplant is a gold standard for end-stage heart failure but is limited by the donor heart shortage creating a definite need for alternative effective therapies. The earliest and most common form of mechanical circulatory support is counterpulsation therapy. Annually, more than 150,000 patients worldwide receive counterpulsation therapy for various indications including cardiogenic shock or severe left ventricular dysfunction (Nanas and Moulopoulos in Cardiology, 84:156-167, 1994) and many thousands of lives are saved each year (65% survival) (Torchiana et al. in Journal of Thoracic and Cardiovascular Surgery, 113(4):758-764, 1997). There are different types of aortic counterpulsation devices. Here, we will give an overview of different counterpulsation devices with focus on C-Pulse device. Extra-aortic balloon counterpulsation, C-Pulse (Sunshine Heart Inc., Eden Prairie, MN), is an important and novel approach in the management of patients with advanced heart failure who remain symptomatic despite optimum medical and device-based therapy. C-Pulse is designed to provide permanent, long-term, continuous partial circulatory support for New York Heart Association class III and ambulatory class IV heart failure patients. C-Pulse is a nonblood-contacting counterpulsation using an inflatable cuff around the ascending aorta, extra-aortic balloon (EAB) counterpulsation device. A pivotal, multicenter US study to assess the safety and efficacy of C- Pulse in patient with Stage C and NYHA Class III or ambulatory Class IV heart failure is in progress.

The effect of extremity vascular complications on the outcomes of cardiac support device recipients

To assess the effect of extremity vascular complications (EVCs, including ischemia or vessel trauma) on the outcomes of patients receiving cardiac support devices (CSDs, including ventricular assist device [VAD] and extracorporeal membrane oxygenation [ECMO]). Institutional Review Board-approved, retrospective review of a prospectively maintained database of all temporary and permanent CSD recipients from 7/1/10 to 6/30/12. Patient demographics, procedural data, and outcomes were analyzed. The primary endpoint was all-cause mortality at 30-days post-CSD initiation. Of 208 patients who received CSDs, 31 (14.9%) experienced EVC: 13 (8.9%) of the 146 permanent VADs, 10 (26.3%) of the 38 temporary VADs, and 8 (33.3%) of the 24 ECMO patients. The 30-day mortality for CSD-EVC patients was not significantly higher than that of the CSD patients who did not experience EVC for permanent VAD (15.4% vs 4.5%; P = .15) and ECMO patients (50.0% vs 68.75%; P = 1.00), but was significantly higher for temporary VAD patients (80.0% vs 35.7%; P = .03). Within the CSD-EVC cohort, patients who received a temporary VAD had a significantly higher 30-day mortality and decision to withdraw care after EVC compared with those who received a permanent VAD (P = .01 and P < .01, respectively). Looking beyond the 30-day window, EVC was associated with higher mortality rates in the permanent VAD population (53.8% vs 25.6%; P = .025) but not the temporary VAD or ECMO groups. In temporary VAD recipients, EVCs result in higher 30-day mortality, more frequent withdrawal of care, and shortened survival time relative to the global temporary VAD group. EVC in permanent VAD recipients did not affect early (30-day) mortality rates, but strongly predicted a higher cumulative mortality risk for the 2-year study period. Overall ECMO mortality rates were high, and not significantly impacted by the occurrence of EVC. The nature of the EVC (cannulation site complication vs embolic injury) did not impact mortality. This data provides quality improvement targets for VAD programs.

The Effect of Extremity Vascular Complications on the Outcomes of Cardiac Support Device Recipients

To assess the effect of extremity vascular complications (EVC; including ischemia and vessel trauma) on the outcomes of patients receiving cardiac support devices (CSD; including ventricular assist device [VAD] and extracorporeal membrane oxygenation [ECMO]). Institutional review board-approved, retrospective review of a prospectively maintained database of all temporary and permanent CSD recipients from 7/1/10 to 6/30/12. Patient demographics, procedural data, and outcomes were analyzed. The primary endpoint was all-cause mortality at 30 days post-CSD initiation. Of 208 patients who received CSDs, 31 (14.9%) experienced EVC: 13 (8.9%) of the 146 permanent VADs, 10 (26.3%) of the 38 temporary VADs, and eight (33.3%) of the 24 ECMO patients. The 30-day mortality was significantly higher for temporary VAD patients who experienced EVC versus those that did not (80.0% vs 35.7%; P = .03). However, 30-day mortality was not significantly impacted by EVC in the permanent VAD (15.4% EVC vs 4.5% without EVC; P = .15) and ECMO patients (50.0% vs 68.75%; P = 1.00). Preinitiation peripheral arterial disease and cardiogenic shock did not significantly differ between the CSD groups. Outcomes for CSD subgroups following the occurrence of EVC are shown in Table. In temporary VAD recipients, the development of extremity vascular complications results in higher 30-day mortality and more frequent withdrawal of care. In contrast, extremity vascular complications in the permanent VAD and ECMO groups did not significantly impact mortality or withdrawal of care. This prognostic data may be useful in the management of these challenging patients.TableOutcomes for 31 cardiac support device (CSD) recipients who experienced extremity vascular complications (EVC)Permanent VADTemporary VADECMOCSD recipients experiencing EVC13108OutcomesAny vascular procedure, n (%)7 (53.9%)9 (90.0%)6 (75.0%)Revascularization, n (%)5 (38.5%)4 (40.0%)2 (25.0%)Amputation, n (%)0 (0.0%)1 (10.0%)1 (12.5%)Withdrawal of care, n (%)3 (23.1%)8 (80.0%)4 (50.0%)Time to death after EVC, days (± SEM)60.14 ± 21.4815.38 ± 2.3415.20 ± 7.2130-day mortality after EVC, n (%)2 (15.4%)8 (80.0%)4 (50.0%)ECMO, Extracorporeal membrane oxygenation; SEM, standard error of the mean; VAD, ventricular assist device. Open table in a new tab

Impact of cardiac support device combined with slow-release prostacyclin agonist in a canine ischemic cardiomyopathy model

The cardiac support device supports the heart and mechanically reduces left ventricular (LV) diastolic wall stress. Although it has been shown to halt LV remodeling in dilated cardiomyopathy, its therapeutic efficacy is limited by its lack of biological effects. In contrast, the slow-release synthetic prostacyclin agonist ONO-1301 enhances reversal of LV remodeling through biological mechanisms such as angiogenesis and attenuation of fibrosis. We therefore hypothesized that ONO-1301 plus a cardiac support device might be beneficial for the treatment of ischemic cardiomyopathy. Twenty-four dogs with induced anterior wall infarction were assigned randomly to 1 of 4 groups at 1week postinfarction as follows: cardiac support device alone, cardiac support device plus ONO-1301 (hybrid therapy), ONO-1301 alone, or sham control. At 8 weeks post-infarction, LV wall stress was reduced significantly in the hybrid therapy group compared with the other groups. Myocardial blood flow, measured by positron emission tomography, and vascular density were significantly higher in the hybrid therapy group compared with the cardiac support device alone and sham groups. The hybrid therapy group also showed the least interstitial fibrosis, the greatest recovery of LV systolic and diastolic functions, assessed by multidetector computed tomography and cardiac catheterization, and the lowest plasma N-terminal pro-B-type natriuretic peptide levels (P<.05). The combination of a cardiac support device and the prostacyclin agonist ONO-1301 elicited a greater reversal of LV remodeling than either treatment alone, suggesting the potential of this hybrid therapy for the clinical treatment of ischemia-induced heart failure.

Modern cardio respiratory support devices: radiographic appearances

Purpose: 1. Demonstrate the appearances and appropriate positioning of various modern cardiac and respiratory support devices, with particular focus on ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO) apparatus. 2. To educate the general radiologist reporting chest radiographs on the various modern specialized devices used for cardiac and respiratory support. 3. Highlight the importance of understanding device function and recognize complications associated with their use.

Modulation of Diastolic Filling Using an Epicardial Diastolic Recoil Device

Diastolic dysfunction likely contributes to all cases of congestive heart failure and is solely responsible for many. Existing cardiac support devices largely ignore diastolic dysfunction and may exacerbate it. Current diastolic devices in development rely on either extensive extraventricular fixation or intraventricular implantation with complications associated with blood contact. A diastolic recoil device is proposed that pneumatically locks to the outside of the heart wall. The end-diastolic total biventricular pressure-volume relationship (EDTBPVR) was used to evaluate, in vitro, the ability of a recoil device to modulate filling mechanics through pneumatic locking as the method of fixation. The pressure in a model heart was incremented and the corresponding volume changes were measured. The heart model and device were pneumatically locked together using a vacuum sac to model the pericardium. The diastolic recoil component shifted the EDTBPVR towards lower pressures at low volumes, providing up to 0.9 kPa (9 cm H2O) of suction, demonstrating enhanced diastolic recoil at beginning diastole. We conclude that pneumatic locking appears to be a viable method for a recoil device to engage the heart.

Biventricular Finite Element Modeling of the Acorn CorCap Cardiac Support Device on a Failing Heart

The Acorn CorCap Cardiac Support Device (CSD; Acorn Cardiovascular Inc, St. Paul, MN) is a woven polyester jacket that is placed around the heart and designed to reverse the progressive remodeling associated with dilated cardiomyopathy. However, the effects of the Acorn CSD on myofiber stress and ventricular function remain unknown. We tested the hypothesis that the Acorn CSD reduces end-diastolic (ED) myofiber stress. A previously described weakly coupled biventricular finite element (FE) model and circulatory model based on magnetic resonance images of a dog with dilated cardiomyopathy was used. Virtual applications of the CSD alone (Acorn), CSD with rotated fabric fiber orientation (rotated), CSD with 5% prestretch (tight), and CSD wrapped only around the left ventricle (LV; LV-only) were performed, and the effect on myofiber stress at ED and pump function was calculated. The Acorn CSD has a large effect on ED myofiber stress in the LV free wall, with reductions of 55%, 79%, 92%, and 40% in the Acorn, rotated, tight, and LV-only cases, respectively. However, there is a tradeoff in which the Acorn CSD reduces stroke volume at LV end-diastolic pressure of 8 mm Hg by 23%, 25%, 30%, and 7%, respectively, in the Acorn, rotated, tight, and LV-only cases. The Acorn CSD significantly reduces ED myofiber stress. However, CSD wrapped only around the LV was the only case with minimal negative effect on pump function. Findings suggest that LV-only CSD and Acorn fabric orientation should be optimized to allow maximal myofiber stress reduction with minimal reduction in pump function.

CRT-146 Follow-up Results And Health-related Quality-of-life After Implantation Of Left Ventricular Passive Containment Device For Heart Failure And Dilated Cardiomyopathy

We conducted a prospective study of the clinical outcomes and health-related quality-of-life after implantation of the CorCap cardiac support device (Acorn Cardiovascular Inc.) for dilated cardiomyopathy. The CorCap was implanted in case of dilated cardiomyopathy (left ventricular end-diastolic

Use of Prothrombin Complex Concentrate in Patients during Heart Transplantation after Implantation of a Left Ventricular Mechanical Support System

Heart transplantation in patients after implantation of mechanical cardiac support devices entails an extremely high risk for perioperative bleeding. Recombinant activated coagulation factor VII is presently used to reduce the volume of bleeding in this patient group. There are parallel data on its administration-induced thromboembolic events in the literature. This paper describes a case of using a prothrombin complex concentrate in a patient during explantation of a left ventricular bypass system and subsequent orthotopic heart transplantation in the presence of significant hypocoagulation. At the end of a surgery, 1200 IU of the agent was used at a remaining bleeding rate of more than 1000 ml/hour. Within the first 24 hours after surgery, the rate of discharge drainage was less than 100 ml/hour. A control plain chest X-ray study revealed massive left-sided hydrothorax on day 2 postsurgery. The left pleural cavity was revised under thoracoscopic guidance and 1000 ml of blood clots were evacuated. Although the administration of prothrombin complex concentrate did not guard against re-intervention, its use seems a promising strategy in life-threatening bleedings in patients after explantation of mechanical cardiac support devices. Further multicenter investigations are required to determine the efficacy and safety of prothrom-bin complex concentration in cardiac surgery. Key words: Recombinant activated coagulation factor VII, prothrombin complex concentration, mechanical cardiac support device, orthotopic heart transplantation.

Hemodynamic and Metabolic Parameters During Prolonged Cardiac Arrest and Reperfusion by Extracorporeal Circulation

Extracorporeal membranous oxygenation (ECMO) is increasingly used in the management of refractory cardiac arrest. Our aim was to investigate early effects of ECMO after prolonged cardiac arrest. In fully anesthetized swine (48 kg, N=18) ventricular fibrillation (VF) was induced and untreated period (20 min) of cardiac arrest commenced, followed by 60 min extracorporeal reperfusion (ECMO flow 100 ml/kg.min). Hemodynamics, arterial blood gasses, plasma potassium, tissue oximetry (StO(2)) and cardiac (EGM) and cerebral (BIS) electrophysiological parameters were continuously recorded and analyzed. Within 3 minutes of VF hemodynamic and oximetry parameters fall abruptly while metabolic parameters destabilize gradually over 20 minutes peaking at pH 7.04 ± 0.05, pCO(2) 89 ± 14 mmHg, K(+) 8.5 ± 1.6 mmol/l. During reperfusion most parameters restore rapidly: within 3-5 minutes mean arterial pressure reaches >40 mmHg, StO(2)>50 %, paO(2)>100 mmHg, pCO(2)<50 mmHg, K(+)<5 mmol/l. EGMs mean amplitude peaks at 4.5 ± 2.4 min. Cerebral activity (BIS>60) reappeared in 5 animals after 87 ± 21 min. In 12/18 animals return of spontaneous circulation was achieved. In conclusions, ECMO provides rapid restitution of internal milieu even after prolonged arrest. However, despite normalization of global parameters full recovery was not guaranteed since cardiac and cerebral electrical activities were sufficiently restored only in some animals. More sensitive and organ specific indicators need to be identified in order to estimate adequacy of cardiac support devices.

Material Properties of CorCap Passive Cardiac Support Device

Myocardial function deteriorates during ventricular remodeling in patients with congestive heart failure (HF). Ventricular restraint therapy using a cardiac support device (CSD) is designed to reduce the amount of stress inside the dilated ventricles, which in turn halts remodeling. However, as an open mesh surrounding the heart, it is unknown what the mechanical properties of the CSD are in different fiber orientations. Composite specimens of CorCap (Acorn Cardiovascular, Inc, St. Paul, MN) CSD fabric and silicone were constructed in different fiber orientations and tested on a custom-built biaxial stretcher. Silicone controls were made and stretched to detect the parameters of the matrix. CSD coefficients were calculated using the composite and silicone matrix stress-strain data. Stiffness in different fiber orientations was determined. Silicone specimens exerted a linear behavior, with stiffness of 2.57 MPa. For the composites with 1 fiber set aligned with respect to the stretch axes, stiffness in the direction of the aligned fiber set was higher than that in the cross-fiber direction (14.39 MPa versus 5.66 MPa), indicating greater compliance in the cross-fiber direction. When the orientation of the fiber sets in the composite were matched to the expected clinical orientation of the implanted CorCap, the stiffness in the circumferential axis (with respect to the heart) was greater than in the longitudinal axis (10.55 MPa versus 9.70 MPa). The mechanical properties of the CorCap demonstrate directionality with greater stiffness circumferentially than longitudinally. Implantation of the CorCap clinically should take into account the directionality of the biomechanics to optimize ventricular restraint.

Associations Between the Use of Critical Care Procedures and Change in Functional Status at Discharge

Quality improvement initiatives in intensive care units (ICUs) have increased survival rates. Changes in functional status following ICU care have been studied, but results are inconclusive because of insufficient consideration of the combinations of critical care procedures used. Using the Japanese administrative database including the Barthel Index (BI) at admission and discharge, we measured the changes in functional status among the adult patients and determined whether longer ICU stay or use of various critical care procedures was associated with functional deterioration. Of the 12502528 patients admitted to 1206 hospitals over 5 consecutive years from 2006, we analyzed data from patients aged 15 years or older who survived ICU admission in 320 hospitals. Critical care procedures evaluated were ventilation, blood purification (hemodialysis, hemodiafiltration, or hemadsorption), and cardiac support devices (intra-aortic balloon pump or percutaneous cardiopulmonary support system). Functional outcomes were determined by the difference between BI at admission and at discharge and were divided into improvement, no change, or deterioration. We compared patient characteristics, principal diagnosis, comorbidities, timing of surgical procedure, complications, days in ICU, and use of critical care procedures among the 3 categories. Associations between critical care procedures and functional deterioration were identified using multivariate analysis. Of 234209 patients with complete BI information, 7137 (3.1%) received blood purification, 27100 (11.7%) received ventilation, 2888 (1.2%) received blood purification and ventilation, 5613 (2.4%) received a cardiac support device, 247 (0.1%) received a cardiac support device and blood purification, 10444 (4.5%) received a cardiac support device and ventilation, and 1110 (0.5%) received a cardiac support device, ventilation, and blood purification. Longer use of blood purification or ventilation and a longer ICU stay were associated with functional deterioration. Intensivists should be aware of the effects of critical care procedures on functional deterioration and advance the appropriate use of functional support according to each patient's condition.

Surgical left ventricular radius enlargement by patch insertion on the beating heart: a new experimental aneurysm model

We presented a novel experimental aneurysm model for studies in left ventricular (LV) reconstruction techniques and assessed LV function. In eight pigs, the LV radius and geometry were enlarged surgically on the beating heart by inserting an aortic allograft construct. Haemodynamics and LV dimensions were assessed by echocardiography at baseline and under dobutamine stress. Surgery was successfully performed without lethal blood loss or arrhythmias. LV end-diastolic and end-systolic short-axis areas increased from 13.0 ± 1.7 to 17.0 ± 4.3 cm(2) (P = 0.001) and from 4.0 ± 0.9 to 13.0 ± 2.6 cm(2) (P = 0.001), respectively. Stroke volume decreased from 56 ± 11 to 33 ± 16 ml (P = 0.001). Incremental dobutamine infusion concurred with a biphasic response on fractional area shortening. Mitral valve insufficiency ranging from grades 2 to 4 was observed. In the pig, a novel, reproducible aneurysm model for acute cardiac dysfunction was created on the beating heart. Innovative (surgical) strategies for (staged) reconfiguration of the ventricle, e.g. adjustable Dor procedures and stepwise volume restraining cardiac support devices, can be tested for efficacy using this acute model.

The science behind percutaneous hemodynamic support: A review and comparison of support strategies

Patients in a variety of cardiovascular disease states may benefit from temporary percutaneous cardiac support, including those in acute decompensated heart failure, fulminant myocarditis, acute myocardial infarction with or without cardiogenic shock and those undergoing high-risk percutaneous coronary intervention. The ideal percutaneous cardiac support device is safe, easy to use and versatile enough to meet the needs of various clinical situations and patient cohorts. In addition, it should provide maximal hemodynamic support and protection against myocardial ischemia. With these goals in mind, the scientific principles that govern hemodynamic effectiveness and myocardial protection as they pertain to acute support devices are reviewed.

Diastolic ventricular support with cardiac support devices: an alternative approach to prevent adverse ventricular remodeling

Heart failure is a global epidemic with limited therapy. Abnormal left ventricular wall stress in the diseased myocardium results in a biochemical positive feedback loop that results in global ventricular remodeling and further deterioration of myocardial function. Mechanical myocardial restraints such as the Acorn CorCap and Paracor HeartNet ventricular restraints have attempted to minimize diastolic ventricular wall stress and limit adverse ventricular remodeling. Unfortunately, these therapies have not yielded viable clinical therapies for heart failure. Cellular and novel biopolymer-based therapies aimed at stabilizing pathologic myocardium hold promise for translation to clinical therapy in the future.

Extraordinary Devices, Exquisite Care: Palliative Care Assessment and Management of Patients With Ventricular Assist Devices (308): Heart Failure SIG

1.Discuss a general overview of ventricular assist devices and the associated benefits/burdens, morbidity, and mortality.2.Describe the role of the palliative care consultant in shared decision making and informed consent during the decision process; and explore the importance of advance care planning with patient and surrogate(s).3.Review key components of the process of implantable cardiac support device deactivation, to promote successful outcomes and appropriate support in this setting. Cardiovascular disease is the leading cause of death in the world. To this end, ventricular assist devices (VADs) have been developed to promote improved quality of life, as well as improved survival in patients who are or are not eligible for transplantation. As VAD availability and implantation rates increase for patients with advanced heart failure, palliative care (PC) and hospice providers will need to keep pace with developments regarding this therapy to optimize patient-centered outcomes. In this session, we will review selection criteria for VAD implantation, with particular attention to recommendations for PC consultant involvement in this process. The role of the PC consultant evolves as a patient proceeds through the stages of device evaluation, shared decision-making, post-implantation care planning and management, and finally end-of-life care including device deactivation. We will review key fundamentals for performing a palliative care assessment in this patient population, including the indications, applications, benefits/risks, and management of VADs. The unique features, risk profiles, frequently-encountered complications, and symptom management issues in this population will be reviewed. We will further review prognostication for these complex patients, and how to successfully plan and execute device deactivation when the VAD is no longer consistent with the patient's goals of care. In order to accomplish optimal VAD deactivation, factors including care setting, presence of other life support devices, and patient/surrogate(s) preferences must be considered. The contributions that PC can bring to the processes of informed consent, shared decision making, and advance care planning will be discussed.

J241033 心臓矯正ネットの設計を目的とした心機能シミュレーションと評価

The cardiac support device, CSD, which is a net covering the patient's heart to prevent cardiac dilation has been focused In this study, an optimum design method for patient specific 'order-made' support net is developed, which fit the patient's heart shape completely The patient's 3D model heart is constructed using MR imaging In order to evaluate our method, the heart model is represented as a hexahedrons mesh and numerically analyzed its behavior using the finite element method The deformation of the heart model during one cycle beat is calculated and the leftward shift of P-V loop when the net is used is shown which means the prevention of heart dilation