Assisted Circulation

J. Navratil The performance of operations on the heart and its replacement by a trans­ planted or artificial heart has been an age old dream of man. Rehn for example in an early attempt, in 1868 performed a closure of a heart wound after a thoracic puncture. At that time noone thought that this attempt was the beginning of cardiac surgery. The dream was partially realized when the replacement of the heart function by the heart-lungmachine became possible. Immediately following the first operations, cardiac surgeons and cardiologists saw with great enthusiasm that this machine could be an important tool for correcting congenital and non­ congenital heart diseases. However, the heart-lungmachine was soon seen to not be an optimal instrument for controlling cardiac failure after cardiopulmonary bypass or myocardial infarction. then arose for the development of mechanical assistance to the heart. Concepts The rollerpump was first designed for assisted circulation and could be applied clinically in 1962. A new concept of mechanical assistance to the heart was pro­ vided by the intra aortic balloon pump and later by the bypass ventricles. Use of the intra aortic balloon pump can reduce cardiac work by counterpulsation in accord with the natural ECG. The bypass ventricle can functionally replace the heart in series or parallel to the natural heart. The intra aortic balloon pump, now an established method, has reduced the number of patients who used to die from cardiac failure.

Historical Background.- Medical Research and the Doctor’s Conscience.- Questions and Predictions.- I. Counterpulsation.- 1. Counterpulsation: Foundation and Future.- 2. Intra-aortic Balloon Pumping: Current Status and Prospects.- 3. Clinical Experience with Intra-aortic Balloon Pumping and the Pulsatile Assist Device.- 4. Clinical Results of Intra-aortic Balloon Pumping in Selected Groups of Patients.- 5. Indications for Intra-aortic Balloon Pumping.- 6. Changing Role of Cardiac Assistance in the Management of Myocardial Infarction Shock.- 7. The State of Assisted Circulation in the USSR.- 8. The Present Status of External Counterpulsation.- 9. Hemodynamic Response to External Counterpulsation.- II. Left Ventricular Assist Devices.- a) Bypass Ventricles.- 10. A Left Ventricular Aortic Blood Pump for Circulatory Support in Postoperative Patients with Acute Left Ventricular Failure.- 11. An Intracorporeal (Abdominal) Left Ventricular Assist Device: Initial Clinical Trials (LX).- 12. The Ellipsoid Left Ventricular Assist Device: Experimental and Clinical Results.- 13. Design and Evaluation of a Left Ventricular Assist Device: The Angle Port Pump.- 14. An Efficient Electromechanical Left Ventricular Assist Device.- 15. Toward a Blood Pump for Long-Term Left Ventricular Assist Device.- 16. Servo-Controlled Cardiac Assistance: The Effects of Left Ventricular-to-Aortic and Left Atrial-to-Aortic Assistance on Infarct Size.- 17. Atrio-Aortic Left Ventricular Assist Device.- 18. Left Ventricular Assistance with a Double-Chambered Alternate Pumping Device.- b) Roller Pumps.- 19. Concepts and Clinical Experience with a Left Ventricular Assist Device After Intracardiac Operation.- 20. Experimental and Clinical Left or Biventricular Assist Device with Local Heparinization and Blood Filtration.- 21. Low Flow Right Atrial and Left Ventricular Assist Device Without an Oxygenator for Cardiogenic Shock. A Revised Concept.- c) Centrifugal Pumps.- 22. A Centrifugal Pump for Circulatory Assistance.- 23. Partial or Total Heart Substitution with a Double-Centrifugal Device ― Theoretical and Physiologic Studies.- d) Extracorporeal Membrane Oxygenation.- 24. Pulmonary Hemodynamics and Gas Exchange During Venoarterial Bypass with Membrane-Lung Oxygenation.- 25. Aortic Arch Perfusion Modes in Partial and Total Cardiopulmonary Bypass.- III. Total Artificial Heart.- 26. The Total Artificial Heart ― a Research Tool or Potential Clinical Reality.- 27. The State of the Art of the Berlin Total Artificial Heart ― Technical Aspects.- 28. Experimental Results on the Long-Term Survivals (over 1 Month) with a Total Artificial Heart.- 29. Design of the Pennsylvania State University Artificial Heart and Electronic Automatic Control System.- 30. The Ellipsoidheart in Total Artificial Heart Replacement.- 31. Control Systems for the Total Artificial Heart.- 32. The State of Total Artificial Heart Research in the USSR.- 33. Total Artificial Heart Replacement with Consecutive Heart Transplantation.- IV. Heart Transplantation.- 34. The Clinical Application of Implanted Natural Auxiliary Hearts.- 35. Current Status of Heart Transplantation: the Stanford Experience.- 36. Experimental Auxiliary Heart Transplantation.- V. Driving Systems.- 37. Drive and Management of Circulation Support Systems.- 38. Control of Electric Pneumatic Driving Systems.- 39. The Electrically Driven Left Ventricular Assist Device.- VI. Biomaterials, Artificial Valves.- 40. Material Aspects of Cardiac Assist Devices: the Case History of Avcothane 51 Elastomer.- 41. Some Current Problems and New Dimensions of Polymeric Biomaterials for Blood Contacting Applications.- 42. Hydrophobic Polymers as Materials for Interfacing with Blood.- 43. Carbon Cardiovascular Devices.- Artifical Valves.- 44. Hemolysis in Artificial Heart Valves due to High-Level, Short-Duration Laminar Shear Stress.- VII. Current Literature, 1.1.1975–31.12.1978.- VIII. Places Where Assisted Circulation is Performed.- IX. Summaries.- X. Horizons on the Future Trends in Assisted Circulation.- 45. E. S. Bücherl.- 46. D. A. Cooley.- 47. M. E. DeBakey.- 48. P. Frommer.- 49. F. Gschnitzer.- 50. S.D.Moulopoulos.- 51. Y. Nosé.- 52. K.Polzer.- 53. Å. Senning.- 54. J.T.Watson.