Advances in Cardiovascular Technology

New Devices and Concepts

1st Edition - June 5, 2022
Editors: Jamshid Karimov, Kiyotaka Fukamachi, Marc Gillinov
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 9 5 8 7 8 - 3
eBook ISBN:
9 7 8 - 0 - 1 2 - 8 1 6 8 6 2 - 2

Advances in Cardiovascular Technology: New Devices and Concepts is a comprehensive reference for cardiovascular devices of all types. For engineers, this book provides a basic und… Read more

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Advances in Cardiovascular Technology: New Devices and Concepts is a comprehensive reference for cardiovascular devices of all types. For engineers, this book provides a basic understanding of underlying pathologies and their prevalence/incidence. It also covers what devices are available, how they are clinically used, and their impact on pathophysiology. In addition, the book presents the constraints imposed on device design and manufacture by the environment in which it is used (e.g., exposure to tissues within the body, blood in particular) and the primary requirements for each specific type of device, including its durability and resistance to fatigue.

For clinicians, this book contains information on primary engineering challenges, the types of devices available, their advantages and disadvantages, and the (current and emerging) tools and materials available to device designers.

Cover image
Title page
Table of Contents
Copyright
Dedication
List of contributors
Foreword
A Tribute to Innovations in Cardiovascular Care Pioneered at Cleveland Clinic
Preface
Part I: Cardiovascular Practice
Chapter 1. The History of Cardiac Device Innovation: the Collaborative Triumph of the Kay-Cross Oxygenator
Abstract
Chapter Outline
Introduction
Heart-lung machines and the rise of open heart surgery
Developing the Kay-Cross Oxygenator
Device design, manufacturing, and sales
A practical solution
Ease of translation from lab to operating room
(Relative) Ease of cleaning, assembly, and operation
Tech support and tinkering
Conclusion
References
Chapter 2. The Critical Need for Ongoing Innovation in Cardiovascular Medicine
Abstract
Chapter Outline
Conflict of interest
References
Part II: Cardiovascular Perfusion
Chapter 3. Progress in Cardiovascular Perfusion and Technology
Abstract
Chapter Outline
Introduction
Pump
Circuit
Oxygenator
Cardioplegia
Neurological protection
Conclusion
Conflicts of interest
References
Chapter 4. Organ Perfusion and Cardiopulmonary Bypass Techniques
Abstract
Chapter Outline
Adult perfusion circuit
Hemodilution reduction
Goal directed perfusion
Pediatric perfusion circuit and methods
Pediatric autotransfusion
GEM premier 3500
Adult autotransfusion
Arterial line filter technology
Oxygenators—current state-of-the-art
Oxygenators—room for improvement
Heat exchangers
Heater-coolers—field modifications
Heater-coolers—room for improvement
Conclusions
References
Part III: Mechanical Circulatory Support and Organ Replacement
Chapter 5. Demand for Mechanical Circulatory Support
Abstract
Chapter Outline
Introduction
Temporary MCS
Durable MCS
MCS for a pediatric population
Contraindications
Conclusions
References
Chapter 6. Continuous-Flow Ventricular Assist Devices
Abstract
Chapter Outline
Abbreviations
Introduction
Axial-flow pump
Centrifugal-flow pump
Conclusions
References
Chapter 7. Research and Development for Creating a Universal Ventricular Assist Device
Abstract
Chapter Outline
Background
Technology overview
Volute housing enhancements
Improvements to rotating assembly
Engineering and optimization of motor stator
Computational fluid dynamics analysis
In vivo testing
Summary
References
Chapter 8. Right Ventricular Assist Device
Abstract
Chapter Outline
Background
Right heart failure severity grades
Results
Discussion
Conclusion
References
Chapter 9. Advanced Approaches for Total Artificial Heart Development
Abstract
Chapter Outline
Introduction
Cleveland Clinic total artificial heart design
Computational fluid dynamics for biocompatibility analysis
Right impeller design changes
Total artificial heart for pediatric use
Total artificial heart for very small patients
Biventricular heart failure support using a dual centrifugal pump
Summary
References
Chapter 10. Cardiac Transplantation and Organ Preservation
Abstract
Chapter Outline
Introduction
Which solution to preserve the heart?
Warm or cold?
Blood or crystalloid? Which carrier for oxygen?
Ischemic or nonischemic?
How to assess organ preservation?
Hurdles and challenges of prolonged cardiac perfusion
From cardiac preservation to organ banks
Conclusions
References
Chapter 11. Extracorporeal Membrane Oxygenation in Adults
Abstract
Chapter Outline
Introduction
Venovenous extracorporeal membrane oxygenation for respiratory failure
Venoarterial extracorporeal membrane oxygenation for cardiac failure
Extracorporeal cardiopulmonary resuscitation
ECMO anticoagulation
Equipment
Monitoring
Conclusion
References
Chapter 12. Device-Based Circulatory Support Therapy for Heart Failure with Preserved Ejection Fraction
Abstract
Chapter Outline
Introduction
Interatrial shunt device
LV expander
Electrical therapy for HFpEF
Left ventricular assist devices for diastolic dysfunction
Devices in development (preclinical)
Summary
References
Part IV: Innovative Surgical Approaches and Interventional Techniques
Chapter 13. Cardiac Implantable Devices in Heart Failure: Role of Imaging
Abstract
Chapter Outline
Introduction
Types of devices
LV remodeling devices
Cardiac resynchronization therapy
Mechanical circulatory support devices
Short-term assist devices
IABP devices
ECMO devices
Impella devices
Long-term circulatory support devices
Imaging in patients with VAD
Total artificial heart
Conclusions
References
Chapter 14. Imaging Technologies and Virtual Planning for Congenital Heart Repairs
Abstract
Chapter Outline
Introduction
Cross-sectional imaging overview
Role of cardiac computed tomography
Role of cardiac magnetic resonance
Imaging segmentation
CCT versus CMR for segmentation
Image rendering: surface versus volume
3D printing
Augmented reality and mixed reality
Hemodynamic simulation
Addressing limitations of advanced 3D imaging and surgical simulation
Conclusion
References
Chapter 15. Evolution of Device Therapies for Cardiovascular Surgical Care in Children
Abstract
Chapter Outline
History of device therapies in children for cardiovascular surgery
Mechanical circulatory support
Material science and novel devices
Conclusion
References
Chapter 16. Robotic Mitral Valve Surgery: New Techniques and Solutions
Abstract
Chapter Outline
Introduction
History of robotics in cardiac surgery
Clinical presentation
Preoperative testing
Surgical technique
Tips and pitfalls
References
Chapter 17. Transcatheter Aortic Valve Procedures: Technology Update
Abstract
Chapter Outline
Introduction
Anatomical and clinical requirements for TAVI
Technological foundations of contemporary TAVI practice: valve devices
Technological development pathways for clinical outcome improvement
Other technology pathways
Conclusions
References
Chapter 18. Technology Advancement for Percutaneous Interventions for Mitral Regurgitation
Abstract
Chapter Outline
Introduction
Anatomy and pathophysiology
Classification of mitral regurgitation
Acute mitral regurgitation
Chronic primary/organic mitral regurgitation
Chronic secondary/functional mitral regurgitation
Diagnosis
Current treatment options for MR
Percutaneous interventions
Transcatheter mitral valve repair
Conclusion
References
Chapter 19. Transcatheter Mitral Valve Replacement: Technology Update
Abstract
Chapter Outline
Introduction
The challenges inherent to TMVR
Devices and technologies
Conclusions
References
Chapter 20. Novel Developments in Tricuspid Valve Assessment and Treatments
Abstract
Chapter Outline
Background
Tricuspid stenosis
Tricuspid regurgitation
Surgical techniques
Tricuspid replacement
Transcatheter technologies
Noninterventional therapies
Conclusion
References
Chapter 21. Innovative Surgical Techniques for Complex Aortic Repair
Abstract
Chapter Outline
Introduction
Conclusion
References
Chapter 22. Innovative Technologies for Hybrid Cardiovascular Repair
Abstract
Chapter Outline
Introduction
Coronary revascularization
Structural heart disease
Aortic disease
Miscellaneous
Conclusion
References
Chapter 23. Intraoperative Cardiac Deairing: New Concept and Technology
Abstract
Chapter Outline
Background
Cardiac deairing system
Design and development
Discussion
Summary
References
Part V: Treatment of Cardiac Rhythm Disturbances
Chapter 24. Cutting-Edge Technologies for Cardiac Rhythm Treatment: Recent Progress of Catheter Ablation Using Radiofrequency Current and Pulsed Electric Field
Abstract
Chapter Outline
Introduction
Recent progress of radiofrequency ablation systems
Pulsed electric field ablation
Conclusion
References
Chapter 25. Modern Technologies for Cardiac Resynchronization Therapy
Abstract
Chapter Outline
Abbreviations
Introduction
Cardiac resynchronization therapy
Device-based algorithms
SyncAV
Clinical outcome
Future
Summary
References
Chapter 26. Innovative Approaches and Technology Platforms for Pacemaker Lead Extraction
Abstract
Chapter Outline
Introduction
Preoperative phase
Preoperative evaluation and planning
Operative phase
Managing complications
Summary
References
Chapter 27. Surgical Devices for Cardiac Radio-frequency Ablation
Abstract
Chapter Outline
Introduction
Transfer from clinical need to technology—problem definition
RF ablation principles
Design solutions
Future advancements in cardiac ablation
References
Chapter 28. Novel Devices for Epicardial Left Atrial Appendage Management
Abstract
Chapter Outline
Introduction
Transfer from clinical need to technology
Development path to state of art technologies
State of the art
Future directions
References
Chapter 29. Technology for Surgical Cardiac Cryoablation Procedures
Abstract
Chapter Outline
Introduction
Translating clinical drivers to technology needs
Development path to state-of-the-art technologies
State-of-the-art technologies
Future directions
References
Part VI: Hemodynamic Patient Monitoring
Chapter 30. Basic Hemodynamic Parameters
Abstract
Chapter Outline
Introduction to the cardiovascular system
Left heart and systemic circulation
Right heart and pulmonary circulation
Hemodynamic parameters of the systemic circulation
Hemodynamic parameters of the pulmonary circulation
Cardiac output
Secondary parameters: vascular compliance, elastance, resistance
Oxygen saturation
References
Chapter 31. Wearable Technologies for Cardiac Monitoring
Abstract
Chapter Outline
Introduction
Historical innovations for noninvasive measurement devices
Contemporary applications
Development challenges
Summary
References
Chapter 32. Intelligent Systems and Smart Devices for the Continuous Monitoring of Cardiac Hemodynamics
Abstract
Chapter Outline
Abbreviations
Introduction
Pressure sensors
Volume sensors
Flow sensors
Outlook
References
Chapter 33. Microcirculation and Tissue Perfusion Assessments for Complex Cardiovascular Disease Care
Abstract
Chapter Outline
Abbreviations
Introduction
Microcirculation—the business side of circulation
Circulatory failure and oxygen delivery
Tissues for noninvasive microvascular examinations
The oxygen delivery index concept
Oxygen delivery index proof of concept studies
Examples of microvascular parameters in health and disease
Summary
References
Chapter 34. Technologies for Hemodynamic Measurements: Past, Present and Future
Abstract
Chapter Outline
Introduction
Arterial pressure
Venous pressure
Flow measurements
Additional parameters correlated to hemodynamic monitoring
Appendix: Pressure transducers
References
Part VII: Future Directions of Cardiovascular Technology
Chapter 35. Cardiovascular Device Markets: Where Do We Go Now?
Abstract
Chapter Outline
Background
Trends in aortic valve replacement
Lather, rinse, and repeat?
Opportunities in cardiovascular device markets
Contribution of cardiovascular technologies to global medical devices and diagnostics market
Underserved cardiovascular diseases drive growth opportunities
Ingredients for success
Industry trends: dollars and deals
Conclusions
References
Chapter 36. Innovation in Cardiovascular Bioelectronics
Abstract
Chapter Outline
Introduction
Device features
Disease applications
Bioelectronics-enabled medical internet-of-things
References
Chapter 37. Diagnostics and Prevention: Landscape for Technology Innovation in Precision Cardiovascular Medicine
Abstract
Chapter Outline
Introduction
Genomic medicine in cardiovascular care
Stem cell and tissue engineering in cardiovascular medicine
Artificial intelligence in cardiovascular imaging
Digital health advances in individualized cardiovascular care
Summary
Funding support
Disclosure
References
Chapter 38. Devices that Enhance the Biomechanics of the Failing Heart
Abstract
Chapter Outline
Devices for heart failure with reduced ejection fraction
Devices for heart failure with preserved ejection fraction
Augmentation of atrioventricular valvular biomechanics
Conclusion
References
Chapter 39. Advancement of Technology and Innovation for Future Cardiovascular Care
Abstract
Chapter Outline
Setting the stage
Why we need to push for paradigm shifts
CVD paradigm shifts: successful innovation and progress
Necessary elements for healthcare innovation and progress
Emerging and future innovations
Threats to innovation and progress
One institution’s approach to data stewardship in the age of healthcare innovation and progress
Summary and conclusions
References
Index

Jamshid Karimov

Jamshid H. Karimov, MD, PhD, FAHA, FACC is a cardiac surgeon, researcher, inventor and author with extensive experience in device therapies for heart failure, mechanical circulatory support, total artificial hearts, cardiac replacement, and minimally invasive cardiac surgical techniques. He is currently affiliated with the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and the Department of Biomedical Engineering, Molecular Medicine, Cleveland Clinic Lerner Research Institute. Dr. Karimov’s research interests and innovative work focus on development of simple surgical devices, new methodologies, advanced cardiac therapies, and platform technologies for cardiovascular applications. As an inventor and Principal Investigator, Dr. Karimov conducted first-in-man efforts at Cleveland Clinic. He has achieved the longest in vivo duration for continuous flow total artificial heart implantation. He has also introduced innovative methods for intraoperative cardiac device management and designed new cardiovascular devices.

Affiliations and expertise

Project Staff, Adjunct Assistant Professor of Molecular Medicine, Department of Biomedical Engineering, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA

Kiyotaka Fukamachi

Kiyotaka Fukamachi, MD, PhD, is a cardiovascular surgeon by training and has been working full-time in research since joining Cleveland Clinic in 1990. He is Director of the Cardiovascular Dynamics Lab and Section Head of Biomechanical Devices in the Cleveland Clinic Department of Biomedical Engineering. He is also a Professor in the Department of Biomedical Engineering and Department of Molecular Medicine at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Dr. Fukamachi has extensive experience in the development and evaluation of mechanical circulatory support devices such as the Cleveland Clinic-Nimbus total artificial heart (TAH), CorAide™ left ventricular assist device (LVAD), MagScrew TAH and LVAD, PediPump™ pediatric circulatory assist device, DexAide right ventricular assist device (RVAD), continuous-flow TAH (CFTAH), and the pediatric version of the CFTAH (P-CFTAH). He has also been involved in simple cardiac devices such as the Coapsys® and the Gillinov/Cosgrove AtriCure AtriClip. Over the course of his career, he has accumulated nearly 300 scientific publications, 254 abstracts, and 330 presentations.

Affiliations and expertise

Director, Cardiovascular Dynamics Lab and Section Head, Biomechanical Devices, Department of Biomedical Engineering, Cleveland Clinic; Professor, Department of Biomedical Engineering and Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, USA

Marc Gillinov

Marc Gillinov, MD, is Chair of the Cleveland Clinic Department of Thoracic and Cardiovascular Surgery. Since joining Cleveland Clinic in 1997, Dr. Gillinov has become one of the nation’s busiest heart surgeons. He specializes in robotic and minimally-invasive heart valve repair and replacement. His patients range from Academy Award winner Robin Williams to his long-time barber, Vince. A prolific researcher, Dr. Gillinov has more than 450 scientific publications to his credit and has been instrumental in the development of medical devices and treatments that enhance the care of cardiac patients. Spurred by patients’ questions, Dr. Gillinov extended his efforts to help people achieve heart health by teaming with Cleveland Clinic cardiologist Dr. Steven Nissen to write the myth-busting book, “Heart 411: The Only Heart Guide You Will Ever Need.” He also appears on WJW-TV, Fox 8 Cleveland, as “Dr. Marc.” Dr. Gillinov is thrilled and honored to work with the nation’s number one heart team (27 years in a row!) to improve the heart health of people from around the country and around the world.

Affiliations and expertise

Chair, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, USA