- Ventricular Assisted
- Abstract
- There have been various researches done with regard to the development and the use of the artificial heart. This paper provides a brief review with regard to the research done on the use of the use of the artificial heart. The recent studies indicate that the artificial heart can also be used to support the native heart failure recovery among the infants. During the treatment of the acute heart failure the ventricular assist device have been used to provide ventricular support. in addition the discovery of artificial heart has also led to the emergence of some contemporary ethical issue where some people fear that the development lead to creation of machine with human characters. However analyses of the recent research related to artificial hear it is evident that there is need for a research to be done to lower various risks associated with heart transplant.
- Introduction
- The artificial heart refers to a mechanical device that is connected to the heart or may be implanted in the chest to help in the replacing of a failing heart. The artificial heart has several valves that are provides a mechanism that is used to propel the blood into the body. This paper aims at reviewing some of the recent trends with regard to the artificial heart. In relation to this the paper aims reviewing how the mechanical heart is used to reverse heart failure in the infants and children. Another study reviewed in this paper includes some of the physiological benefits associated with use of the artificial hearts. Moreover the paper also reviews some of the ethical issues that have been raised with regard to the use of artificial heart to support the circulatory system. Considering the current research related to the artificial heart, it is evident that there is need for further research to be done in order to develop small artificial heart and hence ensure the patients are comfortable carrying the device. In addition, there has also been an increase in the number of risk associated with heart transplants. This implies that there is need for invention of better effective methods that can help to lower these risks.
- Role of the artificial heart in reversing the heart failure in the infants
- The artificial heart has been used in the treatment of the children with severe heart failure. Most of the studies indicate that the ventricular assisted devices (VAD) are used in the treatment of the heart failure in the children. However, a recent study by Zimmerman et al,. (2010) indicates that the (VAD) can support the native heart recovery among the infants. Recovery of dilated cardiomyopathies with combination of the left ventricular decompression and the treatment maximal medical therapy had previously been investigated in the adult (Zimmerman,et el 2010). In their study they used they used the pulsatile and the continuous flow VAD and the TAH as the bridge to transplant (Zimmerman,et el 2010). In addition in the study they were able to establish that for the children with >20kg the use of the artificial device permitted the thoratic mobility. For the case of large in children the TAH is preferred for the rapid decompensation and the cardiac shock.
- Use of these artificial hearts in the treatment of the infants has various advantages. First, there has been an increase in the number of children in need of the artificial heart transplant, which implies that the presence of recovery of heart failure using this method can help to lower these cases. (Zimmerman,et el, 2010). It has also been established that transplantation limits the long-term survival and lower quality of life of the young child. Recovery of the heart using the artificial heart therapy helps to return the normal functioning of the heart and therefore ensure that the child does not suffer any immunosupression. In this case, the use of this method can help to reverse the heart failure diseases and ensure that the child is able to leave a normal life.
- Role the artificial heart in the support of acute heart failure
- The acute heart failure consists of the varied set of clinical syndromes that are characterized by the sudden decrease in the cardiac functions. However the most serious heart failure is the systemic refractory cardiogenic shock (SRCS) failure, which carries a mortality rate of in the range of 50% to 80%. This implies that in most cases the acute heart failure leads to death. One of the immediate goals of treating the patient with the systemic refractory cardiogenic shock is to try and restore the normal levels and prevent the development of the secondary organ failure. The use of the mechanical circulatory support technology helps to avoid the end organ damage and play a critical role in the survival of the patients suffering from the acute heart failure. Surgically inserted Ventricle Assistance Device helps in providing a major support to the cardiac output. In addition studies indicate that the use of the VAD can help support the heart cardiac muscles.
- Moreover, the use of the cardiopulmonary support with extracorporateral oxygenation cans help to support the respiratory system of the patient with acute heart failure. In relation to this the tandem heart which consist of the centrifugal pump, a transeptal inflow cannura, and a standard arterial outflow canura helps to pump the blood from the left atrium to the femoral artery at a rate of 5l/min. This tandem device is used to stabilize the patients with the severe refractory cardiac shock and therefore provides the patient with an opportunity for a more complete diagnostic and precise therapeutic planning. Current use of the VAD in the treatment of the SRCS has helped to avoid the development of multisystem failure and death of the patients. In addition the availability of the new blood pumping technology has also facilitated the restoration of the adequate circulation of blood and facilitates long-term survival in the patient with severe refractory cardiac shock.
- Currents contemporary ethics related to the artificial heart
- Following a success artificial heart transplant that at the jewish hospital in louisvilles on July 2001 various ethical issues arose (Simmons, 2001). Some people argued that protecting there was needed to protect the human beings from the being used in the research. In relation to this some people argue that it is unethical to subject the human being into research in the name of developing an artificial heart. Various artificial heart programs were initially terminated when people realized that the installation of an artificial heart would be expensive. In this case most people argued that it was a waste of time for scientist to engage in projects, which in the long run cannot benefit anybody. However after intervention from influential researchers and combined with powerful political leaders the project of making artificial heart was able to commence successfully.
- Another contemporary issue related to the implementation of the artificial heart is the issues related to the informed consent. In relation to this the major ethical issue involves keeping the role of a researcher distinct from that of a physician. This is because the caring of the patient should remain the primary role of the patient. Involving the physician in the research may therefore compromise the advocacy role of the physician. Most people also consider that involving the physician in the research to be unethical since most cases these research are conducted without the consent of the patient. Severe consequences such as death of the patient may are also common during the execution of these researches.
- Some people argue that the artificial heart transplant is unethical since it may promote generation of a robot-like creature that has human features. Many people fear that the new scientific invention will lead to generation of the cybernetics, which refers to the science of combining the computer technology with the neurological capacity close to that of human beings. In this case some people fill that allowing such advances of technology to continue will give machines more human characters such as intelligence thought, feeling and therefore lead creation of machine, which resemble humans.
- Problems associated with artificial heart
- There has been an increase in the number of heart failure cases worldwide with over 100000 patients reported in USA alone (Ramakrishna & Pajaro 2011). However, it is important to note that only approximately 225 centers around the world were carrying out heart transplant cases worldwide. This therefore implies that most of the patients are unable to access this treatment. Despite the various improvements in the transplantation the process still has several problems. One of the possible problems associated with the transplant is the graft failure, which leads to the death of the patient. Some of the patient also suffers from the heart failure after the transplant 2-2.5% of patient suffer from the heart failure (Ramakrishna & Pajaro 2011). The process of heart transplant is also expensive for patient from middle income earners may not be able to afford for the payment for the treatment.
- Shortage of donor is also another problem associated with the use of the artificial heart (Khemees, & Shabsigh, 2012). This shortage of the donor is due to the recent raising of the standard required in the manufacture of artificial heart (Barnard & 2012) According to the new requirement the artificial heart should be made following the automobile safety technology and ensure that there is trauma prevention( Ramakrishna & Pajaro, 2011). In addition the transplanting process has also been associated with various risks of infections such as the postoperative bleeding. The patient is also likely to suffer the risk of gastrointestinal bleeding due to the pumping of the artificial heart. Furthermore it has also been established that the most of the patient are uncomfortable living permanently with the artificial pumping heart this implies that the scientist have a challenges of developing a small implantable device and hence ensure that the patient are comfortable with the size of the artificial heart
- Implementation of the cardio west temporary artificial heart
- There have been various advancements in the development of the mechanical circulatory support. One of the major advancement include the introduction of the cardio west temporal artificial heart (TAH-t) which has been approved by the US food and Drug Administration (Platis & Larson, 2009). The cardio west temporal total artificial heart is a biventricul, pulsatile and pneumatically driven blood pump (Cheng,& David,2005). This device helps to replace the failing atrium and ventricles of the heart. Each of the heart ventricles is connected to the device to facilitate blood pumping. The TAH-t is connected to an external primary and back up controller, which help to provide the ability to adjust the heart rates systolic percentages, driveline pressure and vacuum for ventricles (Iaizzo, 2009). The cardio west TAH-t also used in acting as a pivoted bridge before the donor heart becomes available (Platis & Larson, 2009).
- Cardio west temporary artificial heart has several advantages than the ordinary ventricular assisted devices. In this case one of the major advantage of the TAH-t is the fact that it uses the transcutaneous energy transfers system and a radio frequency communication (Platis & Larson, 2009). This allows the system to be controlled by signals transmitted from the across the skin contact. During the treatment of the of patient with the heart failure the TAH-t allows the medical personnel to adjust the vacuum in each of the heart ventricle so that proper amount of blood is ejected out of each ventricle (Platis,2009). However one of the disadvantage of the cardio west temporary artificial is the fact that it can lead to infection. According to platis (2009) the use of the device can also lead to reduced blood pressure and respiratory dysfunction
- Influence of the ventricular assisted device on the survival, infection and rejection rates
- There has been an increase in the use of the ventricular assisted device (Shuhaiber, Hur, & Gibbons, 2009). During the heart transplant the left ventricular assist device have proofed to be effective in extending lifetime of patient awaiting heart transplant. The positive effect of the device is attributed to the efficiency in circulatory support. Various left ventricular assist devices are available in the market today and however it is important to note that are no ideal device..
- Shuhaiber, et al. (2009) set out a study to compare the survival outcomes between the people who received heart transplant in the Novacor and those who received transplant in Heartmate in USA. In addition, the researchers also aimed at identifying the various risk factors that are associated with survival, infections and injection within the two hospitals. In their preliminary study they were able to establish that 154 patient from Novacor were able to receive transplant between 1991 and 2004 while at the same time 1255 patient received heart transplant in Heartmate hospital (Shuhaiber, Hur, & Gibbons, 2009). This therefore implies that data from the two hospitals could therefore be used in the research of determining the risks factors associated with the use of the device. After carrying out the study Shuhaiber et el (2009) was able to establish that the five year recipient of Novacor hospital had a lower post heart survival rates than the Heartmate recipients ( Shuhaiber, Hur, & Gibbons, 2009). One of the major causes of the difference in the survival rate of the patients between the two hospitals was the donor characteristics. Another cause of low survival rates among the patient who undergone heart transplant was due to the presence of foreign objects in the body (Shuhaiber, Hur, & Gibbons, 2009). In addition the increased rate of infection was also due to the immune-compromised condition of the body after transplant. Furthermore recent study indicates that the older patients who exposed to heart transplant are likely to have low survival rates due to the immune suppression of their body ( Shuhaiber, Hur, & Gibbons, 2009). This therefore implies that there is a need for research to be done in order to establish way of increasing the survival rates of the old patient who receive heart transplant.
- Conclusion
- From the above it is evident that the recent research has enabled the use of artificial heart in the treatment of the heart failure among the infant. This new application of the artificial heart has helped to increase the survival rates of infant with heart failure since they are now able to undergo a native heart recovery. The mechanical circulatory support has been used in the treatment of the patient with acute heart failure. In relation to this the ventricular assist device has been used to increase the heart ventricular cardiac output and hence the help the patient with acute heart failure. Various contemporary ethical issues have also emerged with the use of the artificial heart in the treatment of the heart failure. In this case some people argue that it is unethical for the doctors to be involved in the research while at the same time in the treatment of the patient. In addition, some of the patient suffers from risk such as gastrointestinal and respiratory damage. However, analysis of the research related to the heart transplant it is evident that research need to be done in order to improve the survival rates of the old patient who receive heart transplant.
- Reference
- Barnard, J., & L. (2012). The total artificial heart in a cardiac replacement therapy programme. British Journal Of Hospital Medicine (17508460),
- Cheng, D. C. H., & David, T. E. (2005). Perioperative care in cardiac anesthesia and surgery. Philadelphia, PA: Lippincott Williams & Wilkins.
- Gregoric, I. D. (2012). Mechanical Circulatory Support in Acute Heart Failure. Texas Heart Institute Journal, 39(6), 854-855
- Iaizzo, P. A. (2009). Handbook of cardiac anatomy, physiology, and devices. New York, NY: Springer.
- Khemees, T. A., & Shabsigh, A. (2012). Regaining Candidacy for Heart Transplantation after Robotic Assisted Laparoscopic Radical Prostatectomy in Left Ventricular Assist Device Patient. Case Reports In Transplantation, 1-4.
- Platis, A. (2009). Commentary on: CardioWest total artificial heart. Perfusion, 24(5), 347-348
- Platis, A., & Larson, D. (2009). CardioWest temporary total artificial heart. Perfusion, 24(5), 341-346.
- Ramakrishna, H., & Pajaro, O. (2011). Heart transplantation in the era of continuous flow v entricular assist devices and the total artificial heart: will new technologies surpass the gold standard?. Annals Of Cardiac Anaesthesia, 14(3), 174-175
- Shuhaiber, J., Hur, K., & Gibbons, R. (2009). Does the Type of Ventricular Assisted Device Influence Survival, Infection, and Rejection Rates Following Heart Transplantation?. Journal Of Cardiac Surgery, 24(3), 250-25
- Simmons, P. (2001). Currents in contemporary ethics. The artificial heart: how close are we, and do we want to get there?. Journal Of Law, Medicine & Ethics, 29(3-4), 401-40
- Zimmerman, H., Covington, D., Smith, R., & Copeland, J. (2010). Mechanical Support and Medical Therapy Reverse Heart Failure in Infants and Children. Artificial Organs, 34(11), 885-89
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