Mechanical Circulatory Support PDF
Preview Mechanical Circulatory Support
Mechanical Circulatory Support Wayne E. Richenbacher,MD Universityof IowaHospitalsandClinics DivisionofCardiothoracicSurgery , , . . . IowaCity Iowa US A CRC Press Taylor&FrancisCroup Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business VADEMECUM Mechanical Circulatory Support First published 1999 by Landes Bioscience Published 2019 by CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 1999 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works ISBN 13: 978-1-57059-530-1 (pbk) This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint. Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. (Fhotrt pp:/e/rwmwiswsi.coonp tyor ipghhot.tcoocmop/)y oorr cuosen tmacat tetrhiea lC eolepcytrriognhitc aClllye afrraonmc et hCise nwtoerr,k ,I npcl.e a(sCeC aCcc),e s2s2 w2 wRwo.sceowpoyoridg hDt.rciovme. Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Library of Congress Cataloging-in-Publication Data Mechanical circulatory support / Wayne E. Richenbacher. p. cm. "Vademecum." Includes bibliographical references and index. ISBN 1-57059-530-5 (spiral/pbk.) 1. Blood-Circulation, Artificial-Instruments Handbooks, manu als, etc. 2. Extracorporeal membrane oxygenation Handbooks, manuals, etc. 3. Heart, Mechanical Hanbooks, manuals, etc. 4. Heart failure— Treatment Handbooks, manuals, etc. I. Richenbacher, Wayne E. [DNLM: 1. Assisted Circulation. WG 168 M4855 1999] RD598.35.A77M43 1999 617.4T206— dc21 DNLM/DLC 99-33746 for Library of Congress CIP While the authors, editors, sponsor and publisher believe that drug selection and dosage andthespecificationsand usageofequipmentanddevices,assetforth in thisbook,arein accord with current recommendations and practice at the time of publication, they make no warranty, expressed or implied, with respect to material described in this book. In view of the ongoing research, equipment development, changes in governmental regula tions and the rapid accumulation of information relating to the biomedical sciences, the reader is urged to carefully review and evaluate the information provided herein. Dedication - To my parents who provided me with the opportunity. To my wife for her unwavering support. To my children who make it all worthwhile. Contents — 1. Overview of Mechanical Circulatory Support 1 Wayne E. Richenbacher Introduction 1 Developmental Hurdles Encountered During Mechanical Blood Pump Development 2 Management of Heart Failure 6 Future of Mechanical Circulatory Support 8 2. Developing a Mechanical Blood Pump Program 11 Wayne E. Richenbacher Mechanical Circulatory Support Team 11 Selecting a Ventricular Assist System for Postcardiotomy Cardiogenic Shock 13 Selecting a Ventricular Assist System for Use as a Bridge to Cardiac Transplantation 20 Physical Plant Considerations 27 Training 29 3. Intraaortic Balloon Counterpulsation 31 Wayne E. Richenbacher Introduction 31 Balloon Pump Design and Theory of Function 31 Indications for Use 32 Contraindications for Use 35 Insertion Technique 36 Management of the Intraaortic Balloon Pump Patient 41 Transportation of the Patient Requiring Intraaortic Balloon Pump Support 45 Weaning from Intraaortic Balloon Pump Support 47 Intraaortic Balloon Pump Removal 47 Complications of Intraaortic Balloon Counterpulsation 49 4. Extracorporeal Membrane Oxygenation (ECMO) Support for Cardiorespiratory Failure 53 Ralph E. Delius, Angela M. Otto Introduction 53 Team Concepts 54 Economic Considerations 55 Circuit Design 57 Location 59 Venovenous Versus Venoarterial Bypass 60 Indications for ECMO Support 61 Cannulation Techniques 63 Patient Management 70 Weaning 74 Decannulation 75 Follow-up 75 5. Ventricular Assistance for Postcardiotomy Cardiogenic Shock 78 Wayne E. Richenbacher Introduction 78 Patient Selection and Preparation 79 Operative Management 83 Postoperative Management 96 Weaning from Mechanical Circulatory Support 99 Device Removal 101 Patient Care Following Ventricular Assist Device Removal 104 6. Ventricular Assistance as a Bridge to Cardiac Transplantation 106 Wayne E. Richenbacher Introduction 106 Patient Selection and Primary Management 107 Preoperative Preparation 109 Ventricular Assist Device (VAD) Selection 115 Operative Management 117 Postoperative Management 127 Preparation for Cardiac Transplantation 131 Cardiac Transplantation 132 Posttransplant Care and Management 136 7. Special Situations 138 Wayne E. Richenbacher Introduction 138 Interhospital Transfer 138 Ventricular Arrhythmias and Electrical Defibrillation 141 Valvular Heart Disease 143 Primary Right Ventricular Failure 145 8. Anesthesia for Patients with Ventricular Assist Devices 148 Javier H. Campos Introduction 148 Anesthetic Management 149 Induction and Maintenance of Anesthesia 151 Placement of Left Ventricular Assist Device and Anesthetic Implications 152 Placement of Right Ventricular Assist Device and Anesthetic Implications 154 Placement of the Biventricular Assist Devices and Anesthetic Implications 154 Aprotinin in Patients Requiring a Ventricular Assist Device 155 Intraoperative Transesophageal Echocardiographic Evaluation in Patients with Ventricular Assist Devices 156 Transport of Patients with Ventricular Assist Device to the Surgical Intensive Care Unit 159 9. Nursing Care of the Patient Requiring Mechanical Circulatory Support 161 Kelly L. Jones, Carolyn J. Laxson, Sarah C. Seemuth, Sara J. Vance Nursing Staff Education 161 Preimplantation Psychosocial Assessment 166 Postoperative Care 168 Home Discharge Preparation 178 Educating the Local Community 181 10. Complicationsof MechanicalVentricularAssistance.... 183 Wayne E. Richenbacher Introduction 183 Early Complications 183 Late Complications 189 11. Device-Specific Considerations 199 Wayne E. Richenbacher, Shawn L Jensen, Scott D. Niles, James M. Ploessl Introduction 199 Centrifugal Pump 199 Abiomed BVS 5000 Biventricular Support System 202 Thoratec VAD System 204 Thermo Cardiosystems HeartMate LVAS 208 Novacor N-100 LVAD 212 12. Financial Aspects of a Mechanical Circulatory Support Program 214 Jane E. Reedy Introduction 214 Food and Drug Administration Approval Process 215 Justification 215 Financial Implications 217 Reimbursement Overview 218 Patient’s Coverage Policy 219 Hospital 219 Physician 220 Medicare Coverage 221 Reimbursement Strategies 222 Conclusions 223 Appendix 225 Index 227 Editor Wayne E. Richenbacher, MD University of Iowa Hospitals and Clinics Department of Surgery Division of Cardiothoracic Surgery Iowa City, Iowa, USA Chapters 1, 2, 3, 5-25 Contributors Javier H. Campos, MD Kelly L. Jones, LISW Associate Professor Department of Social Services Cardiac Anesthesia Group The University of Iowa Hospitals Department of Anesthesia and Clinics The University of Iowa Hospitals Iowa City, Iowa, USA and Clinics Chapter 9 Iowa City, Iowa, USA Chapter 8 Carolyn J. Laxson, RN, MA Nurse Specialist Ralph E. Delius, MD The University of Iowa Hospitals Associate Professor and Clinics Division of Cardiothoracic Surgery Iowa City, Iowa, USA Department of Surgery Chapter 9 University of California Davis Medical Center Scott D. Niles, CCP School of Medicine Perfusionist Co-director Department of Surgery University of California Davis/Sutter The University of Iowa Hospitals Childrens Heart Surgery Center and Clinics Sacramento, California, USA Iowa City, Iowa, USA Chapter 4 Chapter 11 Shawn L. Jensen, RN, BSN Angela M. Otto, RN, BSN Clinical Coordinator ECMO Coordinator Division of Cardiothoracic Surgery The University of Iowa Hospitals Department of Surgery and Clinics The University of Iowa Hospitals Iowa City, Iowa, USA and Clinics Chapter 4 Iowa City, Iowa, USA Chapter 11
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