Table Of ContentMechanical 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
