A latest generation artificial heart, equipped with biological valves, has been implanted for the first time in Lombardy, which completely replaces the heart with functions very close to physiological ones. The new device, which exactly reproduces the activity of the original organ and automatically adapts to the patient's physical activity, has been used in recent days at the Niguarda hospital in Milan – the Asst Grande metropolitan hospital informs today – to treat a patient with severe heart failure with left and right ventricular dysfunction, on the waiting list for a heart transplant for several months. The operation was successfully performed by the Cardiac Surgery and Heart Transplant team directed by Claudio Russo, supported by the Anesthesia and Cardiothoracic Resuscitation staff directed by Michele Mondino. The new device will allow the patient to face the period leading up to the heart transplant with a better quality of life.
The new generation artificial heart – they explain from Niguarda – totally replaces the native heart which is removed with cardiac surgery in extracorporeal circulation. The device is made up of a left ventricular chamber and a right ventricular chamber, unlike the VAD (Ventricular Assist Device) assistance systems normally used, which are miniaturized turbine pumps capable of providing continuous blood flow (constant, without a systole and one diastole), with an almost exclusive support function for the left ventricle. The new artificial heart, with its 4 biological valves which correspond to the tricuspid, pulmonary, mitral and aorta valves of the native heart, is instead capable of generating a physiological flow of the pulsed type, i.e. with a systolic and diastolic pressure, like that guaranteed in kind from the heart.
“This characteristic – underlines Russo – protects against all the possible complications of continuous flow. Furthermore, the artificial heart with biological valves is equipped with sensors that allow an adaptation of the activity based on the organism's requests, as happens in native heart. The advantages of this new device also include the internal surfaces totally covered with biological membranes which require low levels of anticoagulant therapy with a reduced risk of related complications”.
The operation for the implantation of the new device is a rather complex procedure, Niguarda highlights, because it requires the total removal of the native heart which is sectioned at the level of the tricuspid and mitral valve. “The technique must be extremely accurate to avoid any risk of hemorrhage,” Russo points out. After completing the sutures, the system is activated, suspending extracorporeal circulation. The activation is electromagnetic and the energy, as in the Vads, is supplied via a percutaneous cable which powers the system from the outside, completely housed in the chest in place of the native heart.
“This type of device represents a step forward in improving the conditions of those who suffer from biventricular heart failure, which makes a heart transplant necessary, but who, due to the compromise of both ventricles, cannot benefit from the implantation of a Vad”, the experts point out, recalling that “the shortage of organs to transplant unfortunately considerably lengthens the waiting period for these patients”.
“Consider that the average wait on the ordinary list for a heart transplant in Italy is around 3 years – recalls Russo – and a technology that closely mimics the physiology of the heart can help bring patients to face the transplant in the best possible conditions The hope is that in the near future the use of the artificial heart can be perfected and become a definitive alternative solution to heart transplantation, in particular for those categories of patients with biventricular cardiac dysfunction and with contraindications (due to age or associated diseases) heart transplant”, concludes the specialist.
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