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Cardiovascular Surgery

Cardiovascular disease continues to be the leading cause of death in the United States, but hope is on the horizon. Researchers are developing novel surgical approaches that hold the promise of saving lives and improving the overall quality of life. At ASRI, scientists are exploring a variety of methods — such as devices and minimally invasive techniques — that could soon revolutionize cardiovascular surgery.

In one promising study, basic science researchers are developing a muscle-powered ventricular assist device (MVAD) — an internally-powered mechanism — that would eliminate the need for external components and daily maintenance. For patients with end-stage congestive heart failure, this device can serve as a “bridge” to cardiac transplantation or as “destination therapy” for patients deemed unsuitable for heart transplantation because of age or illness acuity.

According to Dennis Trumble, MS, an ASRI researcher specializing in cardiovascular surgery, this groundbreaking technology would harness the body’s own muscle power to activate the VAD and offer an attractive alternative to chronic drive systems currently in use. “

We are taking the working end of the latissimus dorsi muscle — a large skeletal muscle found in the back — and attaching it to an implantable muscle energy converter (MEC) that is mounted across the ribcage,” said Trumble. “While the MEC has the potential to drive a wide variety of pulsatile blood pumps, the most attractive pairings are with a family of direct cardiac compression devices designed to squeeze or otherwise manipulate the heart from the outside. This approach, apart from being extremely efficient from an energy transfer perspective, would eliminate the need for artificial valves and blood contacting surfaces while at the same time allowing for intermittent device activation as might occur during muscle training or device weaning procedures.”

In addition, clinical researchers are investigating the use of several new VAD technologies that may improve the hemodynamics and symptoms of critically ill patients who have been hospitalized with acute decompensated heart failure, and are currently seeking better ways of using ECMO machines to keep open-heart surgery patients alive until their heart and lungs have a chance to recover. Allegheny General Hospital — part of the West Penn Allegheny Health System — is a leading center for VAD research and has participated in every major clinical trial performed in the United States to date. George Magovern, MD, was the Principal Investigator for a major trial examining an implanted heart pump, while David Dean, MD, and Stephen Bailey, MD, serve as Site Principal Investigators for several device trials. AGH has also become a regional training center for teaching surgical implantation of an innovative heart pump and has pioneered a new driveline technique that shows promise in reducing driveline infections.

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