Artificial heart implant surgery involves placing a mechanical device to support or replace the pumping function of a failing heart. It is used in end‑stage heart failure when other treatments are ineffective. Understanding indications, procedure steps, and postoperative care is essential in cardiology and surgical practice.
Introduction
Artificial heart implant surgery represents a significant milestone in the field of medical science, offering a lifeline to patients with severe heart conditions. This procedure involves replacing a failing human heart with a mechanical device that mimics the functionality of a biological heart. The advent of artificial hearts has not only prolonged the lives of countless individuals but also enhanced their quality of life, enabling them to regain independence and engage in everyday activities.
History and Development
The concept of an artificial heart dates back to the early 20th century. However, it was not until the 1950s that significant advancements were made in the field of cardiac prosthetics. Dr. Paul Winchell, a ventriloquist and inventor, is credited with developing the first artificial heart prototype in 1956. His design laid the groundwork for future innovations, leading to the first successful implantation of an artificial heart in a human patient by Dr. Barney Clark in 1982.
Types of Artificial Hearts
There are primarily two types of artificial hearts: total artificial hearts (TAHs) and ventricular assist devices (VADs).
Total Artificial Hearts (TAHs)
TAHs are designed to completely replace the patient’s diseased heart. These devices are typically used for patients with end-stage heart failure who are ineligible for a heart transplant. The SynCardia temporary Total Artificial Heart is one of the most widely used TAHs, offering patients a bridge to transplantation or a long-term solution.
Ventricular Assist Devices (VADs)
In contrast to TAHs, VADs support the function of the patient’s existing heart by assisting one or both ventricles. VADs are often used as a bridge to transplantation, allowing patients to maintain a better quality of life while awaiting a donor heart. Additionally, VADs can be utilized as a destination therapy for patients who are not candidates for transplantation.
Indications for Artificial Heart Implant Surgery
Artificial heart implant surgery is typically considered for patients with severe heart failure who have not responded to conventional treatments. Indications for the procedure include:
- End-stage heart failure
- Ineligibility for heart transplantation
- Failure of medical management
- Cardiogenic shock
- Severe ventricular dysfunction
Preoperative Evaluation and Preparation
Before undergoing artificial heart implant surgery, patients must undergo a comprehensive evaluation to determine their suitability for the procedure. This evaluation includes a thorough medical history, physical examination, and various diagnostic tests such as echocardiography, cardiac catheterization, and blood tests. Additionally, patients may undergo psychosocial evaluations to assess their readiness and ability to adhere to postoperative care requirements.
The Surgical Procedure
Artificial heart implant surgery is a complex and highly specialized procedure that requires a multidisciplinary team of cardiologists, cardiothoracic surgeons, anesthesiologists, and perfusionists. The surgery typically involves the following steps:
Anesthesia and Incision
The patient is placed under general anesthesia, and a median sternotomy is performed to access the heart.
Cardiopulmonary Bypass
The patient is connected to a cardiopulmonary bypass machine, which takes over the function of the heart and lungs during the surgery.
Removal of the Diseased Heart
The surgeon removes the patient’s diseased heart, leaving the atria and the great vessels intact.
Implantation of the Artificial Heart
The artificial heart is carefully implanted and connected to the patient’s atria and great vessels. Once the device is securely in place, the cardiopulmonary bypass machine is gradually weaned, and the artificial heart begins to take over the function of pumping blood throughout the body.
Postoperative Care and Recovery
Following artificial heart implant surgery, patients require intensive monitoring and care in the cardiac intensive care unit (CICU). Key aspects of postoperative care include:
1.Hemodynamic Monitoring
Continuous monitoring of the patient’s hemodynamic status is essential to ensure the proper functioning of the artificial heart and to detect any potential complications.
2.Anticoagulation Therapy
Patients are placed on anticoagulation therapy to prevent blood clots, which can pose a significant risk with artificial heart devices.
3.Infection Prevention
Strict infection control measures are implemented to reduce the risk of infection, which can have serious consequences for patients with artificial hearts.
4.Rehabilitation
Patients undergo a comprehensive rehabilitation program to help them regain strength and functionality. This program includes physical therapy, occupational therapy, and education on lifestyle modifications and device management.
Nursing Care of Patients with Artificial Heart Implant Surgery
Artificial heart implant surgery represents a significant advancement in the treatment of severe heart failure. However, ensuring optimal patient outcomes requires comprehensive nursing care encompassing preoperative, perioperative, and postoperative phases.
Preoperative Care
Patient Assessment and Education
Nurses play a critical role in assessing the patient’s physical and psychological readiness for surgery. This includes:
- Medical History and Physical Examination: Detailed review of the patient’s medical history, current medications, and physical examination to identify any potential risk factors or contraindications.
- Psychosocial Assessment: Evaluating the patient’s mental and emotional state, support systems, and coping mechanisms.
- Patient Education: Providing comprehensive information about the surgery, potential risks, benefits, and the expected recovery process. This helps in alleviating anxiety and enhancing patient cooperation.
Preoperative Preparations
Preparation for surgery involves several key steps:
- Infection Control: Preoperative skin preparation and administration of prophylactic antibiotics to minimize the risk of infection.
- Medication Management: Adjusting medications that may interfere with surgery or anesthesia, such as anticoagulants.
- Nutritional Support: Ensuring the patient is nutritionally optimized to promote healing and recovery.
- Baseline Measurements: Recording baseline vital signs, laboratory values, and imaging studies for postoperative comparison.
Perioperative Care
Intraoperative Monitoring
During surgery, nurses must closely monitor the patient’s physiological status:
- Hemodynamic Monitoring: Continuous assessment of blood pressure, heart rate, and oxygen saturation.
- Fluid and Electrolyte Balance: Managing intravenous fluids and monitoring electrolyte levels to prevent imbalances.
- Infection Prevention: Maintaining a sterile environment to reduce the risk of intraoperative infections.
- Communication: Effective communication with the surgical team to promptly address any emerging issues.
Postoperative Care
Immediate Postoperative Phase
The immediate postoperative period is critical for patient stabilization:
- Vital Signs Monitoring: Frequent monitoring of vital signs, including blood pressure, heart rate, respiratory rate, and temperature.
- Pain Management: Administering analgesics as prescribed and assessing pain levels to ensure patient comfort.
- Fluid and Electrolyte Management: Continuing to monitor and adjust fluid and electrolyte balance as needed.
- Infection Control: Observing for signs of infection at the surgical site and administering antibiotics prophylactically.
Ongoing Postoperative Care
As the patient transitions to a stable condition, ongoing care focuses on recovery and rehabilitation:
- Wound Care: Regular assessment and dressing changes of the surgical site to promote healing and prevent infection.
- Mobility and Physical Therapy: Encouraging gradual mobilization and coordinating with physical therapists to develop a tailored rehabilitation plan.
- Device Management: Educating the patient and caregivers on the proper use, maintenance, and troubleshooting of the artificial heart device.
- Emotional and Psychological Support: Providing continuous support to address the emotional and psychological challenges associated with recovery.
Complications and Challenges
While artificial heart implant surgery can be life-saving, it is not without risks. Nurses must remain vigilant for potential complications, including:
- Infection: Monitoring for signs of infection and ensuring strict adherence to infection control protocols.
- Thromboembolism: Administering anticoagulants as prescribed and assessing for signs of thromboembolic events.
- Bleeding: Monitoring for signs of bleeding and managing anticoagulation therapy carefully.
- Device Malfunction: Regularly checking the functionality of the artificial heart device and being prepared to address any malfunctions promptly.
- Psychosocial Challenges: Supporting the patient and family in coping with the psychological impact of the surgery and the lifestyle changes it necessitates.
REFERENCES
- Atti V, et al. A comprehensive review of mechanical circulatory support devices. Heart International. 2022; doi:10.17925/HI.2022.16.1.37.
- Vieira JL, et al. Mechanical circulatory support devices in advanced heart failure: 2020 and beyond. Progress in Cardiovascular Diseases. 2020; doi:10.1016/j.pcad.2020.09.003.
- Libby P, et al., eds. Mechanical circulatory support. In: Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Elsevier; 2022. https://www.clinicalkey.com.
- Goodwin ML, Mokadam NA. Total Artificial Heart Implantation: How I Teach It (https://pubmed.ncbi.nlm.nih.gov/31520634/). Ann Thorac Surg. 2019;108(5):1271-1276.
- Henn MC, Mokadam NA. Total artificial heart as a bridge to transplantation (https://pubmed.ncbi.nlm.nih.gov/35649113/). Curr Opin Organ Transplant. 2022 Jun 1;27(3):222-228.
- National Heart, Lung and Blood Institute (U.S.). What Is Heart Failure? (https://www.nhlbi.nih.gov/health/heart-failure) Last updated 3/24/2022.
- National Heart, Lung and Blood Institute (U.S.). What Is Total Artificial Heart? https://www.nhlbi.nih.gov/health/total-artificial-heart Last updated 4/12/2023.
- The Mended Hearts Inc. Artificial Hearts, Real Lifelines (https://mendedhearts.org/story/real-lifeline/).
- Villa CR, Morales DLS. The Total Artificial Heart in End-Stage Congenital Heart Disease (https://pubmed.ncbi.nlm.nih.gov/28536530/). Front Physiol. 2017 May 9;8:131..
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