HEART FAILURE,Devices is a new era in cardiac therapy .

1. ‫أ.د. أحمد الحميدي مقرر 333 حين‬

2. CYBORGS ARE DEVICES
IMPLEMENTED IN HUMEN
BEINGS FOR NEW
MODALITY OF THERAPY
Dr SAMIR TAYFOUR
CONSULTANT CARDIOLOGIST

3. CYBORG
•
•
•
•
Kybernàn= pilotare “steerman”
Cyber+ organism “ hybrid “
Mixture of machin+organism
Norbert Wiener (1947)
.
Cybernaut , Cyberspace
Borg (Star Trek)
. a human being whose body has been taken
over in whole or in part by electromechanical
devices ; " a cyborg is a cybernetic organism .

4. Cyborg = cybernetics + organism
Cybernetics or Communication in the human being or animal and the
Machine. Based on the Greek “Kybernetics”, meaning “captain”to navigate
cybernetics is the science or study of the control or regulation mechanism
in human and machine systems, including computers.

5. What is a cyborg?
‘A cyborg is a cybernetic organism, a hybrid
‘mixture’ of machine and organism, a creature
of social reality as well as a creature of fiction’
– Donna Haraway A Cyborg Manifesto
A human cyborg is a human who has
certain physiological processes aided or
controlled by mechanical or electronic
devices

6. Cyborg:a science of communication and control processes in animals and
automated machines, where the study of control systems , such as the nervous
system , in living organisms and the development of similar systems in the
electronic and mechanical devices .

7. Monster or cyborg-object?

8. Cyborg = Cybernetic Organism
Organism (natural)
• Complex, inflexible feedback loop
• Too much change – organism will die
Cybernetic (artificial)
• Flexible feedback loop
• Responsive to stimuli,
able to adapt to survive
What does it mean
to be human?

13. Dual chambres pacemaker

14. Cardiac resynchronization therapy
(CRT)
CRT device:
Patients with NYHA Class Ⅲ /Ⅳ
Sympotomatic despite optimal medical therapy
QRS ≥ 120 msec
LVEF ≤ 35%
CRT plus ICD:
Same as above with ICD indication

16. CHF and MRI
• Dimensions
• Contractility,
Viability
• Valve function
MRI crossectional
sequence of dilated LV
March 2013
ghennersdorf DGK ESC SES
16

20. Consequences of contractility due to LBBB
• In DCM, certain areas of the LV wall are contracted
(blue) when others are already relaxed (red). Other
areas are constrained (yellow)

26. 1980-82:ICD is First implanted patient in the
U.S. (Johns Hopkins, Baltimore) and France
(Lariboisière, AP-HP)
Short-lived systems
250g, non-programmable
Abdominal implant thoracotomy

27. 1966-1980 : works of Dr Mirowski,
inventor and designer OF ICD

28. Severity of Heart Failure
Modes of Death
NYHA II
NYHA III
CHF
12%
CHF
Other
26%
59%
Sudden
Death
24%
64%
15%
n = 103
NYHA IV
33%
11%
Other
Sudden
Death
n = 103
CHF
Other
56%
Sudden
Death
n = 27
MERIT-HF Study Group. Effect of Metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL randomized intervention trial
in congestive heart failure (MERIT-HF). LANCET. 1999;353:2001-07.

40. ICD Therapy
CLASS I INDICATIONS:
1. Ischemic cardiomyopathy with LVEF
< 35%, at least 40 days post MI, NYHA class II OR III. (Strength of
Evidence = A)
2. Ischemic cardiomyopathy with LVEF < 30%, at least 40 days post MI,
NYHA class I. (Strength of Evidence = A)
3. Non Ischemic cardiomyopathy with LVEF ≤ 35%, NYHA class II OR III.
(Strength of Evidence = B)
The ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

43. HEART SURGERY IN THE 21ST CENTURY

45. Indications
• Bridge to Transplantation
• Bridge to Recovery
• Destination Therapy

47. Implantable Ventricular Assist Device

48. People Don’t want a LVAD, they want a Heart

49. Artificial Heart
The HeartMateII is a continuous flow cardiac assist device. Heart surgeon
"Bud" Frazier and his team are working with two such devices to develop
a continuous flow artificial heart. (Courtesy: Texas Heart® Institute)

50. Multicenter Trial of the Orqis® Medical
Cancion System for the ENhanced
Treatment of CHF Unresponsive to
Medical Therapy

51. Cancion System for Continuous Aortic Flow
Augmentation (CAFA)

52. Continuous Aortic Flow Augmentation (CAFA) Changes Flow
Signature in Heart Failure
Early Diastole
Backflow against the
aortic wall
Forward flow
in the center of
the aorta
Early Diastole
With CAFA

53. Cardiac Transplant
On December 3rd 1967
Dr CHRISTIAN BERNARD
At Groote Schuur Hospital

55. Management of Refractory Heart Failure
• Inotropic drugs:
– Dobutamine, dopamine, milrinone, nitroprusside,
nitroglycerin
• Mechanical circulatory support:
– Intraaortic balloon pump
– Left ventricular assist device (LVAD)
• Cardiac Transplantation
– A history of multiple hospitalizations for HF
– Escalation in the intensity of medical therapy
– A reproducable peak oxygen consumption with maximal
exercise (VO2max) of < 14 mL/kg per min. (normal is 20
mL/kg per min. or more) is relative indication, while a VO2max
< 10 mL/kg per min is a stronger indication.

56. Heart transplantation
March 2013
ghennersdorf DGK ESC SES
56

58. Dick Cheney robot heart watch
Several heart attacks, a bypass, a
pump and now a heart transplant
later, Dick Cheney is back in action.
Is he a ROBOT NOW ?.

67. THANK YOU…!!