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The University of Minnesota has a unique history relative to advances in cardiovascular research, surgery, and the development of medical devices. Interestingly, the completion of this textbook coincides with two important anniversaries in cardiovascular medicine and engineering at the university. First, it was 50 years ago, in 1958, upon the request of Dr. C. Walton Lillehei, that the first wearable,...
Clinical trial design requires inclusion criteria that patients be on optimal medical therapy prior to enrollment or randomization, meaning that they are on medical regimens proven to be safe and effective and considered a standard in clinical practice for the particular disease state being studied. Only then can any clinical or statistical significance be determined between study groups. This chapter...
The modern era of cardiac surgery is largely considered to have begun in the animal research laboratories. Today, animal models continue to be used for the study of cardiovascular diseases and are required for the preclinical assessment of pharmaceuticals, mechanical devices, therapeutic procedures, and/or continuation therapies. This chapter was designed to provide readers and potential investigators...
The range of the resting sinus heart rate is 50–90 beats per minute (bpm); most average healthy individuals have resting rates in the 60–70 bpm range. Bradycardia (slow heart beat) is arbitrarily defined as any heart rate <60 bpm, and tachycardia (fast heart beat) as any rate >100 bpm. Disturbances of cardiac impulse formation and/or transmission comprise the principal mechanisms causing abnormalities...
Currently most implanted pacing and defibrillation systems monitor and treat inappropriate cardiac rhythms. In general, these inappropriate rhythms result in cardiac outputs that are inadequate to meet metabolic demands, and thus can be life-threatening. In order to best understand the function of such pacing and defibrillation systems, the underlying physiologic situations indicated for their use...
Congestive heart failure (CHF) has become a major health problem. Despite improved pharmacologic therapies, refractory symptoms and high mortality remain a challenge in such patients. There has been increased interest in the application of ancillary nonpharmacologic therapies for CHF management, such as implantable pacemakers, defibrillators, and/or left ventricular assist devices. Various methods...
In general, the methodologies for cardiac electrical mapping entail registration of the electrical activation sequences of the heart by recording extracellular electrograms. The initial use of cardiac mapping was primarily to better understand the normal electrical excitations of the heart. However, the focus in mapping over time has shifted to the study of mechanisms and substrates underlying various...
This chapter describes the history and techniques of cardiopulmonary bypass, a process that effectually excludes the heart from the general circulation and leaves it empty so that it can accommodate open cardiac surgical intervention. Since its first implementation, cardiopulmonary bypass has improved significantly to become a very highly sophisticated, but reliably performed procedure. The near future...
This chapter was designed to provide the reader with a brief overview of the current surgical treatment options for heart valve disease. Major topics of discussion are: (1) development of prosthetic valve replacements; (2) current issues with valve replacement; (3) major valvular diseases that affect humans in the Western world; and (4) recent advances in therapeutic options for valvular diseases.
To date, more and more cardiac surgeons are moving toward smaller incisions and the use of specialized less invasive surgical methodologies. The use of (and advances in) less invasive approaches or minimally invasive cardiac surgery can minimize or eliminate complications that may occur in conventional cardiac surgery. For example, for some surgeons, partial sternotomy and minithoracotomy have supplanted...
Cardiac device technologies continue to advance at a rapid pace, with heart valve design and placement procedures being one of the major focus areas. Minimally or less invasive procedures to replace cardiac valves will enable an increasing number of individuals to receive this therapy, including the older and more frail individual or the adult patient with prior surgeries for repair of congenital...
The majority of patients with congenital heart disease present with defects comprised of vascular narrowing or absence (such as interruption or coarctation of the aorta or pulmonary arteries) or failure of structures to fuse or separate during development (total anomalous pulmonary venous connection, septal defects, fusion of valve cusps). Correction of these defects began with open-heart surgery...
Novel noninvasive technologies that harness the inherent physiological interactions between the heart, lungs, and brain have recently been shown to improve circulation and outcomes after cardiac arrest and other states of low blood pressure including hypovolemic shock. The impedance threshold devices (ResQPOD® and ResQGard®) and the intrathoracic pressure regulator (CirQlator™) are three new devices...
Approximately 5 million Americans have congestive heart failure (CHF), and every year about 50,000 new cases are diagnosed. Advances in medical therapy, biventricular pacing, defibrillator implantation, and the ability to successfully perform surgery in high-risk patients have revolutionized the management of patients with CHF and greatly delayed CHF progression to end stage. Once patients develop...
Cardiomyocyte regeneration may occur during physiological and pathological states in the adult heart; these data highlight the possibility that myocardial regeneration may occur via cardiomyocyte proliferation and/or differentiation of putative cardiac stem cells. To date, various cell types have been used for cardiac repair, including skeletal myoblasts, bone marrow-derived cells, mesenchymal stem...
The primary goals of this last chapter are to: (1) discuss, in more detail, some of the technologies mentioned earlier in this book; (2) introduce readers to several additional technological advances associated with cardiovascular health care that have been recently introduced, are currently in clinical testing, or will soon be released; and (3) discuss future opportunities in the cardiac device arena...
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