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After decades of laboratory investigations mechanical circulatory support for the failing heart has entered the clinical arena. Today, a growing number of patients with progressive myocardial failure awaiting cardiac transplantation is successfully bridged to transplantation with ventricular assist devices. The proceedings of the "Mechanical Circulatory Support"-meeting, held in Berlin, October 21-22, 1995, present new aspects of mechanical circulatory support, recent experience with MCS in newborns and children using specially developed small devices, and the results of long-term mechanical assistance. The ability of the myocardium to recover under pressure de-loading and reduced workload is discussed. All these topics open up new perspectives for the use of mechanical circulatory support, not only as a bridge to transplantation, but also as a definitive approach for treating patients with end-stage heart failure. Some of these concepts may even provide real alternatives to heart transplantation, these being sorely needed in light of the severe donor organ shortage. Regulatory as well as ethical aspects of the extended use of mechanical circulatory support systems and new technical developments in the field are discussed by internationally distinguished experts.
Table des matières
Mechanical ventricular assist in children: Experience at the Children's Hospital, Boston (1990-1995).- Mechanical circulatory support at the Royal Children's Hospital.- Individual center experiences in pediatric mechanical circulatory support for bridge-to-transplant and myocardial recovery.- Extracorporeal circulatory support in pediatric cardiac patients - The Berlin Experience.- Mechanical circulatory support in pediatric age: Experience of Bergamo.- Discussion Session, October 21, 1995.- What is dilated cardiomyopathy?.- Agonistic anti-? 1-adrenoceptor autoantibodies in the serum of patients with dilated cardiomyopathy.- Weaning from mechanical support after complete recovery in patients with idiopathic dilated cardiomyopathy.- Discussion Session, Morning of October 22, 1995.- to Afternoon Session, October 22, 1995.- Epidemiology of heart failure.- On the way to permanent support: Battery-powered, vented ventricular assist systems and other innovative new systems.- The wearable Novacor LVAS at Henri Mondor Hospital.- Long-term mechanical circulatory support.- Left ventricular assistance with Novacor device: the "Pavia Experience".- Long-term mechanical circulatory support: The Berlin Experience.- Mechanical circulatory support systems 1995 - New devices under investigation.- Prospects for permanent mechanical circulatory support.- Quality of life with ventricular assist devices.- Lessons from the heart: Ethical reflections on the clinical trials of the Jarvik-7.- Discussion Session, Afternoon of October 22, 1995.- Closing remarks.- Author Index.
