Artificial hearts

The isotope plutonium-238 [13981 -16-3] Pu, is of technical importance because of the high heat that accompanies its radioactive decay. This isotope has been and is being used as fuel in small terrestrial and space nuclear-powered sources (3,4). Tu-based radioisotope thermal generator systems dehvered 7 W/kg and cost 120,000/W in 1991 (3). For some time, %Pu was considered to be the most promising power source for the radioisotope-powered artificial heart and for cardiovascular pacemakers. Usage of plutonium was discontinued, however, after it was determined that adequate elimination of penetrating radiation was uncertain (5) (see PROSTHETIC AND BIOMEDICAL devices). 

Economic Aspects. The cardiovascular devices market is estimated to be approximately 2.9 biUion annually on a worldwide basis. This market can be further segmented as follows angiography and angioplasty, 644 x 10 arrhythmia control, 1500 x 10 cardiovascular surgery, 700 x 10 cardiac assist (intra-aortic balloon pump), 80 x 10 and artificial hearts, which are experimental. 

Cardiomyopathy. The best available solution to cardiomyopathy may be one that is less sophisticated than transplant surgery or the artificial heart. The cardiomyoplasty-assist system combines eariier electrical stimulation technology with a new surgical technique of utilizing muscle from another part of the body to assist the heart. 

Efforts to develop an artificial heart have resulted in a number of advancements in the assist area. The centrifugal pump for open-heart surgery, the product of such an effort, has frequently been used to support patients after heart surgery (post-cardiotomy), or as a bridge to life prior to transplant. 

Artificial Hearts. Congestive heart failure (CHF) is a common cause of disabiHty and death. It is estimated that three to four million Americans suffer from this condition. Medical therapy in the form of inotropic agents, diuretics (qv), and vasofilators is commonly used to treat this disorder (see Cardiovascularagents). Cardiac transplantation has become the treatment of choice for medically intractable CHF. Although the results of heart transplantation are impressive, the number of patients who might benefit far exceeds the number of potential donors. Long-term circulatory support systems may become an alternative to transplantation (5). 

In contrast, the total artificial heart (TAH) is designed to overtake the function of the diseased natural heart. While the patient is on heart—lung bypass, the natural ventricles are surgically removed. Polyurethane cuffs are then sutured to the remaining atha and to two other blood vessels that connect with the heart. 

One successful total artificial heart is ABIOMED s electric TAH. This artificial heart consists of two seamless blood pumps which assume the roles of the natural heart s two ventricles (Fig. 7). The pumps and valves are fabricated from a polyurethane, Angioflex. Small enough to fit the majority of the adult population, the heart s principal components are implanted in the cavity left by the removal of the diseased natural heart. A modest sized battery pack carried by the patient suppHes power to the drive system. Miniaturized electronics control the artificial heart which mns as smoothly and quietly as the natural heart. Once implanted, the total artificial heart performs the critical function of pumping blood to the entire body (6). 

There appear to be conflicting reports regarding the degradation of urethanes. For example, some urethanes are reported to have relatively poor hydrolysis resistance and good biodegradability [77], while other urethanes are reported to be so hydrolytically stable that they have been successfully used as an artificial heart [78]. Both reports are correct. It will be shown that the thermal, oxidative, and hydrolytic stability of urethanes can be controlled, to some degree, by the choice of raw materials used to make the urethane. 

Polymers are a fundamental part of the modem world, showing up in everything from coffee cups to cars to clothing. In medicine, too, their importance is growing for purposes as diverse as cardiac pacemakers, artificial heart valves, and biodegradable sutures. 

We start with synthetic organic polymers. Since about 1930, a variety of synthetic polymers have been made available by the chemical industry. The monomer units are joined together either by addition (Section 23.1) or by condensation (Section 23.2). They are used to make cups, plates, fabrics, automobile tires, and even artificial hearts. 

Artificial heart Kidney-dialysis system Artificial blood (synthetic oxygen carriers)... 

Siloxane-urethane segmented copolymers, which have very good mechanical, fatigue and surface properties 370,377 or their blends with conventional polyurethane-(ureas) have been successfully used in the production of blood pumps, intra-aortic balloons and artificial hearts 200,332,370,376,377). 

Medicine has made major advances in the past 50 or so years partly by the use of devices to improve patient health. These devices include artificial hearts and pacemakers, machines for artificial kidney dialysis, replacement joints for hips, knees, and fingers, and intraocular lenses. These devices need to survive in sustained contact with blood or living tissue. 

Currently, few data are available on the fatigue properties of elastomers cycled at body temperature and in contact with blood. Artificial heart device applications are particularly demanding of elastomers since even a three-year implantation of a heart will involve in excess of 10 cycles. 

Artificial Heart Program Conference proceedings, Washington, D.C., June 9-13, 1969. Edited by Ruth Johnsson Hegyeli. National Institutes of Health. 

The first ever injectable crude biomaterial, that is a dental implant, appeared early in ad 6oo (Fig. 12.1). During those times, Mayan people trimmed seashells into artificial teeth to replace missing teeth (Michael, 2006 Ratner et al., 2004). Early biomaterials also led to problems, including sterilization, toxicity, inflammation, and immunological issues. Since the Mayan s initial use of artificial teeth, biomaterials have evolved to be used in modem artificial hearts, hip and knee pros-theses, artificial kidneys, and breast implants. Materials used in these applications include titanium, silicons, polyurethanes, teflon, polybiodegradable polymers, and most recently bio-nanomaterials (Pearce et al., 2007)... 

Short-acting dipyridamole (Persantine). Do not consider the long-acting dipyridamole (which has better properties than the short-acting in older adults) except with patients with artificial heart valves May cause orthostatic hypotension Low... 

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