Mechanical circulatory support at the University of Pittsburgh – marriage of clinical practice and bioengineering

According to recent published statistics from the American Heart Association, cardiovascular disease remains the number one killer of Americans with more than 600,000 deaths attributable to diseases of the heart in 2017. Heart failure accounts for 9.4% of these deaths, which implies that ~55,000 Americans succumbed to this disease in 2017. The prevalence of heart failure increases with age; 6.9% of the male population and 4.8 % of the female population aged 60 - 79 and 12.8 % of the male population and 12% of the female population ≥ 80 years of age are so afflicted. The literature has documented that patients in end stage heart failure basically face 100% mortality at 2-years post diagnosis in spite of optimum medical management. For these heart failure patients the “gold standard” for treatment is cardiac transplantation. However the total number of cardiac transplants performed in the U.S. annually is 2,000 - 2,500, meaning that tens of thousands of heart failure patients will not receive a cardiac transplant. This has led to the use of mechanical circulatory support devices (ventricular assist devices) to support the circulation of heart failure patients. The use of these devices continues to expand due an aging population and an increased prevalence of heart failure both in the United States and worldwide.

The University of Pittsburgh (UoP) began using mechanical circulatory support devices in fall, 1985 … a Jarvik-7 total artificial heart as a bridge-to-cardiac transplantation. In the intervening years a total of 1,365 UoP heart failure patients have been implanted with various mechanical circulatory support devices; this includes 75 pediatric patients who were supported due to congenital and/or acquired cardiac defects. A unique feature of the UoP program is the participation of more than 150 engineering students in the clinical support of these patients. These engineers participate in all aspects of patient support … from the operating room to preparing the patients and their caregivers for hospital discharge. The clinical experiences for the engineers have also served as the basis for numerous M.S. and Ph.D. dissertations, which focus on the limitations of mechanical circulatory support technology and how these limitations could be addressed. This talk will describe this marriage of clinical practice and bioengineering as applied to heart failure patients supported by mechanical circulatory support technology. The impact on the student engineers of working at the interface between state-of-the art technology and patient care will be discussed as will the impact bioengineering students have on the care of these heart failure patients.