If your family member becomes critically ill due to a heart attack, cardiogenic shock, or heart failure or requires a procedure to fix a heart problem in the setting of poor heart function, then you want to go to a program that can offer the most cutting-edge technology and expertise around the use of acute mechanical circulatory support pumps. The CardioVascular Center at Tufts Medical Center is the only hospital in Boston that can offer this.
Mechanical circulatory support pumps are devices used to support heart and lung function in patients with cardiogenic shock, end-stage heart failure waiting for a heart transplant or for who transplant is not an option, and during high-risk interventions such as coronary stenting, valve therapy, or procedures used to treat arrhythmias.
Our acute mechanical circulatory support program offers a variety of options in all categories of heart dysfunction: RV (right ventricle), LV (left ventricle), Biventricular (both RV and LV), and cardiopulmonary failure.
The reason we are able to offer these technologies at Tufts Medical Center is because we have:
- The largest experience with all existing acute circulatory support strategies
- Some of the world’s top experts in mechanical circulatory support
Program Director, Dr. Navin Kapur
has developed an algorithm used by hospitals across the globe to determine when and which pump to use for these patients. As one of the few dual, board-certified Interventional Cardiologists and Advanced Heart Failure/Transplant specialists in the United States, he works closely with Dr. Michael Kiernan
, Dr. Greg Couper
, and Dr. David Denofrio
from our Advanced Heart Failure
Program, which is highly regarded and has performed more transplants than any other hospital in New England over the past five years.
The growing use of acute mechanical circulatory support pumps
Each year, 8 million individuals in the United States experience a heart attack. Of these patients, nearly 25% will develop acute heart failure or cardiogenic shock. Of these 8 million, nearly 50% will develop heart failure within 5 years of their first heart attack. Poor heart function associated with a heart attack, cardiogenic shock, or advanced heart failure limits the flow of blood to vital organs and if untreated contributes to organ failure. As soon as poor heart function is identified, mechanical circulatory support is often considered as part of the treatment algorithm.
Over the past 10 years, the use of acute mechanical circulatory support has grown exponentially, however successful outcomes are more likely when these devices are used in the right setting at the right time with the right teams involved.
These devices are used primarily in three ways:
- To stabilize a critically ill patient with poor heart function by taking over a significant portion of the heart’s workload, thereby allowing the heart to rest, while providing adequate blood flow and oxygen to vital organs. By stabilizing patients, a window-in-time is created so that physicians can explore therapeutic options and make decisions in conjunction with the patient and their family.
- To help maintain the flow of blood throughout the body during major procedures including complex coronary revascularization (ie coronary stent placement), valve replacement or repair, electrophysiology procedures, and major cardiac surgery.
- To support patients with end-stage heart failure who are being considered for advanced therapies such as cardiac transplantation or durable ventricular assist devices such as LVADs.
As mentioned above, our program offers the full range of acute mechanical circulatory support pumps for all areas of the heart. The key to knowing when and how to utilize these pumps is in understanding the engineering and hemodynamics behind them.
That is where Tufts Medical Center’s acute mechanical circulatory support team truly excels. Our physicians have published some of the most fundamental observations centered on acute circulatory support and as a result have a strong understanding and expertise in the use of all acute circulatory support pumps, including:
LV Support – Centrimag LVAD, IABP, Impella CP, Impella 5.0, Tandem LVAD, VA-ECMO
RV Support – Centrimag RVAD, Impella RP, Tandem RVAD, VA-ECMO
BiV Support – Centrimag BiVAD, Impella BiPella, Tandem Bi-VAD and VA-ECMO.
Given our expertise in the domain of acute circulatory support, our team is among the first to use emerging technologies, which includes early participation in clinical trials not widely available throughout the United States.These emerging options include Thoratec PHP, Axillary IABP, Tandem Protek RVAD and Ambulatory Acute MCS, Impella RP.
Types of pumps
The IABP is the most widely used nondurable mechanical circulatory support device in the U.S. It is a catheter-mounted balloon that assists blood flow by inflating during diastole, displacing blood volume in the descending aorta and increasing aortic pressure.
The Impella pump is a tiny, catheter-based axial flow pump that is placed in the left ventricle (LV) of the heart across the aortic valve. The pump transfers kinetic energy to the blood stream – creating a continuous flow of blood from the LV to the ascending aorta.
Our team uses pumps like the Impella 5.0 as an ambulatory option to support patients with advanced heart failure while they recover and engage in activities such as physical therapy.
The TandemHeart device is a pump that reduces left ventricular preload by transferring oxygenated blood from the left atrium to the descending aorta via 2 cannulas.
VA-ECMO stands for venoarterial extracorporeal membrane oxygenation. This device is commonly used to improve systemic oxygenation during cardiorespiratory collapse (shock), cardiac arrest and myocarditis. A patient is hooked up to the ECMO circuit via tubing that allows his or her blood to run through the circuit instead of through the heart and lungs. The ECMO continuously removes carbon dioxide and adds oxygen to the blood and then returns it to the patient. This process reduces both right and ventricular blood flow volumes with an increase in arterial pressure and left ventricular systolic and diastolic pressures.
Our ECMO program is run in partnership with the Medical Intensive Care Unit (MICU) at Tufts MC and is one of the strongest programs in New England. Other major academic medical centers in the area often transfer patients in need of ECMO treatment to Tufts MC because of our expertise. Read one patient’s testimonial about how ECMO saved her life >
Failure of both the right and left ventricles (Biventricular Failure) is associated with high rates of morbidity and mortality. At Tufts Medical Center, we have been the first employ percutaneous acute circulatory support technologies for Biventricular Failure. For example, the use of two axial flow pumps to support both right and left heart failure (BiPella) has been performed less than 50 times world-wide. Tufts Medical Center was the first to develop and employ this approach in Boston and has successfully recovered several patients from cardiogenic shock with this technology.
One of the most effective ways to maintain our leadership position at the cutting-edge of clinical care is to engage in research. By taking one step towards a more fundamental understanding of how acute circulatory support pumps work, we gain valuable insight into our current treatment algorithms, future treatment strategies, and how new devices may work even better to support a disabled heart and potentially lead to recovery of heart function.
The Acute MCS Working Group at Tufts Medical Center has earned more than $4 million dollars in research awards from multiple cutting-edge companies (Figure). Over the past 5 years, this funding has led to the publication of more than 50 articles in peer-reviewed journals and has helped us push the limits of innovation and understanding of acute mechanical support worldwide.
Our current research is focused on:
- Exploring the hypothesis that early mechanical circulatory support may limit myocardial damage due to a heart attack
- Studying how intra-aortic balloon counterpulsation pumps work in patients with end-stage heart failure
- Studying devices specifically designed for right ventricular failure and pulmonary hypertension
- Defining algorithms for optimal acute mechanical support utilization in patients
- Developing novel devices and approaches for acute and chronic heart failure
In addition to providing cutting-edge clinical care and researching innovative strategies for the use of acute mechanical circulatory support, the program at Tufts Medical Center has invested in developing the next generation of experts in this domain.
First, we offer a 2-year hybrid training program for physicians to become board-eligible for certification in Interventional Cardiology and Advanced Heart Failure/Cardiac Transplantation. Launched in 2011, the Interventional Heart Failure (IHF) program was the first of its kind in the United States and has graduated 5 IHF fellows who now serve as Interventional Cardiologists with expertise in managing acute and chronic heart failure including the use of acute mechanical circulatory support devices.
Second, we have developed a 1-year research fellowship for physicians to gain advanced training in acute mechanical circulatory support. This program offers clinical and pre-clinical research opportunities as well as exposure to biomechanical engineers from around the world working on acute mechanical circulatory support pumps.
To apply to either program, contact Dr. Navin Kapur.
Every donation, no matter the size has an influential impact on our program. We are actively seeking new sponsors and funding.
To show your support and assist the efforts of our dedicated staff, please contact Tufts Medical Center Trust at the address below or visit the Giving website and click Give Now.
If you are submitting a donation online through the Tufts Medical Center Trust, please make sure to select “Other” when asked where you would like to designate your gift and type in Acute Mechanical Circulatory Support Program in the text box provided.
All donations made to support our mission or specific program objectives of the department are tax-deductible.
Thank you for your support.
Tufts Medical Center Trust
800 Washington Street Box #9248
Boston, MA 02111