page_title: Ventricular assist device
section_title: History
hierarchical_section_title: Ventricular assist device / History
caption_attribution_description: English: 1966 DeBakey ventricular assist device. This is part of the collections of the National Museum of Health and Medicine.
context_page_description: A ventricular assist device is an electromechanical device for assisting cardiac circulation, which is used either to partially or to completely replace the function of a failing heart. The function of VADs is different from that of artificial cardiac pacemakers; some are for short-term use, typically for patients recovering from myocardial infarction and for patients recovering from cardiac surgery; some are for long-term use, typically for patients suffering from advanced heart failure.
  VADs are designed to assist either the right ventricle or the left ventricle, or to assist both ventricles. The type of ventricular assistance device applied depends upon the type of underlying heart disease, and upon the pulmonary arterial resistance, which determines the workload of the right ventricle. The left ventricle assistance device is the most common device applied to a defective heart, but when the pulmonary arterial resistance is high, then an right ventricle assistance device might be necessary to resolve the problem of cardiac circulation. If both a LVAD and a RVAD is needed a BiVAD is normally used, rather than a separate LVAD and an RVAD.
context_section_description: The first Left Ventricular Assist Device (LVAD) system was created by Domingo Liotta at Baylor College of Medicine in Houston in 1962. The first left ventricular assist device (LVAD) was implanted in 1963 by Liotta and E. Stanley Crawford.
  The first successful implantation of a left ventricular assist device was completed in 1966 by Liotta along with Dr. Michael E. DeBakey to a 37-year-old woman. A paracorporeal (external) circuit was able to provide mechanical support for 10 days after the surgery. The first successful long-term implantation of an artificial LVAD was conducted in 1988 by Dr. William F. Bernhard of Boston Children's Hospital Medical Center and Thermedics, Inc of Woburn, MA under a National Institutes of Health (NIH) research contract which developed HeartMate, an electronically controlled assist device. This was funded by a three-year $6.2 million contract to Thermedics and Children's Hospital, Boston MA from the National Heart and Lung and Blood Institute, a program of the NIH. The early VADs emulated the heart by using a "pulsatile" action where blood is alternately sucked into the pump from the left ventricle then forced out into the aorta. Devices of this kind include the HeartMate IP LVAS, which was approved for use in the US by the Food and Drug Administration (FDA) in October 1994. These devices began to gain acceptance in the late 1990s as heart surgeons including Eric Rose, O. H. Frazier and Mehmet Oz began popularizing the concept that patients could live outside the hospital. Media coverage of outpatients with VADs underscored these arguments.
  More recent work has concentrated on continuous flow pumps, which can be roughly categorized as either centrifugal pumps or axial flow impeller driven pumps. These pumps have the advantage of greater simplicity resulting in smaller size and greater reliability. These devices are referred to as second generation VADs. A side effect is that the user will not have a pulse,
  or that the pulse intensity will be seriously reduced.
  Third generation VADs suspend the impeller in the pump using either hydrodynamic or electromagnetic suspension, thus removing the need for bearings and reducing the number of moving parts to one.
  Another technology undergoing clinical trials is the use of transcutaneous induction to power and control the device rather than using percutaneous cables. Apart from the obvious cosmetic advantage this reduces the risk of infection and the consequent need to take preventative action. A pulsatile pump using this technology has CE Mark approval and is in clinical trials for US FDA approval.
  A very different approach in the early stages of development is the use of an inflatable cuff around the aorta. Inflating the cuff contracts the aorta and deflating the cuff allows the aorta to expand—in effect the aorta becomes a second left ventricle. A proposed refinement is to use the patient's skeletal muscle, driven by a pacemaker, to power this device which would make it truly self-contained. However a similar operation (cardiomyoplasty) was tried in the 1990s with disappointing results. In any case, it has substantial potential advantages in avoiding the need to operate on the heart itself and in avoiding any contact between blood and the device. This approach involves a return to a pulsatile flow.
  Peter Houghton was the longest surviving recipient of a VAD for permanent use. He received an experimental Jarvik 2000 LVAD in June 2000. Since then, he completed a 91-mile charity walk, published two books, lectured widely, hiked in the Swiss Alps and the American West, flew in an ultra-light aircraft, and traveled extensively around the world. He died of acute kidney injury in 2007 at the age of 69.
caption: 1966 DeBakey ventricular assist device.[14]
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