heart failure 3/3 cyborgs are devices implemented in humen beings for new modality of therapy (2)

. مقرر. الحميدي أحمد د حين 333أ

CYBORGS ARE DEVICES IMPLEMENTED IN HUMEN

BEINGS FOR NEW MODALITY OF THERAPY

Dr SAMIR TAYFOURCONSULTANT CARDIOLOGIST

CYBORG

• Kybernàn= pilotare “steerman”• Cyber+ organism “ hybrid “• Mixture of machin+organism• Norbert Wiener (1947)

. Cybernaut , Cyberspace

. a human being whose body has been taken over in whole or in part by electromechanical devices ; " a cyborg is a cybernetic organism .

Borg (Star Trek)

Cyborg = cybernetics + organismCybernetics or Communication in the human being or animal and the Machine. Based on the Greek “Kybernetics”, meaning “captain”to navigatecybernetics is the science or study of the control or regulation mechanism in human and machine systems, including computers.

What is a cyborg?‘A cyborg is a cybernetic organism, a hybrid ‘mixture’ of machine and organism, a creature of social reality as well as a creature of fiction’ – Donna Haraway A Cyborg Manifesto

A human cyborg is a human who has certain physiological processes aided or controlled by mechanical or electronic devices

Cyborg:a science of communication and control processes in animals and automated machines, where the study of control systems , such as the nervous system , in living organisms and the development of similar systems in the electronic and mechanical devices .

Monster or cyborg-object?

Cyborg = Cybernetic Organism

Organism (natural)• Complex, inflexible feedback loop• Too much change – organism will die

Cybernetic (artificial)• Flexible feedback loop• Responsive to stimuli,

able to adapt to survive What does it mean to be human?

Dual chambres pacemaker

Cardiac resynchronization therapy (CRT)

CRT device:Patients with NYHA Class /Ⅲ Ⅳ

Sympotomatic despite optimal medical therapy

QRS ≥ 120 msec

LVEF ≤ 35%

CRT plus ICD:Same as above with ICD indication

CHF and MRI

• Dimensions

• Contractility, Viability

• Valve function

March 2013 ghennersdorf DGK ESC SES 16

MRI crossectionalsequence of dilated LV

Consequences of contractility due to LBBB

• In DCM, certain areas of the LV wall are contracted (blue) when others are already relaxed (red). Other areas are constrained (yellow)

1980-82:ICD is First implanted patient in the U.S. (Johns Hopkins, Baltimore) and France

(Lariboisière, AP-HP)

Short-lived systems250g, non-programmableAbdominal implant thoracotomy

1966-1980 : works of Dr Mirowski, inventor and designer OF ICD

MERIT-HF Study Group. Effect of Metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL randomized intervention trial MERIT-HF Study Group. Effect of Metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL randomized intervention trial in congestive heart failure (MERIT-HF). in congestive heart failure (MERIT-HF). LANCET. LANCET. 1999;353:2001-07.1999;353:2001-07.

Severity of Heart FailureModes of Death

12%12%

24%24%

64%64%

CHFCHF

OtherOther

SuddenSuddenDeathDeath

n = 103n = 103

NYHA IINYHA II

26%26%

15%15%

59%59%

CHFCHF

OtherOther

SuddenSuddenDeathDeath

n = 103n = 103

NYHA IIINYHA III

56%56%

11%11%

33%33%

CHFCHF

OtherOther

SuddenSuddenDeathDeath

n = 27n = 27

NYHA IVNYHA IV

ICD TherapyICD TherapyCLASS I INDICATIONS:CLASS I INDICATIONS:

1.1. Ischemic cardiomyopathy with LVEF Ischemic cardiomyopathy with LVEF < 35%, at least 40 days post MI, NYHA class II OR III. < 35%, at least 40 days post MI, NYHA class II OR III. (Strength of (Strength of Evidence = A)Evidence = A)

2.2. Ischemic cardiomyopathy with LVEF < 30%, at least 40 days post MI, Ischemic cardiomyopathy with LVEF < 30%, at least 40 days post MI, NYHA class I. NYHA class I. (Strength of Evidence = A)(Strength of Evidence = A)

3.3. Non Ischemic cardiomyopathy with LVEF ≤ 35%, NYHA class II OR III. Non Ischemic cardiomyopathy with LVEF ≤ 35%, NYHA class II OR III.

(Strength of Evidence = B)(Strength of Evidence = B)

The ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

HEART SURGERY IN THE 21ST CENTURY

Indications• Bridge to Transplantation• Bridge to Recovery• Destination Therapy

Implantable Ventricular Assist DeviceImplantable Ventricular Assist Device

People Don’t want a LVAD, they want a Heart

The HeartMateII is a continuous flow cardiac assist device. Heart surgeon The HeartMateII is a continuous flow cardiac assist device. Heart surgeon "Bud" Frazier and his team are working with two such devices to develop a "Bud" Frazier and his team are working with two such devices to develop a continuous flow artificial heart. (Courtesy: Texas Heart® Institute) continuous flow artificial heart. (Courtesy: Texas Heart® Institute)

Artificial Heart

Multicenter Trial of the Orqis® Medical Cancion System for the ENhanced Treatment of CHF Unresponsive to

Medical Therapy

Cancion System for Continuous Aortic Flow Augmentation (CAFA)

Continuous Aortic Flow Augmentation (CAFA) Changes Flow Signature in Heart Failure

Backflow against the aortic wall

Forward flow in the center of

the aorta

Early Diastole Early DiastoleWith CAFA

Cardiac TransplantCardiac Transplant

At Groote Schuur Hospital At Groote Schuur Hospital

On December 3On December 3rdrd 1967 1967 Dr CHRISTIAN BERNARD Dr CHRISTIAN BERNARD

Management of Refractory Heart Failure• Inotropic drugs:

– Dobutamine, dopamine, milrinone, nitroprusside, nitroglycerin

• Mechanical circulatory support:– Intraaortic balloon pump– Left ventricular assist device (LVAD)

• Cardiac Transplantation– A history of multiple hospitalizations for HF– Escalation in the intensity of medical therapy– A reproducable peak oxygen consumption with maximal

exercise (VO2max) of < 14 mL/kg per min. (normal is 20 mL/kg per min. or more) is relative indication, while a VO2max < 10 mL/kg per min is a stronger indication.

Heart transplantation

March 2013 ghennersdorf DGK ESC SES 56

Dick Cheney robot heart watch

Several heart attacks, a bypass, a pump and now a heart transplant

later, Dick Cheney is back in action.Is he a ROBOT NOW ?.

THANK YOU…!!