Advances and Future Directions for Mechanical Circulatory Support

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Advances and Future Directions for Mechanical Circulatory Support Michelle Capdeville, MD, Nicholas G. Smedira, MD Anesthesiology Clinics Volume 31, Issue 2, Pages 321-353 (June 2013) DOI: 10.1016/j.anclin.2012.12.003 Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 1 HeartMate II LVAD in situ. Left ventricular inflow cannula is located at LV apex; outflow cannula is anastomosed to the ascending aorta. Anesthesiology Clinics 2013 31, 321-353DOI: (10.1016/j.anclin.2012.12.003) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 2 HeartMate II axial flow pump showing titanium-coated internal rotor. (Courtesy of Thoratec Corporation, Pleasanton, CA, USA.) Anesthesiology Clinics 2013 31, 321-353DOI: (10.1016/j.anclin.2012.12.003) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 3 Chest radiograph showing HeartMate II LVAD in situ. (Courtesy of Thoratec Corporation, Pleasanton, CA, USA.) Anesthesiology Clinics 2013 31, 321-353DOI: (10.1016/j.anclin.2012.12.003) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 4 Graphic illustration of pressure-flow relationship at various pump speeds. Anesthesiology Clinics 2013 31, 321-353DOI: (10.1016/j.anclin.2012.12.003) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 5 TEE 4-chamber view showing proper positioning of LV apical inflow cannula. Anesthesiology Clinics 2013 31, 321-353DOI: (10.1016/j.anclin.2012.12.003) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 6 TEE 4-chamber view with color flow Doppler showing laminar flow in the apical inflow cannula. Anesthesiology Clinics 2013 31, 321-353DOI: (10.1016/j.anclin.2012.12.003) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 7 Pulse wave Doppler of LV apical inflow cannula showing normal velocities (see text) and laminar flow. Anesthesiology Clinics 2013 31, 321-353DOI: (10.1016/j.anclin.2012.12.003) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 8 TEE long-axis view with color flow Doppler showing laminar flow in the aortic outflow cannula. Anesthesiology Clinics 2013 31, 321-353DOI: (10.1016/j.anclin.2012.12.003) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 9 Pulse wave Doppler of aortic outflow cannula showing normal velocities (see text). Anesthesiology Clinics 2013 31, 321-353DOI: (10.1016/j.anclin.2012.12.003) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 10 Algorithm illustrating differential diagnosis of increased pump power and echocardiographically determined decreased flow (output). Anesthesiology Clinics 2013 31, 321-353DOI: (10.1016/j.anclin.2012.12.003) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 11 Algorithm illustrating differential diagnosis of decreased pump power and echocardiographically determined low or normal flow (output). Anesthesiology Clinics 2013 31, 321-353DOI: (10.1016/j.anclin.2012.12.003) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 12 HeartWare LVAD in situ. (Courtesy of Heartware, Inc, Miami Lakes, FL, USA.) Anesthesiology Clinics 2013 31, 321-353DOI: (10.1016/j.anclin.2012.12.003) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 13 HeartWare LVAD in situ showing LV apical (pericardial) location of pump. (Courtesy of Heartware, Inc, Miami Lakes, Florida.) Anesthesiology Clinics 2013 31, 321-353DOI: (10.1016/j.anclin.2012.12.003) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 14 Miniaturized HeartWare HVAD pump. (Courtesy of Heartware, Inc, Miami Lakes, FL, USA.) Anesthesiology Clinics 2013 31, 321-353DOI: (10.1016/j.anclin.2012.12.003) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 15 Internal view of HeartWare HVAD showing impeller. (Courtesy of Heartware, Inc, Miami Lakes, FL, USA.) Anesthesiology Clinics 2013 31, 321-353DOI: (10.1016/j.anclin.2012.12.003) Copyright © 2013 Elsevier Inc. Terms and Conditions