A Historical Review of Mechanical Circulatory Support Devices
Mechanical circulatory support devices have evolved significantly from the first heart pumps to today’s cutting-edge ECMO therapy and heart transplants.
Advancements in medical device technology over the decades have transformed outcomes for critically ill patients, offering renewed hope and saving lives. With heart disease a persistent leading cause of mortality worldwide, these devices’ importance cannot be overstated.
Diving into a historical review of mechanical circulatory support devices is far from an exercise in nostalgia – it’s a testimony to human ingenuity and the relentless pursuit of better solutions for patients across the fields of medicine, surgery and biomedical engineering.
It’s a pursuit that continues to this day.
History of Extracorporeal Membrane Oxygenation
We dive deeper into the full history of mechanical circulatory support devices in our eBook “Why You Need Flow Verification During ECMO” – which you can read here – but we’ll recap some of the highlights.
Early attempts at mechanical circulatory support date back to the development of Extracorporeal Life Support and the heart-lung machine in the 1950s. Dr. John Gibbon, credited with inventing the heart–lung machine, created a freestanding roller pump device for extracorporeal support (1953.)
A few years later, the synthesis of silicone rubber – strong enough to withstand hydrostatic pressure while still being permeable to gas transfer – opened new opportunities with membrane oxygenators. The term extracorporeal membrane oxygenation (ECMO) was born.
ECMO was used in the 1970s to treat acute respiratory distress syndrome (ARDS). In 1976, Dr. Robert Bartlett, known as the “Father of ECMO,” reported the first neonatal ECMO survivor: baby Esperanza. Her groundbreaking recovery opened up new frontiers for treating babies with infant respiratory distress syndrome (IRDS).
Nowadays, ECMO is a common treatment for critically ill patients who need heart and lung support while they recover from diseases like COVID-19, ARDS, or other critical care situations.
History of Ventricular Assist Devices
Ventricular assist devices (VADs) are often used as a bridge to heart transplantation, supporting patients who either need time to become strong enough for the transplant surgery or who are waiting for a donor heart to become available.
They can be used to assist the left ventricle, the right ventricle, or both. In essence, VADs are mechanical pumps that support heart function and blood flow.
The first clinical use of a left ventricular assist device (LVAD) was in 1963 to help a patient who went into cardiac arrest after aortic valve replacement surgery. By 1966, the first successful pneumatically-driven paracorporeal left ventricular assist device was employed in cardiac surgery.
A year later, in 1967, Dr. Christiaan Barnard performed the first human heart transplant surgery. This landmark event set the foundation for further advancements in both technique and technology. As heart transplants became a life-saving reality, they drove a correspondingly greater need for VAD support.
Tens of thousands of heart transplants have been performed since 1967. About a quarter of those patients were supported by a VAD prior to the transplant surgery.
History of Total Artificial Hearts
Theories about human-made artificial hearts were circulating back in the 1800s, but didn’t come to fruition until the 20th century.
In 1937, Dr. Vladimir P. Demikhov developed a total artificial heart device (TAH) and performed the first coronary artery bypass surgery and intrathoracic transplantation on a dog. Further advancements in the use of mechanical hearts during surgery, along with development of the heart-lung machine, spurred interest in developing a TAH for human use.
The first artificial heart was successfully implanted in a human in 1982, following decades of development and testing. The patient lived for 112 days after transplant. The next recipient lived for 620 days.
Now, there are several different types of artificial hearts available, including portable ones that allow the patient to leave the hospital and be treated as an outpatient while they wait for a donor heart to come available.
Transonic and Mechanical Circulatory Support Device Advancements
The brilliance and tenacity of surgeons like Dr. John Gibbon, Dr. Robert Bartlett, Dr. Christiaan Barnard and many others have pushed cardiopulmonary treatments to the technological heights they occupy today.
A little known part of the story, however, is the product innovation from medical device companies like Transonic that supported – and continue to support – their work.
For example, “Father of ECMO” Dr. Robert Bartlett needed a way to accurately measure flow in the tubing of his membrane lung. Transonic’s breakthrough in 1987 with the C-Series clamp-on sensor, designed specifically for noninvasive sterile tubing, was the answer.
Dr. Bartlett ended up incorporating the Transonic Tubing Flowsensor and its companion HT101DBLZ Flowmeter into his ECMO protocol to ensure correct flow was delivered to the patient. The C-Series Clamp-on was also adopted by American Society for Artificial Internal Organs for total artificial hearts, ventricular assist devices and cardiopulmonary bypass, in addition to ECMO.
As mechanical circulatory support devices progressed over the decades, Transonic technologies advanced to support surgeons and patients in step with scientific and medical progression.
From today’s ELSA Monitor to other flowsensor and flowmeter products, Transonic technology is a trusted manufacturer of precise measurements that give surgeons and care teams critical quantitative data they need to make the best decisions for their patients.
This is Part 3 of a series on Mechanical Circulatory Support Devices. Click here for Part 1: Mechanical Circulatory Support Devices That Make a Difference and click here for Part 2: Circulatory Support Devices in Action.