Page 80 - Biomedical Engineering and Design Handbook Volume 2, Applications

CHAPTER 3

OVERVIEW OF

CARDIOVASCULAR DEVICES

Kenneth L. Gage and William R. Wagner
University of Pittsburgh, Pittsburgh, Pennsylvania

3.1 INTRODUCTION 59 3.5 ARTIFICIAL VASCULAR GRAFTS 76
3.2 ARTIFICIAL HEART VALVES AND 3.6 ARTIFICIAL KIDNEY 80
RELATED TECHNOLOGIES 60 3.7 INDWELLING VASCULAR CATHETERS
3.3 STENTS AND STENT-GRAFTS: AND PORTS 84
PERCUTANEOUS VASCULAR 3.8 CIRCULATORY SUPPORT DEVICES 88
THERAPIES 66 3.9 ARTIFICIAL LUNG 95
3.4 PACEMAKERS AND IMPLANTABLE ACKNOWLEDGMENTS 98
DEFIBRILLATORS 71 REFERENCES 99

3.1 INTRODUCTION

Despite almost a 25 percent reduction in the mortality rate between 1994 and 2004, cardiovascular
disease (CVD) remains the leading cause of death in the United States, with one in three adults liv-
ing with some form of CVD (Rosamond et al., 2008). The economic impact of CVD is equally stag-
gering. It is estimated that the total cost (direct and indirect) for CVD in the United States was
almost 450 billion USD in 2008 (Rosamond et al., 2008). The burden of CVD is not limited to
developed nations; with almost 17 million fatalities in 2002 (Mackay and Mensah, 2004), CVD is
also the leading cause of death worldwide and is projected to remain so for decades (Mathers and
Loncar, 2006). Clearly, technological advancements in cardiovascular devices have an impact that
cannot be understated.
Many biomedical engineers have focused their careers on the study of cardiovascular disease and
the development of devices to augment or replace function lost to the disease process. The applica-
tion of engineering principles to device design has improved device function while minimizing the
detrimental side effects, allowing complex, challenging cardiovascular surgical procedures (e.g.,
open-heart surgery) and medical therapies (e.g., dialysis) to become routine. In this chapter, eight
major categories of cardiovascular devices are addressed, including cardiac valves and related tech-
nologies, stents and stent grafts, pacemakers and implantable defibrillators, vascular grafts, hemodi-
alyzers, indwelling catheters, circulatory support devices, and blood oxygenators. Taken together,
these categories span from the most basic equipment used in healthcare to cutting-edge devices still
undergoing rapid change in both development and application.
For each topic the market size, indications for device use, device design, complications and
patient management, and future trends are covered. The intent is to provide a brief introduction to
the current status of cardiovascular device development and application and to identify challenges
that remain in the field.

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