This book is a detailed practical guide to the use of ventricular assist devices and total artificial hearts to provide mechanical circulatory support (MCS) in patients with end-stage heart failure. It explains why MCS may be indicated, which patients require MCS, when and how to implant ventricular assist devices or a total artificial heart, and how to avoid potential complications of MCS. Management throughout the period of care is described, from preimplantation to follow-up, and both typical and atypical cases are discussed. The text features numerous helpful tips and tricks relating to surgical and nonsurgical management and is supported by a wealth of high-quality illustrations that document preoperative evaluation and implantation technique. Heart transplantation remains the gold standard for the treatment of patients suffering from end-stage heart failure, but the shortage of donors has led to an increase in the use of MCS. This book will assist all physicians, and especia
lly cardiologists and anesthesiologists, who are involved in the care of these patients.
PART I: PREOPERATIVE EVALUATION - 1 Physiopathology and Fate of End-Stage Cardiac Heart Failure in the era of Mechanical Circulatory Support.- 2 The Advantage of Mechanical Solution: Results of Clinical Trials to Date.- 3 Mechanical Circulatory Support Candidate Selection Criteria.- 4 Preoperative Assessment and Clinical Optimization.- 5 Preoperative Evaluation of Right Ventricular Function.- 6 High INTERMACS profiles: Medical vs. Mechanical Circulatory Support treatment.- 7 Low INTERMACS Profiles: which Strategies? (Temporary ECMO or TAH support; Temporary mid-term Paracorporeal Ventricular Assisted Device Support; Primary long-term Ventricular Assisted Device placement).- 8 From BTT to DT Strategy: USA and Europe views.- 9 Mechanical Circulatory Support as a Bridge to Recovery.- 10 Mechanical Circulatory Support as a Bridge to Candidacy.- PART II: INTRAOPERATIVE TIPS AND PITFALLS - 11 Pulsatile vs. Continuous Flow pumps: Engineering and Clinical Considerations.- 12 Which Approac
h? Traditional vs. MICS.- 13 To Pump or not to Pump: the Role of Cardio-Pulmonary Bypass or ECMO.- 14 Techniques for Inflow Cannula Placement.- 15 Techniques for Outflow Cannula Placement.- 16 Techniques for Driveline Positioning.- 17 Percutaneous Devices: Options.- 18 Paracorporeal Biventricular Devices.- 19 Biventricular Implantable Continuous flow pumps.- 20 The Total Artificial Heart.- 21 Mechanical Circulatory Support in Pediatric Population.- 22 Concomitant Cardiac Surgery during Ventricular Assisted Device Placement: When is It too Much .- 23 Pump Removal after Recovery.- 24 Intraoperative anesthesiological monitoring and management.- 25 Intraoperative right ventricular failure management.- PART III: POSTOPERATIVE RECOMMENDATIONS - 26 Physiotherapy and Rehabilitation Management in Ventricular Assisted Device Patients.- 27 Coagulation Monitoring.- 28 Adverse events management: Ischemic and Haemorragic Stroke.- 29 Adverse events management: Gastro-intestinal Bleeding.- 30 Adv
erse events management: Pump Thrombosis.- 31 Adverse events management: Infectious Complications.- 32 Adverse events management: AVW Syndrome.- 33 Adverse events management: Concomitant non-Cardiac Surgery during MCS: Management of Therapy.- 34 Pump and Equipment Failure: How to Behave.- 35 The Outpatient Care: The Role of Ventricular Assisted Device coordinator and the Remote Monitoring.- PART IV: MISCELLANEA - 36. Miniaturization and Future Technologies.- 37 ReliantHeart - Forward Compatibility and TET.- 38 The BIVACOR project.- 39 Potential of CARMAT in the Future.- 40 The ReinHeart Solution.- 41 Ethical and Psychological aspects of long-term MCS.- 42 Health-Economic Aspects of Mechanlical Circulatory Support Therapy.- 43 The Mechanical Circulatory Support Registries: Role and Perspectives.- 44 Conclusions.
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1 Invited Lecture "Pioneering the Future: From Transplant to Device Development" |
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1 | (12) |
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I Preoperative Evaluation |
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2 Physiopathology and Fate of End-Stage CHF in the Era of MCS |
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13 | (12) |
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3 Cardiomyopathies and Clinical Features |
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25 | (12) |
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4 MCS Candidate Selection Criteria |
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37 | (22) |
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5 Preoperative Assessment and Clinical Optimization |
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59 | (16) |
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6 Preoperative Evaluation of Right Ventricular Function |
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75 | (18) |
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7 High INTERMACS Profiles: Medical Versus MCS Treatment |
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93 | (10) |
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8 Low INTERMACS Profiles: Temporary ECMO or TAH Support |
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103 | (4) |
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9 Low INTERMACS Profiles: Temporary Midterm Paracorporeal VAD Support |
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107 | (8) |
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10 Low INTERMACS Profiles: One-Stage Durable LVAD Implantation for INTERMACS Level 1: Indications and Contraindications |
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115 | (6) |
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11 Bridge to Transplant and Destination Therapy Strategies in the United States |
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121 | (10) |
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12 Mechanical Circulatory Support as Bridge to Recovery |
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131 | (18) |
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13 Mechanical Circulatory Support as Bridge to Candidacy |
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149 | (14) |
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II Intraoperative Tips and Pitfalls |
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14 Engineering and Clinical Considerations in Rotary Blood Pumps |
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163 | (12) |
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15 Engineering and Clinical Considerations in Pulsatile Blood Pump |
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175 | (8) |
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16 Intraoperative Anesthesiological Monitoring and Management |
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183 | (10) |
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17 Transesophageal Echocardiography During LVAD Implantation |
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193 | (8) |
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18 Intraoperative Anticoagulation and Coagulation Management |
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201 | (10) |
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19 Intraoperative Right Ventricular Failure Management |
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211 | (10) |
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20 Tricuspid Valve Regurgitation and Right Ventricular Dysfunction During Left Ventricular Assist Device Implantation |
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221 | (6) |
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21 Role of Inotropes, Pulmonary Vasodilators, and Other Pharmacologic Interventions for Right Ventricular Dysfunction |
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227 | (8) |
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235 | (6) |
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23 Which Approach? Traditional Versus MICS |
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241 | (12) |
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24 Minimal Invasive: Padua's Approach and Technique |
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253 | (12) |
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25 To Pump or Not to Pump: The Role of CPB or ECMO |
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265 | (6) |
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26 Techniques for Inflow Cannula Placement |
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271 | (6) |
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27 Techniques for Outflow Cannula Placement |
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277 | (4) |
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28 Techniques for Driveline Positioning |
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281 | (6) |
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29 Percutaneous Devices: Options |
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287 | (12) |
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30 Paracorporeal Biventricular Assist Devices: The EXCOR® VAD System |
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299 | (6) |
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31 Biventricular Circulatory Support with Two Implantable Continuous-Flow Pumps |
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305 | (8) |
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32 The Total Artificial Heart |
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313 | (24) |
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33 Concomitant Cardiac Surgery During VAD Placement: When Is It Too Much? |
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337 | (12) |
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34 Pump Removal After Myocardial Recovery During Left Ventricular Assist Device Support |
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349 | (6) |
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III MCS in Pediatric Population |
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35 Mechanical Circulatory Support in Pediatric Population: Clinical Considerations, Indications, Strategies, and Postoperative Management |
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355 | (6) |
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36 Continuous-Flow Pumps in Pediatric Population |
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361 | (10) |
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37 The Berlin Heart EXCOR Experience in the USA |
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371 | (10) |
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38 Ventricular Assist Device Support for Hypoplastic Left Heart Syndrome, Fontan Failure, and End-Stage Systemic Right Ventricular Dysfunction |
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381 | (10) |
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39 Continuous-Flow Pumps in Infants, Jarvik Infant System, and Destination Therapy in Pediatrics |
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391 | (12) |
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IV Postoperative Recommendations |
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40 Physiotherapy and Rehabilitation Management in Adult LVAD Patients |
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403 | (18) |
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41 Physiotherapy and Rehabilitation Programs for Pediatric VAD Patients |
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421 | (6) |
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42 Patient-and Device-Tailored Antithrombotic Treatment |
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427 | (6) |
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43 Coagulation Monitoring |
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433 | (12) |
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44 Outpatient Management: The Role of the VAD Coordinator and Remote Monitoring |
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445 | (22) |
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45 Psychosocial Considerations of Mechanical Circulatory Support: Decision Making, Behavioral Evaluation, Quality of Life, Caregivers, and End of Life |
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467 | (12) |
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V Adverse Events Management |
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46 Ischemic and Hemorrhagic Stroke |
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479 | (10) |
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47 Gastrointestinal Bleeding |
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489 | (6) |
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495 | (18) |
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49 Infectious Complications |
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513 | (26) |
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50 Acquired von Willebrand Syndrome |
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539 | (6) |
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51 Concomitant Noncardiac Surgery During Mechanical Circulatory Support: Management of Therapy |
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545 | (12) |
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VI Miniaturization and Future Technologies |
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52 Novel HeartMate Cardiac Assist Systems (Thoratec) |
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557 | (8) |
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53 HeartWare® HVAD® System |
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565 | (4) |
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54 ReliantHeart: Forward Compatibility and TET |
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569 | (12) |
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55 Early Experience with the CARMAT Bioprosthetic Artificial Heart |
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581 | (8) |
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56 The ReinHeart Solution |
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589 | (6) |
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VII Health-Economic Aspects |
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57 Health-Economic Aspects of MCS Therapy |
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595 | (12) |
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VIII Registries Perspectives |
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58 The EUROMACS Registry of Patients Who Receive Mechanical Circulatory Support: Role and Perspectives |
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607 | (7) |
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Telemonitoring and Teleconsultation |
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Dr. Antonio Loforte, MD, PhD
Dr. Antonio Loforte received his Medical Degree from Catania University School of Medicine, Italy, and completed his cardiothoracic surgery residency at the University of Bologna, S. Orsola-Malpighi Hospital, Italy, after a period of training at St. Antonius Ziekenhuis, Nieuwegein, Utrecht, The Netherlands. He completed a two-year cardiothoracic and transplantation surgery fellowship at the Deutsches Herzzentrum Berlin, Germany, and then joined the Michael E. DeBakey Department of Surgery, Division of Tranplant and Assist Devices, Baylor College of Medicine, Houston, Texas, USA, and the Klinic fur Herzchirurgie, Universitat Leipizig, Herzzentrum, Leipizig.
He became permanent staff surgeon at S. Camillo Hospital, Department of Cardiac Surgery and Transplantation, Rome, Italy, and currently moved back as permanent staff surgeon to S. Orsola-Malpighi Hospital, Bologna University, Department of Cardiovascular Surgery and Transplantation, Italy.
Dr. Lofortes main clinical areas of interest are Heart Tranplantation, Mechanical Circulatory Support therapy, Aortic Surgery, Minimally-Invasive Heart Surgery, OPCABG and new technologies in cardiac surgery.
Dr. Lofortes main scientific and research areas of interest are Organ Transplantation and Mechanical Circulatory Support (ECMO, VAD, TAH).
He got a European PhD Label in Organ Transplantation awarded by Rome Tor Vergata University, Italy, and the dissertation title has been: "The role of Mechanical Circulatory Support in end-stage heart failure as bridge or alternative to Heart Transplantation".
He got, by time, 3 International Awards by such Societies as SITO, ASAIO and EACTS, respectively, on clinical reaserch studies focused on Mechanical Circulatory Support therapy.
He has published over 60 papers in peer-reviewed Journals, as well as 5 book chapters and he is author of more then 170 abstracts (communications) for International meetings. He is a reviewer for 19 International Journals and on the Editorial Board of 8.
He is active member of SICCH, EACTS, ASAIO, ISHLT, RHICS, STS, EUROMACS.
Dr. Cristiano Amarelli, MD
Dr. Amarelli, is a cardiac nonacademic surgeon involved in the field of heart transplantation during the last 15 years with a strong scientific activity in the field of transplantation, mechanical valve and mechanical circulatory support. Born in Naples he graduated in Naples at the Second University of Naples where he completed in 2003 his training in cardiovascular surgery. He is an active promotor of heart donation for the European Cardiothoracic Transplant Association (ECTTA) stimulating and coordinating the writing process of the European Consensus Conference on thoracic donors, takes active part to the editorial board and to the historic committee of the ASAIO, and is active reviewer for manyjournals and international meetings. During last years undertake to a national network looking to expand the adoption of mechanical circulatory support in Italy under the auspices of National Transplant Center and of the Italian Society of Cardiac Surgery. Dr. Andrea Montalto, MD.
Dr. Andrea Montalto obtained his Medical Degree at Federico II University School of Medicine in Neaples, Italy.
After completed the residency in cardiac surgery at the University Federico II, he moved to Rome to complete the training by attending the cardiac surgery center at S. Camillo Hospital.
Since 2006 he became permanent staff surgeon at S. Camillo Hospital, Department of Cardiac Surgery and Transplantation, Rome, Italy,
Dr. Montalto has shown particular interest in the field of surgical treatment of advanced heart failure becoming familiar in the management of patients implantedwith mechanical devices.
Dr.Montalto, since 2012, has acquired the role of head of the VAD program at the center of cardiac surgery at the San Camillo Hospital.
He is active member of SICCH, EUROMACS.
Prof. hc. Dr. med. habil. Thomas Krabatsch
Thomas Krabatsch, MD, PhD is Senior Cardiac Surgeon at Deutsches Herzzentrum Berlin. Dr. Krabatsch has expertise in the surgical treatment of a variety of cardiovascular diseases in adults including severe diffuse coronary artery disease, valvular heart diseases, mechanical circulatory support and transplantation. He is the Director of Deutsches Herzzentrum Berlin's mechanical circulatory support team, which has experience with over 2,800 implants. Dr. Krabatsch's basic science research interests include endothelial growth factors for coronary disease and gene transfer, laser therapy and cell therapy. He is Member of the ISHLT, EACTS, DGTHG, German society for Gene Therapy, BBGHK, and author or coauthor of more than 150 scientific articles. Dr. Krabatsch also has relations with several universities and cardio-surgical hospitals in Eastern Europe, such as Russia, Belarus, Bosnia and Hungary. He is Honorary Professor in one of Russia's largest medical schools.