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Invited Talk

Biomedical Engineering in Cardiology: Applications and Problems

Prof. Rolf Vogel, MD, PhD, MSEE
ARTORG Center Cardiovascular Engineering, University of Bern and
Department of Cardiology, Inselspital, Bern

031 632 0430
rolf.vogel@artorg.unibe.ch
rolf.vogel@insel.ch
www.artorg.unibe.ch

Abstract

Cardiovascular diseases are the leading cause of morbidity and mortality among adults in industrialized countries, thus generating enormous clinical and socioeconomic impact. The contemporary diagnostic and therapeutic management of cardiovascular diseases mainly relies on the biomedical engineer’s approach, whereas pharmacologic therapy proved its efficacy in the setting of prevention and risk factor control. Cardiovascular diseases, hereditary or acquired, can be divided into three major groups:

1. Vascular diseases such as incorrect cross-linking (fistula, transposition of great arteries), lumen narrowing (coronary artery stenosis, carotid artery stenosis, renal artery stenosis, …) or lumen bulging (aneurysm, dissection, varix).

2. Heart diseases such as cardiac malformations, heart valve diseases, cardiomyopathies and acute or chronic pump failure.

3. Diseases of the cardiovascular control system such as heart rhythm disorders, arterial hypertension and fluid overload.

The evaluation of cardiovascular diseases includes apparatus-supported diagnostics by means of blood chemistry, blood pressure measurement, electrocardiogram, ultrasound, computed tomography, magnet resonance imaging, positron emission tomography and angiography with invasive pressure and flow assessment.

Regarding the treatment of cardiovascular diseases, most of them can be handled by either percutaneous, i.e. catheter-based, keyhole techniques or open surgery; the clinical situation may guide the selection.

Vessel stenoses are treated by balloon dilatation (angioplasty) and stent implantation or bypass graft (biologic or artificial) surgery. Acute vessel occlusions can be reopened by catheter-based aspiration or fragmentation of thrombi or surgical embolectomy. High speed burr or laser systems can be used to deal with chronic arterial occlusions. Aneurysms with imminent or evident rupture require prompt surgical (dacron grafts) or percutaneous (endovascular stents) intervention. Arteriovenous short-circuits at the vascular (fistulas) or cardiac (shunts) level can be corrected by various catheter-based closure systems.

However, surgery is the preferred, or often the only option for large and complex defects. Heart valve surgery (repair of native valves or replacement by mechanical or bio-prosthetic valves) is well established. The same is true for percutaneous valvuloplasty (balloon dilatation of narrowed heart valves), whereas catheter-based valve repair and replacement may herald the next revolution in cardiovascular therapy.

End-stage heart failure requires heart replacement therapy by transplantation, either directly or after temporary support by mechanical assist devices. However, long-term destination therapy by a total artificial heart, the ideal strategy in view of the shortage of donor organs, has not yet been established.

The management of cardiac arrhythmias has made impressive progress due to recent technical advances. Pacemakers with more and more complex features reliably handle symptomatic bradycardias and implantable defibrillators increase life expectancy of patients threatened by fatal ventricular tachycardias. Cardiac resynchronisation therapy by multisite pacing ameliorates severe symptomatic heart failure.

Finally, prevalent arrhythmias such as atrial fibrillation or re-entry tachycardias can be restored by radiofrequency catheter ablation. Further devices are currently evaluated such as the electrical carotid sinus stimulator for severe arterial hypertension refractory to medical treatment or implantable recorder/transmitter of various physiologic parameters, which may serve as early-warning system possibly in conjunction with telemedicine.

 

Biography

Rolf Vogel (*1965) received a double degree (MSc) in electrical engineering and human medicine (ETH Zurich, 1991 and University of Bern, 1999). He was a postgraduate research fellow from 1995 to 1999 at the department of physiology, University of Bern and received doctorates (MD-PhD) from the faculty of philosophy and the faculty of medicine in 2000. Between 2000 and 2006, he had his fellow-ship in clinical cardiology with focus on interventional cardiology (board certification). This training included a 18 month postdoctoral research fellowship in biomedical engineering. From May 2006 till the end of 2008, he was senior interventional cardiologist and senior scientist at the Inselspital Bern. Since 2007, he acts as visiting lecturer for cardiovascular technology in the master program in biomedical engineering of the University of Bern. He was appointed for the ARTORG professorship with focus on cardiovascular engineering in January 2009. His broader research interests include all aspects of engineering and their clinical implications in the field of cardiovascular interventions and device therapy.

Volker Koch, 02/2009