Redefining Cardiac Care: The Path to Advanced Mechanical Circulatory Support

Heart failure continues to be one of the most challenging conditions faced in modern medicine, affecting about 64 million people globally. Traditional treatments, while beneficial, often fail to provide long-term solutions for patients with severe cardiac conditions, highlighting the growing need for innovative approaches. 

When it comes to people’s well-being, innovation is not optional—it’s essential. Today, healthcare professionals worldwide are pushing the boundaries of cardiac care to offer new hope to those battling heart failure.

As the Head of the Cardiac Surgery section and the Director of the Robotics and Heart Transplant Surgical Program at King Faisal Specialist Hospital & Research Centre (KFSHRC), I am proud of the advancements the Kingdom of Saudi Arabia has achieved in mechanical circulatory support (MCS) systems. These technologies are revolutionizing the treatment of heart and respiratory failure. 

To better appreciate the innovations that have transformed cardiac patient care and anticipate future breakthroughs that will improve patient outcomes, here’s a quick recap of the evolution of MCS systems.

For many years, the Extracorporeal Membrane Oxygenation (ECMO) provided support for severe heart and lung failure. While ECMO’s life-saving capabilities are typically temporary, Ventricular Assist Devices (VADs) have revolutionized long-term care by helping the heart pump blood, serving as either a bridge to transplantation or a permanent solution for patients ineligible for transplants. Modern VADs have dramatically improved patients’ quality of life. For severe biventricular heart failure, the Total Artificial Heart (TAH) replaces the heart entirely, while other devices offer temporary support during high-risk procedures. 

One of the most exciting developments in MCS is the advent of fully implantable VADs. These devices, which are smaller and more efficient than their predecessors, offer patients greater mobility and freedom. As we continue to refine these technologies, we anticipate a future where VADs become a routine treatment option for heart failure patients, providing them with a durable and effective means of support.

KFSHRC is currently the highest-volume centre for MCS, with an average of 70 ECMO, 30 non-durable VADs, and 22 durable VADs per year, and is increasingly integrating robotic technology into cardiac procedures. The precision and efficiency of robotic-assisted VAD implantation have reduced recovery times by up to 30% and improved surgical precision. From 2013 to 2019, the implementation of a multidisciplinary heart team improved 1-year LVAD survival rates to 70%. The HeartMate 3 LVAD further enhanced 1-year survival rates to 75%, with morbidity rates similar to those in clinical trials. 

Looking forward, the integration of artificial intelligence (AI) and machine learning into MCS systems is highly promising for improving cardiac patient outcomes. These technologies can help predict complications, optimize device settings, and personalize treatment plans based on real-time data. By harnessing the power of AI, we can enhance the precision and efficacy of MCS.

Furthermore, the development of biocompatible materials and improved bioengineering techniques will play a pivotal role in the future of MCS. These advancements will reduce the risk of infection and thrombosis, making MCS devices safer and more reliable. As these materials evolve, they will enable the creation of next-generation devices that are both highly effective and minimally invasive.

The future of MCS systems holds immense potential, presenting radical advancements that offer renewed hope for patients and signify a remarkable progression in cardiac care. It is our collective responsibility to push the boundaries of what is possible, to strive for excellence in developing and implementing these life-saving devices, and to ensure that every patient benefits from them. Together, let us embrace this challenge, commit to continuous improvement in MCS systems, and lead the way in shaping the future of cardiac healthcare.

About Dr. Feras Khaliel

Dr. Khaliel has profound expertise in heart failure management, specializing in heart transplantation, ventricular assist devices (VADs), and pulmonary thromboendarterectomy (PTE) procedures. Under his leadership, KFSHRC’s robotic program has distinguished itself as the only intra-cardiac surgical program in the Middle East. It is recognized among the top five globally for complex robotic multivalve surgery. A prolific speaker and author, Dr. Khaliel has delivered presentations at over 200 medical congresses and published more than 30 scientific papers.