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Shida S, Tsushima K, Osa M, Timms DL, Masuzawa T. Effects of biventricular shunt on pump characteristics in a maglev total artificial heart. Int J Artif Organs 2023; 46:636-643. [PMID: 37908140 DOI: 10.1177/03913988231209010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Severe left ventricular failure can progress to right ventricular failure, necessitating alternatives to heart transplantation, such as total artificial heart (TAH) treatment. Conventional TAHs encounter challenges associated with miniaturization and hemocompatibility owing to their reliance on mechanical valves and bearings. A magnetically levitated TAH (IB-Heart) was developed, utilizing a magnetic bearing. The IB-Heart features a distinctive biventricular shunt channel situated between the flow paths of the left and right centrifugal blood pumps, simplifying and miniaturizing its control system. However, the impact of these shunt channels remains underexplored. This study aimed to investigate the effects of shunt flow on pump characteristics and assess the IB-Heart's potential to regulate flow balance between systemic and pulmonary circulation. At a rotational speed of 2000 rpm and flow rate range of 0-10 L/min, shunt flow exhibited a minor impact, with a 1.4 mmHg (1.3%) effect on pump characteristics. Shunt flow variation of about 0.13 L/min correlated with a 10 mmHg pressure difference between the pumps' afterload and preload conditions. This variance was linked to changes in the inlet flow rates of the left and right pumps, signifying the ventricular shunt structure's capacity to mirror the function of an atrial shunt in alleviating pulmonary congestion. The IB-Heart's ventricular shunt structure enables passive regulation of left-right flow balance. The findings establish a fundamental technical groundwork for the development of IB-Hearts and TAHs with similar shunt structures. The innovative coupling of centrifugal pumps and the resultant effects on flow dynamics contribute to the advancement of TAH technology.
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Affiliation(s)
- Shuya Shida
- Faculty of Science and Engineering, Toyo University, Kawagoe, Saitama, Japan
| | - Kenichi Tsushima
- Graduate School of Science and Engineering, Ibaraki University, Hitachi, Ibaraki, Japan
| | - Masahiro Osa
- Graduate School of Science and Engineering, Ibaraki University, Hitachi, Ibaraki, Japan
| | | | - Toru Masuzawa
- Graduate School of Science and Engineering, Ibaraki University, Hitachi, Ibaraki, Japan
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2
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Loardi CM, Zanobini M, Ricciardi G, Vermes E. Current and future options for adult biventricular assistance: a review of literature. Front Cardiovasc Med 2023; 10:1234516. [PMID: 38028456 PMCID: PMC10657899 DOI: 10.3389/fcvm.2023.1234516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
In cardiogenic shock various short-term mechanical assistances may be employed, including an Extra Corporeal Membrane Oxygenator and other non-dischargeable devices. Once hemodynamic stabilization is achieved and the patient evolves towards a persisting biventricular dysfunction or an underlying long-standing end-stage disease is present, aside from Orthotopic Heart Transplantation, a limited number of long-term therapeutic options may be offered. So far, only the Syncardia Total Artificial Heart and the Berlin Heart EXCOR (which is not approved for adult use in the United States unlike in Europe) are available for extensive implantation. In addition to this, the strategy providing two continuous-flow Left Ventricular Assist Devices is still off-label despite its widespread use. Nevertheless, every solution ensures at best a 70% survival rate (reflecting both the severity of the condition and the limits of mechanical support) with patients suffering from heavy complications and a poor quality of life. The aim of the present paper is to summarize the features, implantation techniques, and results of current devices used for adult Biventricular Mechanical Circulatory Support, as well as a glance to future options.
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Affiliation(s)
| | - Marco Zanobini
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Emmanuelle Vermes
- Department of Cardiology, Amiens University Hospital, Amiens, France
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3
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Lutun J, Fauvel C, Gay A, Bauer F. COVID-19 in a patient implanted with a total artificial heart: a case report. Eur Heart J Case Rep 2022; 6:ytac317. [PMID: 36245854 PMCID: PMC9555052 DOI: 10.1093/ehjcr/ytac317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/12/2022] [Accepted: 07/27/2022] [Indexed: 11/05/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) was first identified in December 2019 and is currently still a public health issue affecting millions of people worldwide. Heart failure patients are known to be at higher risk of morbidity and mortality in this case. Yet, few data exist concerning COVID-19 among patients with a left ventricular assistance device, and even less among those with a total artificial heart (TAH). Case summary A 27-year-old man with Marfan syndrome underwent prophylactic ascending aorta replacement. Shortly after surgery completion, he developed refractory cardiogenic shock with biventricular dysfunction leading to veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implantation. In the context of no appropriate eligible donor during the following 10 days while waiting on the heart transplantation list, the patient was scheduled for a TAH as a bridge to transplantation. Meanwhile, he developed an acute respiratory distress syndrome secondary to SARS-CoV-2. The patient was successfully treated with corticosteroids, prone positioning and mechanical ventilation, and heart transplantation occurred 5 weeks after COVID-19 onset. Discussion Here, we report the first case of a patient presenting with COVID-19 infection following TAH implantation in a bridge to transplantation. We highlight that (i) cardiogenic shock patients simultaneously infected by COVID-19 should be treated instantly with all-time available technology to ensure best outcomes, including TAH and prone positioning, (ii) heart transplantation safety 5 weeks after COVID-19 onset.
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Affiliation(s)
- Juliette Lutun
- Service de chirurgie cardiaque, Clinique d’insuffisance cardiaque avancée, centre de compétence en hypertension pulmonaire 27/76, Centre Hospitalier Universitaire Charles Nicolle, F-76000 Rouen, France
| | - Charles Fauvel
- INSERM EnVI U1096, Université de Rouen, F-76000 Rouen, France,Department of Cardiology, Rouen University Hospital, F-76000 Rouen, France,Cardiovascular Medicine Division, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
| | - Arnaud Gay
- Service de chirurgie cardiaque, Clinique d’insuffisance cardiaque avancée, centre de compétence en hypertension pulmonaire 27/76, Centre Hospitalier Universitaire Charles Nicolle, F-76000 Rouen, France
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4
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Manning KB, Nicoud F, Shea SM. Mathematical and Computational Modeling of Device-Induced Thrombosis. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2021; 20:100349. [PMID: 35071850 PMCID: PMC8769491 DOI: 10.1016/j.cobme.2021.100349] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Given the extensive and routine use of cardiovascular devices, a major limiting factor to their success is the thrombotic rate that occurs. This both poses direct risk to the patient and requires counterbalancing with anticoagulation and other treatment strategies, contributing additional risks. Developing a better understanding of the mechanisms of device-induced thrombosis to aid in device design and medical management of patients is critical to advance the ubiquitous use and durability. Thus, mathematical and computational modelling of device-induced thrombosis has received significant attention recently, but challenges remain. Additional areas that need to be explored include microscopic/macroscopic approaches, reconciling physical and numerical timescales, immune/inflammatory responses, experimental validation, and incorporating pathologies and blood conditions. Addressing these areas will provide engineers and clinicians the tools to provide safe and effective cardiovascular devices.
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Affiliation(s)
- Keefe B. Manning
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Franck Nicoud
- CNRS, IMAG, Université de Montpellier, Montpellier, France
| | - Susan M. Shea
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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Le Picault B, David CH, Alexandre PL, Lenoble C, Bizouarn P, Lepoivre T, Groleau N, Rozec B, Desal H, Roussel JC, Sénage T. Success of Thrombectomy in Management of Ischemic Stroke in Two Patients with SynCardia Total Artificial Heart in Bridge-to-Transplantation. Bioengineering (Basel) 2021; 8:bioengineering8090126. [PMID: 34562948 PMCID: PMC8469750 DOI: 10.3390/bioengineering8090126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: Circulatory assistance from a SynCardia Total Artificial Heart (SynCardia-TAH) is a reliable bridge-to-transplant solution for patients with end-stage biventricular heart failure. Ischemic strokes affect about 10% of patients with a SynCardia-TAH. We report for the first time in the literature two successful thrombectomies to treat the acute phase of ischemic stroke in two patients treated with a SynCardia-TAH in the bridge-to-transplant (BTT). Case report: We follow two patients with circulatory support from a SynCardia-TAH in the bridge-to-transplant for terminal biventricular cardiac failure with ischemic stroke during the support period. An early in-hospital diagnosis enables the completion of a mechanical thrombectomy within the first 6 h of the onset of symptoms. There was no intracranial hemorrhagic complication during or after the procedure and the patients fully recovered from neurological deficits, allowing a successful heart transplant. Conclusion: This case report describes the possibility of treating ischemic strokes under a SynCardia-TAH by mechanical thrombectomy following the same recommendations as for the general population with excellent results and without any hemorrhagic complication during or after the procedure.
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Affiliation(s)
- Brendan Le Picault
- Department of Cardiothoracic Surgery, Nantes University Hospital, 44093 Nantes, France; (C.-H.D.); (J.-C.R.); (T.S.)
- Correspondence:
| | - Charles-Henri David
- Department of Cardiothoracic Surgery, Nantes University Hospital, 44093 Nantes, France; (C.-H.D.); (J.-C.R.); (T.S.)
| | - Pierre-Louis Alexandre
- Department of Neuroradiology, Nantes University Hospital, 44093 Nantes, France; (P.-L.A.); (C.L.); (H.D.)
| | - Cédric Lenoble
- Department of Neuroradiology, Nantes University Hospital, 44093 Nantes, France; (P.-L.A.); (C.L.); (H.D.)
| | - Philippe Bizouarn
- Department of Cardiothoracic Anesthesiology, Nantes University Hospital, 44093 Nantes, France; (P.B.); (T.L.); (N.G.); (B.R.)
| | - Thierry Lepoivre
- Department of Cardiothoracic Anesthesiology, Nantes University Hospital, 44093 Nantes, France; (P.B.); (T.L.); (N.G.); (B.R.)
| | - Nicolas Groleau
- Department of Cardiothoracic Anesthesiology, Nantes University Hospital, 44093 Nantes, France; (P.B.); (T.L.); (N.G.); (B.R.)
| | - Bertrand Rozec
- Department of Cardiothoracic Anesthesiology, Nantes University Hospital, 44093 Nantes, France; (P.B.); (T.L.); (N.G.); (B.R.)
| | - Hubert Desal
- Department of Neuroradiology, Nantes University Hospital, 44093 Nantes, France; (P.-L.A.); (C.L.); (H.D.)
| | - Jean-Christian Roussel
- Department of Cardiothoracic Surgery, Nantes University Hospital, 44093 Nantes, France; (C.-H.D.); (J.-C.R.); (T.S.)
| | - Thomas Sénage
- Department of Cardiothoracic Surgery, Nantes University Hospital, 44093 Nantes, France; (C.-H.D.); (J.-C.R.); (T.S.)
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David CH, Lacoste P, Nanjaiah P, Bizouarn P, Lepoivre T, Michel M, Pattier S, Toquet C, Périgaud C, Mugniot A, Al Habash O, Petit T, Groleau N, Rozec B, Trochu JN, Roussel JC, Sénage T. A heart transplant after total artificial heart support: initial and long-term results. Eur J Cardiothorac Surg 2020; 58:1175-1181. [PMID: 32830239 DOI: 10.1093/ejcts/ezaa261] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES At our centre, the SynCardia temporary Total Artificial Heart (TAH-t) (SynCardia Systems, LLC, Tucson, AZ, USA) is used to provide long-term support for patients with biventricular failure as a bridge to a transplant. However, a heart transplant (HT) after such support remains challenging. The aim of this retrospective study was to assess the immediate and long-term results following an HT in the cohort of patients who had a TAH-t implant. METHODS A total of 73 patients were implanted with the TAH-t between 1988 and 2019 in our centre. Of these 73 consecutive patients, 50 (68%) received an HT and are included in this retrospective analysis of prospectively collected data. RESULTS In the selected cohort, in-hospital mortality after an HT was 10% (n = 5). The median intensive care unit stay was 33 days (range 5-278). The median hospital stay was 41 days (range 28-650). A partial or total pericardiectomy was performed during the HT procedure in 21 patients (42%) due to a severe pericardial reaction. Long-term survival rates after an HT at 5, 10 and 12 years were 79.1 ± 5.9% (n = 32), 76.5 ± 6.3% (n = 22) and 72.4 ± 7.1% (n = 12), respectively, which was similar to the long-term survival for a primary HT without TAH-t during the same period (n = 686). An HT performed within 3-6 months post-TAH-t implantation appeared to provide the best survival (P = 0.007). Eight (16%) patients required chronic dialysis during the subsequent follow-up period, with 3 patients requiring a kidney transplant. CONCLUSIONS The long-term outcomes with the SynCardia TAH-t as a bridge to transplant in patients with severe biventricular failure are very encouraging. Our review noted that an HT following TAH-t can be technically challenging, especially in the case of a severe pericardial reaction, with potential pitfalls that should be recognized preoperatively.
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Affiliation(s)
- Charles-Henri David
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France
| | - Philippe Lacoste
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France
| | - Prakash Nanjaiah
- Department of Cardiac Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Philippe Bizouarn
- Department of Anesthesiology, Nantes Hospital University, Nantes, France
| | - Thierry Lepoivre
- Department of Anesthesiology, Nantes Hospital University, Nantes, France
| | - Magali Michel
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France.,Thoracic Transplantation Unit, Nantes Hospital University, Nantes, France
| | - Sabine Pattier
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France.,Thoracic Transplantation Unit, Nantes Hospital University, Nantes, France
| | - Claire Toquet
- Department of Cardiology and Vascular Diseases, Institut du thorax, UMR 1087, Clinical Research Unit-INSERM 1413, Teaching Hospital of Nantes, Nantes, France.,Anatomopathology Department, Nantes University Hospital, Nantes, France
| | - Christian Périgaud
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France
| | - Antoine Mugniot
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France
| | - Ousama Al Habash
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France
| | - Thierry Petit
- Thoracic Transplantation Unit, Nantes Hospital University, Nantes, France
| | - Nicolas Groleau
- Department of Anesthesiology, Nantes Hospital University, Nantes, France
| | - Bertrand Rozec
- Department of Anesthesiology, Nantes Hospital University, Nantes, France
| | - Jean Noel Trochu
- Department of Cardiology and Vascular Diseases, Institut du thorax, UMR 1087, Clinical Research Unit-INSERM 1413, Teaching Hospital of Nantes, Nantes, France
| | - Jean Christian Roussel
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France.,Thoracic Transplantation Unit, Nantes Hospital University, Nantes, France
| | - Thomas Sénage
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France.,Thoracic Transplantation Unit, Nantes Hospital University, Nantes, France.,INSERM 1246, Methods in Patients-Centered Outcomes and Health Research - SPHERE, Nantes University, Nantes, France
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7
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Chamogeorgakis T, Cowger J, Apostolou D, Tanaka D, Nemeh H. Right Ventricular Device HeartWare Implant to the Right Atrium with Fixation to the Chest Wall in Patient with Biventricular Support. ASAIO J 2020; 66:e102-e104. [PMID: 32740361 DOI: 10.1097/mat.0000000000001143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Jennifer Cowger
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan
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8
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Abstract
The total artificial heart (TAH) is a device that replaces the failing ventricles. There have been numerous TAHs designed over the last few decades, but the one with the largest patient experience is the SynCardia temporary TAH. The 50-mL and 70-mL sizes have been approved in the United States, Europe, and Canada as a bridge to transplantation. It is indicated in patients with severe biventricular failure or structural heart issues that preclude the use of a left ventricular assist device. The majority of the patients implanted are Interagency Registry for Mechanically Assisted Circulatory Support profile 1 or 2. The 1-year survival in experienced centers that have implanted over 10 TAHs is 73%. The risk factors for death include older age, need for preimplantation dialysis, and malnutrition. The most common causes of death are multiple organ failure, usually the result of physiologic deterioration before implantation, and neurologic dysfunction. The device allows the patient to be discharged home and managed as an outpatient. Proper patient selection, the timing of intervention, patient care, and device management are essential for a suitable outcome. In addition, the CARMAT TAH is another device that will soon be studied in a clinical trial in the United States. The BiVACOR TAH is a revolutionary design utilizing electromagnetic levitation that is expected to enter a clinical trial in the next few years.
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9
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Predictors of Renal Failure in Patients Treated With the Total Artificial Heart. J Card Fail 2020; 26:588-593. [PMID: 32470378 DOI: 10.1016/j.cardfail.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 04/24/2020] [Accepted: 05/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The incidence of hemodialysis (HD)-dependent renal failure after total artificial heart (TAH) implantation is high. We sought to determine the preoperative predictors of HD after TAH implantation. METHODS AND RESULTS We studied 87 patients after TAH implantation at our institution between April 2006 and March 2017. Baseline clinical data were obtained from the medical records, and patients were followed until death or heart transplantation. We performed logistic regression analysis to identify predictors of HD after TAH implantation. Of the patients, 24 (28%) required postimplantation HD. Those requiring HD were more likely to have histories of coronary artery disease (58% vs 29%; P = 0.01), required preoperative membrane oxygenation (33% vs 4.8%; P = 0.001) and had lower baseline estimated glomerular filtration rates (54 ± 29 vs 67 ± 24 mL/min/1.73m2; P = 0.04). Patients requiring HD were at a higher risk of death on device at 1 year (33% vs 5%, P = 0.001; log rank test: P =0.001, hazard ratio 6.6 [95% CI:1.8-23], P = 0.003). CONCLUSIONS The incidence of postimplantation HD is high and is associated with increased likelihood of mortality. Lower baseline estimated glomerular filtration rates, histories of coronary artery disease and preoperative membrane oxygenation support are predictors of postimplantation requirement of HD. These data may help to identify patients at risk for adverse outcomes after TAH implantation.
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10
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Shah KB. Renal function after implantation of the total artificial heart. Ann Cardiothorac Surg 2020; 9:124-125. [PMID: 32309164 DOI: 10.21037/acs.2020.03.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Keyur B Shah
- The Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
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11
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Melmed KR, Schlick KH, Rinsky B, Dumitrascu OM, Volod O, Nezhad M, Padrick MM, Runyan C, Arabia FA, Moriguchi JD, Lyden PD, Song SS. Assessing Cerebrovascular Hemodynamics Using Transcranial Doppler in Patients with Mechanical Circulatory Support Devices. J Neuroimaging 2020; 30:297-302. [PMID: 32037621 DOI: 10.1111/jon.12694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Mechanical circulatory support (MCS) devices are commonly used in heart failure patients. These devices carry risk for presumably embolic and additionally hemorrhagic stroke. Alterations in blood flow play a key role in stroke pathophysiology, and we aimed to learn more about hemodynamic compromise. In this study, we used transcranial Doppler (TCD) ultrasound to define hemodynamics of commonly used nonpulsatile MCS devices, as well as pulsatile devices, with special attention to the total artificial heart (TAH). METHODS From 2/2013 through 12/2016, we prospectively enrolled patients with MCS who underwent TCD imaging. We analyzed TCD parameters, including peak systolic velocity, end-diastolic velocity, pulsatility indices (PIs), and number of high-intensity transient signals. Waveform morphologies were compared between various MCS devices. RESULTS We performed 132 TCD studies in 86 MCS patients. Waveforms in patients supported by venoarterial-extracorporeal membrane oxygenation demonstrated continuous flow without clear systolic peaks with an average (±SD) PI of .43 (±.2). PIs were low in patients with continuous-flow left ventricular assist devices with a mean PI of .32 (±.13). Impella patients had morphologically distinct pulsatile waveforms and a higher mean PI of .65 (±.24). In intra-arterial balloon pump patients, mean PI was 1.01 (±.16) and diastolic upstrokes were pronounced. In TAH patients, mean middle cerebral artery velocity of 79.69 (±32.33) cm/seconds and PI of .74 (±.14) approached normal values. CONCLUSION TCD can detect characteristic waveforms in patients supported by various MCS devices. These device-specific TCD patterns are recognizable and reproducible.
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Affiliation(s)
- Kara R Melmed
- Department of Neurology and Comprehensive Stroke Center, Cedars-Sinai Medical Center, Los Angeles, CA.,Department of Neurology, New York University Langone Health, New York, NY
| | - Konrad H Schlick
- Department of Neurology and Comprehensive Stroke Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Brenda Rinsky
- Department of Neurology and Comprehensive Stroke Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Oana M Dumitrascu
- Department of Neurology and Comprehensive Stroke Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Oksana Volod
- Department of Pathology, Cedars-Sinai Medical Health, Los Angeles, CA
| | - Mani Nezhad
- Department of Neurology and Comprehensive Stroke Center, Cedars-Sinai Medical Center, Los Angeles, CA.,Department of Neurology, Dignity Health Medical Foundation, San Francisco, CA
| | - Matthew M Padrick
- Department of Neurology and Comprehensive Stroke Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Carmelita Runyan
- Cedars-Sinai Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Francisco A Arabia
- Cedars-Sinai Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA.,Department of Surgery & Medicine, Banner-University of Arizona, Phoenix, AZ
| | | | - Patrick D Lyden
- Department of Neurology and Comprehensive Stroke Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Shlee S Song
- Department of Neurology and Comprehensive Stroke Center, Cedars-Sinai Medical Center, Los Angeles, CA
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Dal Sasso E, Bagno A, Scuri STG, Gerosa G, Iop L. The Biocompatibility Challenges in the Total Artificial Heart Evolution. Annu Rev Biomed Eng 2019; 21:85-110. [PMID: 30795701 DOI: 10.1146/annurev-bioeng-060418-052432] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There are limited therapeutic options for final treatment of end-stage heart failure. Among them, implantation of a total artificial heart (TAH) is an acceptable strategy when suitable donors are not available. TAH development began in the 1930s, followed by a dramatic evolution of the actuation mechanisms operating the mechanical pumps. Nevertheless, the performance of TAHs has not yet been optimized, mainly because of the low biocompatibility of the blood-contacting surfaces. Low hemocompatibility, calcification, and sensitivity to infections seriously affect the success of TAHs. These unsolved issues have led to the withdrawal of many prototypes during preclinical phases of testing. This review offers a comprehensive analysis of the pathophysiological events that may occur in the materials that compose TAHs developed to date. In addition, this review illustrates bioengineering strategies to prevent these events and describes the most significant steps toward the achievement of a fully biocompatible TAH.
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Affiliation(s)
- Eleonora Dal Sasso
- Cardiovascular Regenerative Medicine Group, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua and Veneto Institute of Molecular Medicine, 35128 Padua, Italy; , , .,Padua Heart Project, Division of Cardiac Surgery, University Hospital of Padua, 35128 Padua, Italy;
| | - Andrea Bagno
- Department of Industrial Engineering, University of Padua, 35128 Padua, Italy;
| | - Silvia T G Scuri
- Padua Heart Project, Division of Cardiac Surgery, University Hospital of Padua, 35128 Padua, Italy;
| | - Gino Gerosa
- Cardiovascular Regenerative Medicine Group, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua and Veneto Institute of Molecular Medicine, 35128 Padua, Italy; , , .,Padua Heart Project, Division of Cardiac Surgery, University Hospital of Padua, 35128 Padua, Italy;
| | - Laura Iop
- Cardiovascular Regenerative Medicine Group, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua and Veneto Institute of Molecular Medicine, 35128 Padua, Italy; , , .,Padua Heart Project, Division of Cardiac Surgery, University Hospital of Padua, 35128 Padua, Italy;
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13
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Interagency registry for mechanically assisted circulatory support report on the total artificial heart. J Heart Lung Transplant 2018; 37:1304-1312. [DOI: 10.1016/j.healun.2018.04.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/30/2018] [Accepted: 04/18/2018] [Indexed: 12/21/2022] Open
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15
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Zainab A, Tuazon D, Uddin F, Ratnani I. How New Support Devices Change Critical Care Delivery. Methodist Debakey Cardiovasc J 2018; 14:101-109. [PMID: 29977466 DOI: 10.14797/mdcj-14-2-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Mechanical support devices are used to support failing cardiac, respiratory, or both systems. Since Gibbon developed the cardiopulmonary bypass in 1953, collaborative efforts by medical centers, bioengineers, industry, and the National Institutes of Health have led to development of mechanical devices to support heart, lung, or both. These devices are used as a temporary or long-term measures for acute collapse of circulatory system and/or respiratory failure. Patients are managed on these support devices as a bridge to recovery, bridge to long term devices, or bridge to transplant. The progress in development of these devices has improved mortality and quality of life in select groups of patients. Care of these patients requires a multidisciplinary team approach, which includes cardiac surgeons, critical care physicians, cardiologists, pulmonologists, nursing staff, and perfusionists. Using a team approach improves outcomes in these patients.
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Beaupré RA, Frazier OH, Morgan JA. Total artificial heart implantation as a bridge to transplantation: a viable model for the future? Expert Rev Med Devices 2018; 15:701-706. [DOI: 10.1080/17434440.2018.1524294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Rachel A. Beaupré
- Department of Thoracic Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | - Jeffrey A. Morgan
- Division of Mechanical Circulatory Support and Cardiac Transplantation, Baylor College of Medicine, Houston, TX, USA
- Department of Cardiothoracic Surgery, Texas Heart Institute, Houston, TX, USA
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17
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Fox C, Chopski S, Murad N, Allaire P, Mentzer R, Rossano J, Arabia F, Throckmorton A. Hybrid Continuous-Flow Total Artificial Heart. Artif Organs 2018; 42:500-509. [PMID: 29349805 DOI: 10.1111/aor.13080] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 12/18/2022]
Abstract
Clinical studies using total artificial hearts (TAHs) have demonstrated that pediatric and adult patients derive quality-of-life benefits from this form of therapy. Two clinically-approved TAHs and other pumps under development, however, have design challenges and limitations, including thromboembolic events, neurologic impairment, infection risk due to large size and percutaneous drivelines, and lack of ambulation, to name a few. To address these limitations, we are developing a hybrid-design, continuous-flow, implantable or extracorporeal, magnetically-levitated TAH for pediatric and adult patients with heart failure. This TAH has only two moving parts: an axial impeller for the pulmonary circulation and a centrifugal impeller for the systemic circulation. This device will utilize the latest generation of magnetic bearing technology. Initial geometries were established using pump design equations, and computational modeling provided insight into pump performance. The designs were the basis for prototype manufacturing and hydraulic testing. The study results demonstrate that the TAH is capable of delivering target blood flow rates of 1-6.5 L/min with pressure rises of 1-92 mm Hg for the pulmonary circulation and 24-150 mm Hg for the systemic circulation at 1500-10 000 rpm. This initial design of the TAH was successful and serves as the foundation to continue its development as a novel, more compact, nonthrombogenic, and effective therapeutic alternative for infants, children, adolescents, and adults with heart failure.
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Affiliation(s)
- Carson Fox
- The BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Steven Chopski
- The BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Nohra Murad
- The BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Paul Allaire
- Rotor Bearing Solutions International, Charlottesville, VA, USA
| | | | - Joseph Rossano
- Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Amy Throckmorton
- The BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
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18
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Kwant PB, Finocchiaro T, Förster F, Reul H, Rau G, Morshuis M, El Banayosi A, Körfer R, Schmitz-Rode T, Steinseifer U. The MiniACcor: Constructive Redesign of an Implantable Total Artificial Heart, Initial Laboratory Testing and Further Steps. Int J Artif Organs 2018; 30:345-51. [PMID: 17520573 DOI: 10.1177/039139880703000411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Aachen Total Artificial Heart (ACcor) has been under development at the Helmholtz Institute in Aachen over the last decade. It may serve as a bridge to transplant or as a long-term replacement of the natural heart. Based upon previous in vivo experiments with the ACcor total artificial heart, it was decided to optimize and redesign the pump unit. Smaller dimensions, passive filling and separability into three components were the three main design goals. The new design is called the MiniACcor, which is about 20% smaller than its predecessor, and weighs only 470 grams. Also its external driver/control unit was miniaturized and a new microcontroller was selected. To validate the design, it was extensively tested in laboratory mock loops. The MiniACcor was able to pump between 4.5 and 7 l/min at different pump rates against normal physiological pressures. Several requirements for the future compliance chamber and transcutaneous energy transmission (TET) system were also measured in the same mock loop. Further optimization and validation are being performed in cooperation with the Heart and Diabetes Centre North Rhine-Westphalia.
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Affiliation(s)
- P B Kwant
- Helmholtz Institute, Aachen, Germany.
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19
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An ISHLT consensus document for prevention and management strategies for mechanical circulatory support infection. J Heart Lung Transplant 2017; 36:1137-1153. [DOI: 10.1016/j.healun.2017.06.007] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/20/2017] [Indexed: 12/18/2022] Open
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20
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Hanna RM, Hasnain H, Kamgar M, Hanna M, Minasian R, Wilson J. Patient with a total artificial heart maintained on outpatient dialysis while listed for combined organ transplant, a single center experience. Hemodial Int 2017; 21:E69-E72. [PMID: 28799694 DOI: 10.1111/hdi.12580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Advanced mechanical circulatory support is increasingly being used with more sophisticated devices that can deliver pulsatile rather than continuous flow. These devices are more portable as well, allowing patients to await cardiac transplantation in an outpatient setting. It is known that patients with renal failure are at increased risk for developing worsening acute kidney injury during implantation of a ventricular assist device (VAD) or more advanced modalities like a total artificial heart (TAH). Dealing with patients who have an implanted TAH who develop renal failure has been a challenge with the majority of such patients having to await a combined cardiac and renal transplant prior to transition to outpatient care. Protocols do exist for VAD implanted patients to be transitioned to outpatient dialysis care, but there are no reported cases of TAH patients with end stage renal disease (ESRD) being successfully transitioned to outpatient dialysis care. In this report, we identify a patient with a TAH and ESRD transitioned successfully to outpatient hemodialysis and maintained for more than 2 years, though he did not survive to transplant. It is hoped that this report will raise awareness of this possibility, and assist in the development of protocols for similar patients to be successfully transitioned to outpatient dialysis care.
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Affiliation(s)
- Ramy M Hanna
- Division of Nephrology, Department of Medicine, Ronald Regan Medical Center, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Huma Hasnain
- Division of Nephrology, Department of Medicine, Ronald Regan Medical Center, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Mohammad Kamgar
- Division of Nephrology, Department of Medicine, Ronald Regan Medical Center, David Geffen School of Medicine, UCLA, Los Angeles, California, USA.,Surgical and Consultative Nephrology, Ronald Regan Medical Center, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Mina Hanna
- School of Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| | - Raffi Minasian
- Corporate medical director of home dialysis centers 1500 S Central Ave. Suite # 300, Glendale CA 91204, USA
| | - James Wilson
- Division of Nephrology, Department of Medicine, Ronald Regan Medical Center, David Geffen School of Medicine, UCLA, Los Angeles, California, USA.,Surgical and Consultative Nephrology, Ronald Regan Medical Center, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
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21
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Yaung J, Arabia FA, Nurok M. Perioperative Care of the Patient With the Total Artificial Heart. Anesth Analg 2017; 124:1412-1422. [PMID: 28107271 DOI: 10.1213/ane.0000000000001851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Advanced heart failure continues to be a leading cause of morbidity and mortality despite improvements in pharmacologic therapy. High demand for cardiac transplantation and shortage of donor organs have led to an increase in the utilization of mechanical circulatory support devices. The total artificial heart is an effective biventricular assist device that may be used as a bridge to transplant and that is being studied for destination therapy. This review discusses the history, indications, and perioperative management of the total artificial heart with emphasis on the postoperative concerns.
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Affiliation(s)
- Jill Yaung
- From the *Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California; and †Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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22
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Wells D, Villa CR, Simón Morales DL. The 50/50 cc Total Artificial Heart Trial: Extending the Benefits of the Total Artificial Heart to Underserved Populations. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2017; 20:16-19. [PMID: 28007058 DOI: 10.1053/j.pcsu.2016.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/14/2016] [Indexed: 06/06/2023]
Abstract
While use of the total artificial heart (TAH) is growing, the use of the device is not uniform across the gender and age spectrum because the vast majority of implants are in adult males. SynCardia has recently developed a smaller 50 cc TAH that was designed to accommodate patients with a body surface area as low as 1.2 m2 (potentially even lower using virtual implantation). Herein, we describe the early use of the 50 cc TAH (10 implants in the US and 18 outside the US). Twenty-eight devices have been implanted worldwide. Nineteen (68%) patients were female, 4 (14%) were 21 years of age or younger, and 2 (7%) had a diagnosis of congenital heart disease (1 Fontan). The smallest patient, by body surface area, was 1.35 m2. Six patients (21%) have been placed on the Freedom Driver, all of whom have survived. Fourteen patients (50%) have had a positive outcome to date. The development of the 50 cc TAH has expanded the population of patients who may benefit from TAH support and thus may help improve outcomes for patients who have had limited biventricular support options to date.
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Affiliation(s)
- Dennis Wells
- Department of Cardiothoracic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Chet R Villa
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - David Luís Simón Morales
- Department of Pediatric Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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23
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Kusne S, Staley L, Arabia F. Prevention and Infection Management in Mechanical Circulatory Support Device Recipients. Clin Infect Dis 2016; 64:222-228. [PMID: 27986679 DOI: 10.1093/cid/ciw698] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/05/2016] [Indexed: 12/19/2022] Open
Abstract
There are currently no guidelines for the management of infection and its prevention in mechanical circulatory support (MCS) device recipients. The International Society of Heart and Lung Transplantation (ISHLT) has initiated a multidisciplinary collaboration for the creation of a consensus document to guide clinicians in infection prevention and management in MCS patients. Most medical centers use local protocols that are based on expert opinion. MCS recipients are debilitated and have some immunological dysfunction. Over the years there have been technical advancements with smaller devices and drivelines with improved durability. The pulsatile devices have been replaced with newer-generation continuous-flow devices. Patient are living longer with MCSs for bridge to transplant (BTT) and destination therapy (DT). MCS centers have improved patient management by introducing standardized driveline protocols, leading to reduced infection rates among MCS recipients.
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Affiliation(s)
| | - Linda Staley
- Cardiothoracic Surgery Division, Mayo Clinic, Phoenix, Arizona; and
| | - Francisco Arabia
- Cardiothoracic Surgery Division, Cedars-Sinai Medical Center, Los Angeles, California
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24
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In vitro performance investigation of SynCardia™ Freedom® driver via patient simulator mock loop. Int J Artif Organs 2016; 39:502-508. [PMID: 27768204 DOI: 10.5301/ijao.5000524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE The gold standard therapy for patients with advanced heart failure is heart transplant. The gap between donors and patients in waiting lists promoted the development of circulatory support devices, such as the total artificial heart (TAH). Focusing on in vitro tests performed with CardioWest™ TAH (CW) driven by the SynCardia Freedom® portable driver (FD) the present study goals are: i) prove the reliability of a hydraulic circuit used as patient simulator to replicate a quasi-physiological scenario for various hydrodynamic conditions, ii) investigate the hydrodynamic performance of the CW FD, iii) help clinicians in possible interpretation of clinical cases outcomes. METHODS In vitro tests were performed using a mechanic-hydraulic patient simulator. Cardiac output (CO), CW ventricles filling, atrial, ventricles, aortic and pulmonary artery pressures were measured for different values of vascular resistance in both systemic (SVR) and pulmonary (PVR) physiological range. RESULTS After increasing the PVR, the left atrial pressure decreased according to the expected physiological trend, while aortic pressure remained almost stable, proving the ability of the simulator to mimic a physiological scenario. Unexpectedly, the mean pulmonary artery pressure (PPA) was found to increase above 30 mmHg in the range of physiological PVR (2.6 WU) and for constant CO. CONCLUSIONS The increase in PPA is probably associated with the pre-set driving setup of the FD. The finding suggests a possible explanation of the clinical course of a patient who experienced complications soon after being supported by the FD, with the occurrence of dyspnea and pulmonary edema despite a high cardiac index.
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25
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Abstract
Heart failure patients requiring total artificial heart (TAH) support often have concomitant renal insufficiency (RI). We sought to quantify renal function recovery in patients supported with TAH at our institution. Renal function data at 30, 90, and 180 days after TAH implantation were analyzed for patients with RI, defined as hemodialysis supported or an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m. Between January 2008 and December 2013, 20 of the 46 (43.5%) TAH recipients (age 51 ± 9 years, 85% men) had RI, mean preoperative eGFR of 48 ± 7 ml/min/1.73 m. Renal function recovery was noted at each follow-up interval: increment in eGFR (ml/min/1.73 m) at 30, 90, and 180 days was 21 ± 35 (p = 0.1), 16.5 ± 18 (p = 0.05), and 10 ± 9 (p = 0.1), respectively. Six patients (30%) required preoperative dialysis. Of these, four recovered renal function, one remained on dialysis, and one died. Six patients (30%) required new-onset dialysis. Of these, three recovered renal function and three died. Overall, 75% (15 of 20) of patients' renal function improved with TAH support. Total artificial heart support improved renal function in 75% of patients with pre-existing significant RI, including those who required preoperative dialysis.
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26
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Cook JA, Shah KB, Quader MA, Cooke RH, Kasirajan V, Rao KK, Smallfield MC, Tchoukina I, Tang DG. The total artificial heart. J Thorac Dis 2016; 7:2172-80. [PMID: 26793338 DOI: 10.3978/j.issn.2072-1439.2015.10.70] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The total artificial heart (TAH) is a form of mechanical circulatory support in which the patient's native ventricles and valves are explanted and replaced by a pneumatically powered artificial heart. Currently, the TAH is approved for use in end-stage biventricular heart failure as a bridge to heart transplantation. However, with an increasing global burden of cardiovascular disease and congestive heart failure, the number of patients with end-stage heart failure awaiting heart transplantation now far exceeds the number of available hearts. As a result, the use of mechanical circulatory support, including the TAH and left ventricular assist device (LVAD), is growing exponentially. The LVAD is already widely used as destination therapy, and destination therapy for the TAH is under investigation. While most patients requiring mechanical circulatory support are effectively treated with LVADs, there is a subset of patients with concurrent right ventricular failure or major structural barriers to LVAD placement in whom TAH may be more appropriate. The history, indications, surgical implantation, post device management, outcomes, complications, and future direction of the TAH are discussed in this review.
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Affiliation(s)
- Jason A Cook
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Keyur B Shah
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Mohammed A Quader
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Richard H Cooke
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Vigneshwar Kasirajan
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Kris K Rao
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Melissa C Smallfield
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Inna Tchoukina
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Daniel G Tang
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
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27
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Petukhov DS, Selishchev SV, Telyshev DV. Total Artificial Heart: State-of-the-art. BIOMEDICAL ENGINEERING-MEDITSINSKAYA TEKNIKA 2015. [DOI: 10.1007/s10527-015-9528-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Total Artificial Heart as Bridge to Transplantation for Severe Culture-Negative Prosthetic Valve Endocarditis Due to Gemella haemolysans. ASAIO J 2015; 60:479-81. [PMID: 24727539 DOI: 10.1097/mat.0000000000000080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We report a rare case of a patient with prosthetic valve endocarditis (PVE) requiring implantation of a total artificial heart (TAH) as a bridge to heart transplantation. Gemella haemolysans, an unusual cause of PVE, was identified as the organism responsible only by 16s rRNA polymerase chain reaction analysis of surgical tissue samples. We also describe one of the first uses of combined TAH and veno-venous extracorporeal membrane oxygenation therapy in the setting of severe respiratory and cardiac failure. Implantation of a TAH may be considered in situations where more traditional reconstructive methods are not feasible.
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29
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Cardiopulmonary exercise testing responses to different external portable drivers in a patient with a CardioWest Total Artificial Heart. J Artif Organs 2015; 19:188-91. [PMID: 26497137 DOI: 10.1007/s10047-015-0868-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
Management of patients treated with CardioWest Total Artificial Heart (CW-TAH) as a bridge to heart transplantation (HTx) is complicated by difficulties in determining the optimal timing of transplantation. We present a case of a 53-year-old man supported as an outpatient with a CW-TAH, whose condition deteriorated following exchange of the portable driver. The patient was followed-up with serial cardiopulmonary exercise testing (CPET) which demonstrated a fall of peak VO2 to below 12 ml/kg/min following driver substitution, and the patient was subsequently treated with urgent orthotopic HTx. This case highlights the potential utility of CPET as a means for monitoring and indicating timing of HTx in patients with CW-TAH, as well as the potential for clinical deterioration following portable driver substitution.
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31
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Lorts A, Villa C, Morales DLS. Children Are Not Small Adults: Options for Pediatric Ventricular Assist Devices. CURRENT PEDIATRICS REPORTS 2015. [DOI: 10.1007/s40124-015-0085-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Baumann Kreuziger L, Massicotte MP. Mechanical circulatory support: balancing bleeding and clotting in high-risk patients. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2015; 2015:61-68. [PMID: 26637702 DOI: 10.1182/asheducation-2015.1.61] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Mechanical circulatory support (MCS) provides a bridge to heart transplant in children and adults with life-threatening heart failure and sustains patients ineligible for transplant. Extracorporeal membrane oxygenation (ECMO) provides temporary support for patients in cardiac or pulmonary failure through external gas exchange and continuous flow of blood. Because the median time to heart transplant exceeds event-free time on ECMO, pulsatile left ventricular assist devices (LVADs) are used to support infants and children. Continuous flow LVADs are preferred in adolescents and adults due to increased pump durability and improved overall survival. The shear stress created by the mechanical pumps cause changes in the hematologic system; acquired von Willebrand syndrome occurs in almost all patients treated with MCS. Despite the improvements in survival, major bleeding occurs in one-third of patients with a LVAD and ischemic stroke and LVAD thrombosis can affect 12% of adults and 29% of children. An antithrombotic strategy to mitigate LVAD bleeding and thrombotic complications has been tested in a randomized trial in children, but intensity of antithrombotic therapy in adults varies widely. Consensus guidelines for antithrombotic therapy during ECMO were created due to significant differences in management across centers. Because of the high risk for both bleeding and thrombotic complications, experts in hemostasis can significantly impact care of patients requiring mechanical circulatory support and are a necessary part of the management team.
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Affiliation(s)
- Lisa Baumann Kreuziger
- BloodCenter of Wisconsin, Department of Medicine, Division of Hematology, Medical College of Wisconsin, Milwaukee, WI; and
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33
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Virtual implantation evaluation of the total artificial heart and compatibility: Beyond standard fit criteria. J Heart Lung Transplant 2014; 33:1180-3. [DOI: 10.1016/j.healun.2014.08.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/30/2014] [Accepted: 08/13/2014] [Indexed: 11/22/2022] Open
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34
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Rehfeldt KH, Wittwer ED, Mauermann WJ. Inferior Vena Cava Obstruction after Total Artificial Heart Implantation. Anesth Analg 2014; 119:26-29. [DOI: 10.1213/ane.0000000000000244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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35
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Lala A, Mehra MR. Durable mechanical circulatory support in advanced heart failure: a critical care cardiology perspective. Cardiol Clin 2014; 31:581-93, viii-ix. [PMID: 24188222 DOI: 10.1016/j.ccl.2013.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Though cardiac transplantation for advanced heart disease patients remains definitive therapy for patients with advanced heart failure, it is challenged by inadequate donor supply, causing durable mechanical circulatory support (MCS) to slowly become a new primary standard. Selecting appropriate patients for MCS involves meeting a number of prespecifications as is required in evaluation for cardiac transplant candidacy. As technology evolves to bring forth more durable smaller devices, selection criteria for appropriate MCS recipients will likely expand to encompass a broader, less sick population. The "Holy Grail" for MCS will be a focus on clinical recovery and explantation of devices rather than the currently more narrowly defined indications of bridge to transplantation or lifetime device therapy.
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Affiliation(s)
- Anuradha Lala
- Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, A3, Boston, MA 02115, USA
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36
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Hocker S, Wijdicks EFM, Biller J. Neurologic complications of cardiac surgery and interventional cardiology. HANDBOOK OF CLINICAL NEUROLOGY 2014; 119:193-208. [PMID: 24365297 DOI: 10.1016/b978-0-7020-4086-3.00014-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A wide array of neurologic complications can occur in relation to cardiac surgical procedures, most of which are transient and do not result in permanent sequelae. Specific neurologic insults can occur depending on the type of cardiac procedure and are an important cause of morbidity and mortality. Neurologists practicing in the hospital setting as well as outpatient neurologists should be familiar with the cardiac surgical procedures currently available. Prompt identification of neurologic deficits is important in order to plan an appropriate systematic evaluation and initiate possible treatments in a timely manner. This chapter provides a comprehensive overview of all facets of neurologic complications after cardiac surgical procedures.
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Affiliation(s)
- Sara Hocker
- Division of Critical Care Neurology, Mayo Clinic, Rochester, MN, USA.
| | | | - Jose Biller
- Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
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37
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Nielsen VG, Pearson EC, Smith MC. Increased Carbon Monoxide Production by Hemeoxygenase-1 Caused by Device-Mediated Hemolysis: Thrombotic Phantom Menace? Artif Organs 2013; 37:1008-14. [DOI: 10.1111/aor.12122] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Vance G. Nielsen
- Department of Anesthesiology; The University of Arizona College of Medicine; Tucson AZ USA
| | - Ellen C. Pearson
- Department of Surgery; The University of Arizona College of Medicine; Tucson AZ USA
| | - M. Cristina Smith
- Department of Surgery; The University of Arizona College of Medicine; Tucson AZ USA
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Park SS, Sanders DB, Smith BP, Ryan J, Plasencia J, Osborn MB, Wellnitz CM, Southard RN, Pierce CN, Arabia FA, Lane J, Frakes D, Velez DA, Pophal SG, Nigro JJ. Total artificial heart in the pediatric patient with biventricular heart failure. Perfusion 2013; 29:82-8. [PMID: 23868320 DOI: 10.1177/0267659113496580] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mechanical circulatory support emerged for the pediatric population in the late 1980s as a bridge to cardiac transplantation. The Total Artificial Heart (TAH-t) (SynCardia Systems Inc., Tuscon, AZ) has been approved for compassionate use by the Food and Drug Administration for patients with end-stage biventricular heart failure as a bridge to heart transplantation since 1985 and has had FDA approval since 2004. However, of the 1,061 patients placed on the TAH-t, only 21 (2%) were under the age 18. SynCardia Systems, Inc. recommends a minimum patient body surface area (BSA) of 1.7 m(2), thus, limiting pediatric application of this device. This unique case report shares this pediatric institution's first experience with the TAH-t. A 14-year-old male was admitted with dilated cardiomyopathy and severe biventricular heart failure. The patient rapidly decompensated, requiring extracorporeal life support. An echocardiogram revealed severe biventricular dysfunction and diffuse clot formation in the left ventricle and outflow tract. The decision was made to transition to biventricular assist device. The biventricular failure and clot formation helped guide the team to the TAH-t, in spite of a BSA (1.5 m(2)) below the recommendation of 1.7 m(2). A computed tomography (CT) scan of the thorax, in conjunction with a novel three-dimensional (3D) modeling system and team, assisted in determining appropriate fit. Chest CT and 3D modeling following implantation were utilized to determine all major vascular structures were unobstructed and the bronchi were open. The virtual 3D model confirmed appropriate device fit with no evidence of compression to the left pulmonary veins. The postoperative course was complicated by a left lung opacification. The left lung anomalies proved to be atelectasis and improved with aggressive recruitment maneuvers. The patient was supported for 11 days prior to transplantation. Chest CT and 3D modeling were crucial in assessing whether the device would fit, as well as postoperative complications in this smaller pediatric patient.
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Affiliation(s)
- S S Park
- 1Division of Cardiothoracic Surgery, Division of Cardiology, Division of Critical Care Medicine, Children's Heart Center, Division of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
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Demondion P, Fournel L, Niculescu M, Pavie A, Leprince P. The challenge of home discharge with a total artificial heart: the La Pitie Salpetriere experience. Eur J Cardiothorac Surg 2013; 44:843-8. [PMID: 23539421 DOI: 10.1093/ejcts/ezt146] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The total artificial heart (TAH) helps to counteract the current decrease in heart donors and is likely to bridge patients to transplant under favourable conditions. Today's mobile consoles facilitate home discharge. The aim of this study was to report on the La Pitie Hospital experience with CardioWest TAH recipients, and more particularly, on generally successful outpatient' management. METHODS A retrospective analysis was performed on clinical and biological data from patients implanted with a TAH between December 2006 and July 2010 in a single institution. Morbi-mortality during hospital stay, number and causes of rehospitalizations, quality of life during home discharge, bridge to transplant results and survival have all been analysed. RESULTS Twenty-seven patients were implanted with the CardioWest. Fifteen patients (55.5%) died during support. Prior to home discharge, the most frequent cause of death was multi-organ failure (46.6%). Twelve patients were discharged home from hospital within a median of 88 days [range 35-152, interquartile range 57] postimplantation. Mean rehospitalization rate was 1.2 by patient, on account of device infection (n = 7), technical problems with the console (n = 3) and other causes (n = 4). Between discharge and transplant, patients spent 87% of their support time out of hospital. All patients who returned home with the TAH were subsequently transplanted, and 1 died in post-transplant. CONCLUSION Despite the morbidity and mortality occurring during the postimplantation period, home discharge with a TAH is possible. Portables drivers allow for a safe return home. Aside from some remaining weak points such as infectious complications or noise, CardioWest TAH allows for successful rehabilitation of graft candidates, and assures highly satisfactory transplant results.
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Affiliation(s)
- Pierre Demondion
- Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University 'Pierre et Marie Curie', Paris, France
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Aissaoui N, Morshuis M, Diebold B, Guerot E, Gummert J. Heart failure while on ventricular assist device support: a true clinical entity? Arch Cardiovasc Dis 2013; 106:44-51. [PMID: 23374971 DOI: 10.1016/j.acvd.2012.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 09/10/2012] [Accepted: 09/15/2012] [Indexed: 11/16/2022]
Abstract
Ventricular assist devices (VADs) have become an established therapeutic option for patients with end-stage heart failure. The appearance of heart failure in VAD patients seems unexpected. Nevertheless, this phenomenon is not rare. We report six cases of VAD patients with clinical presentation of heart failure at different times after implantation and describe the mechanisms involved. The aetiology of this heart failure, like its clinical presentation, varies and has yet to be identified.
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Affiliation(s)
- Nadia Aissaoui
- Heart & Diabetes Centre, North Rhine-Westphalia, Bad Oeynhausen, Germany.
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Sale SM, Smedira NG. Total artificial heart. Best Pract Res Clin Anaesthesiol 2013; 26:147-65. [PMID: 22910087 DOI: 10.1016/j.bpa.2012.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 04/20/2012] [Indexed: 10/28/2022]
Abstract
End-stage heart failure represents a highly morbid condition for the patient with limited treatment options. From a surgical perspective, the treatment options for effective long-term survival are usually limited to heart transplantation, heart-lung transplantation or implantation of a destination mechanical circulatory support device. Assuming an advanced heart-failure patient is indeed deemed a candidate for transplantation, the patient is subject to shortages in donor organ availability and thus possible further decompensation and potential death while awaiting transplantation. Various extracorporeal and implantable ventricular-assist devices (VADs) may be able to provide temporary or long-term circulatory support for many end-stage heart-failure patients but mechanical circulatory support options for patients requiring long-term biventricular support remain limited. Implantation of a total artificial heart (TAH) currently represents one, if not the best, long-term surgical treatment option for patients requiring biventricular mechanical circulatory support as a bridge to transplant. The clinical applicability of available versions of positive displacement pumps is limited by their size and complications. Application of continuous-flow technology can help in solving some of these issues and is currently being applied in the research towards a new generation of smaller and more effective TAHs. In this review, we discuss the history of the TAH, its development and clinical application, implications for anaesthetic management, published outcomes and the future outlook for TAHs.
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Affiliation(s)
- Shiva M Sale
- Department of Cardiothoracic Anesthesia, Cleveland Clinic Foundation, OH 44195, USA.
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Slepian MJ, Alemu Y, Girdhar G, Soares JS, Smith RG, Einav S, Bluestein D. The Syncardia(™) total artificial heart: in vivo, in vitro, and computational modeling studies. J Biomech 2013; 46:266-75. [PMID: 23305813 DOI: 10.1016/j.jbiomech.2012.11.032] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 11/15/2012] [Indexed: 02/07/2023]
Abstract
The SynCardia(™) total artificial heart (TAH) is the only FDA-approved TAH in the world. The SynCardia(™) TAH is a pneumatically driven, pulsatile system capable of flows of >9L/min. The TAH is indicated for use as a bridge to transplantation (BTT) in patients at imminent risk of death from non-reversible bi-ventricular failure. In the Pivotal US approval trial the TAH achieved a BTT rate of >79%. Recently a multi-center, post-market approval study similarly demonstrated a comparable BTT rate. A major milestone was recently achieved for the TAH, with over 1100 TAHs having been implanted to date, with the bulk of implantation occurring at an ever increasing rate in the past few years. The TAH is most commonly utilized to save the lives of patients dying from end-stage bi-ventricular heart failure associated with ischemic or non-ischemic dilated cardiomyopathy. Beyond progressive chronic heart failure, the TAH has demonstrated great efficacy in supporting patients with acute irreversible heart failure associated with massive acute myocardial infarction. In recent years several diverse clinical scenarios have also proven to be well served by the TAH including severe heart failure associated with advanced congenital heart disease. failed or burned-out transplants, infiltrative and restrictive cardiomyopathies and failed ventricular assist devices. Looking to the future a major unmet need remains in providing total heart support for children and small adults. As such, the present TAH design must be scaled to fit the smaller patient, while providing equivalent, if not superior flow characteristics, shear profiles and overall device thrombogenicity. To aid in the development of a new "pediatric," TAH an engineering methodology known as "Device Thrombogenicity Emulation (DTE)", that we have recently developed and described, is being employed. Recently, to further our engineering understanding of the TAH, as steps towards next generation designs we have: (1) assessed of the degree of platelet reactivity induced by the present clinical 70 cc TAH using a closed loop platelet activity state assay, (2) modeled the motion of the TAH pulsatile mobile diaphragm, and (3) performed fluid-structure interactions and assessment of the flow behavior through inflow and outflow regions of the TAH fitted with modern bi-leaflet heart valves. Developing a range of TAH devices will afford biventricular replacement therapy to a wide range of patients, for both short and long-term therapy.
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Affiliation(s)
- Marvin J Slepian
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA.
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Marinakis S, Niclauss L, Rolf T, von Segesser LK. How to improve flow during cardiopulmonary bypass in an acardia experimental model. Interact Cardiovasc Thorac Surg 2012; 15:574-7. [PMID: 22778142 DOI: 10.1093/icvts/ivs242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In extreme scenarios, such as hyperacute rejection of heart transplant, an urgent heart explantation might be necessary. The aim of this experimental study was to determine the feasibility and to improve the haemodynamics of a venoarterial cardiopulmonary bypass after cardiectomy. METHODS A venoarterial cardiopulmonary bypass was established in seven calves (56.4 ± 7 kg) by the transjugular insertion to the caval axis of a self-expanding cannula, with a carotid artery return. After baseline measurements (A), ventricular fibrillation was induced (B), great arteries were clamped (C), the heart was excised and the right and left atria remnants, containing the pulmonary veins, were sutured together leaving an atrial septal defect over the cannula in the caval axis (D). Measurements were taken with the pulmonary artery clamped and declamped. RESULTS Initial pump flow was 4.16 ± 0.75 l/min dropping to 2.9 ± 0.63 l/min (P(AB )< 0.001) 10 min after induction of ventricular fibrillation. After cardiectomy with the pulmonary artery clamped, the pump flow increased non-significantly to 3.20 ± 0.78 l/min. After declamping, the flow significantly increased close to baseline levels (3.61 ± 0.73 l/min, P(DB )= 0.009, P(DC )= 0.017), supporting the notion that full cardiopulmonary bypass in acardia is feasible only if adequate drainage of pulmonary circulation is assured to avoid pulmonary congestion and loss of volume from the left-to-right shunt of bronchial vessels.
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Shah KB, Tang DG, Kasirajan V, Gunnerson KJ, Hess ML, Sica DA. Impact of low-dose B-type natriuretic peptide infusion on urine output after total artificial heart implantation. J Heart Lung Transplant 2012; 31:670-2. [PMID: 22425232 DOI: 10.1016/j.healun.2012.02.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 02/03/2012] [Accepted: 02/11/2012] [Indexed: 11/15/2022] Open
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Gaitan BD, Thunberg CA, Stansbury LG, Jaroszewski DE, Arabia FA, Griffith BP, Grigore AM. Development, Current Status, and Anesthetic Management of the Implanted Artificial Heart. J Cardiothorac Vasc Anesth 2011; 25:1179-92. [DOI: 10.1053/j.jvca.2011.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Indexed: 11/11/2022]
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Fukazawa K, Pretto EA. Reversal of hypercoagulability with hydroxyethyl starch during transplantation: a case series. J Clin Anesth 2011; 23:61-5. [DOI: 10.1016/j.jclinane.2009.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 10/06/2009] [Accepted: 10/11/2009] [Indexed: 10/18/2022]
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Device Malfunction of the CardioWest Total Artificial Heart Secondary to Catheter Entrapment of the Tricuspid Valve. ASAIO J 2010; 56:481-2. [DOI: 10.1097/mat.0b013e3181e87d4f] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Schönbrodt M, Özpeker C, Morshuis M, Cantow J, Arusoglu L, Gummert J. Kunstherzimplantation als ultima ratio bei fulminantem kardiogenem Schock. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2010. [DOI: 10.1007/s00398-009-0760-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fumoto H, Horvath DJ, Rao S, Massiello AL, Horai T, Takaseya T, Arakawa Y, Mielke N, Chen JF, Dessoffy R, Fukamachi K, Golding LAR. In vivo acute performance of the Cleveland Clinic self-regulating, continuous-flow total artificial heart. J Heart Lung Transplant 2009; 29:21-6. [PMID: 19782590 DOI: 10.1016/j.healun.2009.05.035] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 05/27/2009] [Accepted: 05/27/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the acute in vivo pump performance of a unique valveless, sensorless, pulsatile, continuous-flow total artificial heart (CFTAH) that passively self-balances left and right circulations without electronic intervention. METHODS The CFTAH was implanted in two calves, with pump and hemodynamic data recorded at baseline over the full range of pump operational speeds (2,000 to 3,000 rpm) in 200-rpm increments, with pulsatility variance, and under a series of induced hemodynamic states created by varying circulating blood volume and systemic and pulmonary vascular resistance (SVR and PVR). RESULTS Sixty of the 63 induced hemodynamic states in Case 1 and 73 of 78 states in Case 2 met our design goal of a balanced flow and maximum atrial pressure difference of 10 mm Hg. The correlation of calculated vs measured flow and SVR was high (R(2) = 0.857 and 0.832, respectively), allowing validation of an additional level of automatic active control. By varying the amplitude of sinusoidal modulation of the speed waveform, 9 mm Hg of induced pulmonary and 18 mm Hg of systemic arterial pressure pulsation were achieved. CONCLUSIONS These results validated CFTAH self-balancing of left and right circulation, induced arterial flow and pressure pulsatility, accurate calculated flow and SVR parameters, and the performance of an automatic active control mode in an acute, in vivo setting in response to a wide range of imposed physiologic perturbations.
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Affiliation(s)
- Hideyuki Fumoto
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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