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Nascimbene A, Bark D, Smadja DM. Hemocompatibility and biophysical interface of left ventricular assist devices and total artificial hearts. Blood 2024; 143:661-672. [PMID: 37890145 PMCID: PMC10900168 DOI: 10.1182/blood.2022018096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
ABSTRACT Over the past 2 decades, there has been a significant increase in the utilization of long-term mechanical circulatory support (MCS) for the treatment of cardiac failure. Left ventricular assist devices (LVADs) and total artificial hearts (TAHs) have been developed in parallel to serve as bridge-to-transplant and destination therapy solutions. Despite the distinct hemodynamic characteristics introduced by LVADs and TAHs, a comparative evaluation of these devices regarding potential complications in supported patients, has not been undertaken. Such a study could provide valuable insights into the complications associated with these devices. Although MCS has shown substantial clinical benefits, significant complications related to hemocompatibility persist, including thrombosis, recurrent bleeding, and cerebrovascular accidents. This review focuses on the current understanding of hemostasis, specifically thrombotic and bleeding complications, and explores the influence of different shear stress regimens in long-term MCS. Furthermore, the role of endothelial cells in protecting against hemocompatibility-related complications of MCS is discussed. We also compared the diverse mechanisms contributing to the occurrence of hemocompatibility-related complications in currently used LVADs and TAHs. By applying the existing knowledge, we present, for the first time, a comprehensive comparison between long-term MCS options.
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Affiliation(s)
- Angelo Nascimbene
- Advanced Cardiopulmonary Therapies and Transplantation, University of Texas, Houston, TX
| | - David Bark
- Division of Hematology and Oncology, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO
| | - David M. Smadja
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department, Assistance Publique–Hôpitaux de Paris, Georges Pompidou European Hospital, Paris, France
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2
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Volod O, Colon MJ, Arabía FA. In Search of the Holy Grail of Artificial Hearts: Are We There Yet? Semin Thromb Hemost 2024; 50:104-114. [PMID: 37604198 DOI: 10.1055/s-0043-1772456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
The total artificial heart (TAH) has a long and rich history, being the product of decades of innovation, hard work, and dedication. This review examines the history of the TAH, a device that has revolutionized the treatment of end-stage biventricular heart failure. It reviews the development of the device from early concepts to the current state-of-the-art device, the SynCardia TAH, which has been implanted in over 2,000 patients worldwide. The article also discusses the challenges and successes experienced by researchers, clinicians, and patients throughout the development of TAH devices. Our focus will also be on discussing the hemostatic alterations in patients implanted with TAH and anticoagulation strategies to decrease associated thromboembolic risks. The article concludes with a look at other novel TAH devices and the future of TAH as an increasingly viable treatment for end-stage heart failure.
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Affiliation(s)
- Oksana Volod
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Modesto J Colon
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Francisco A Arabía
- Advanced Heart Program, Department of Surgery and Medicine, Banner Health-University of Arizona College of Medicine, Phoenix, Arizona
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3
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Vis A, Arfaee M, Khambati H, Slaughter MS, Gummert JF, Overvelde JTB, Kluin J. The ongoing quest for the first total artificial heart as destination therapy. Nat Rev Cardiol 2022; 19:813-828. [PMID: 35668176 DOI: 10.1038/s41569-022-00723-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 12/18/2022]
Abstract
Many patients with end-stage heart disease die because of the scarcity of donor hearts. A total artificial heart (TAH), an implantable machine that replaces the heart, has so far been successfully used in over 1,700 patients as a temporary life-saving technology for bridging to heart transplantation. However, after more than six decades of research on TAHs, a TAH that is suitable for destination therapy is not yet available. High complication rates, bulky devices, poor durability, poor biocompatibility and low patient quality of life are some of the major drawbacks of current TAH devices that must be addressed before TAHs can be used as a destination therapy. Quickly emerging innovations in battery technology, wireless energy transmission, biocompatible materials and soft robotics are providing a promising opportunity for TAH development and might help to solve the drawbacks of current TAHs. In this Review, we describe the milestones in the history of TAH research and reflect on lessons learned during TAH development. We summarize the differences in the working mechanisms of these devices, discuss the next generation of TAHs and highlight emerging technologies that will promote TAH development in the coming decade. Finally, we present current challenges and future perspectives for the field.
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Affiliation(s)
- Annemijn Vis
- Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Maziar Arfaee
- Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Husain Khambati
- Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Jan F Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Johannes T B Overvelde
- Autonomous Matter Department, AMOLF, Amsterdam, The Netherlands.,Institute for Complex Molecular Systems and Department of Mechanical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Jolanda Kluin
- Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands. .,Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
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Bioprosthetic Total Artificial Heart Implantation Does Not Induce Chronic Inflammation. ASAIO J 2022; 68:e173-e178. [PMID: 36228635 DOI: 10.1097/mat.0000000000001820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The Aeson total artificial heart (A-TAH) has been developed for patients at risk of death from biventricular failure. We aimed to assess the inflammatory status in nine subjects implanted with the A-TAH in kinetics over one year. Laboratory assessment of leukocyte counts, inflammatory cytokines assay, and peripheral blood mononuclear cell collection before and after A-TAH implantation. Leukocyte counts were not significantly modulated according to time after A-TAH implantation (coefficient of the linear mixed effect model with 95% CI, -0.05 (-0.71 to -0.61); p = 0.44). We explored inflammatory cytokine after A-TAH and did not observe, at any time, a modified profile compared to pre-implantation values (all p -values > 0.05). Finally, we compared the distribution of circulating immune cell subpopulations identified based on sequential expression patterns for multiple clusters of differentiation. None of the population explored had significant modulation during the 12-month follow-up (all p -values > 0.05). In conclusion, using a cytokine multiplex assay combined with a flow cytometry approach, we demonstrated the absence of inflammatory signals in peripheral blood over a period of 12 months following A-TAH implantation.
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Poitier B, Chocron R, Peronino C, Philippe A, Pya Y, Rivet N, Richez U, Bekbossynova M, Gendron N, Grimmé M, Bories MC, Brichet J, Capel A, Rancic J, Vedie B, Roussel JC, Jannot AS, Jansen P, Carpentier A, Ivak P, Latremouille C, Netuka I, Smadja DM. Bioprosthetic Total Artificial Heart in Autoregulated Mode Is Biologically Hemocompatible: Insights for Multimers of von Willebrand Factor. Arterioscler Thromb Vasc Biol 2022; 42:470-480. [PMID: 35139659 DOI: 10.1161/atvbaha.121.316833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Carmat bioprosthetic total artificial heart (Aeson; A-TAH) is a pulsatile and autoregulated device. The aim of this study is to evaluate level of hemolysis potential acquired von Willebrand syndrome after A-TAH implantation. METHODS We examined the presence of hemolysis and acquired von Willebrand syndrome in adult patients receiving A-TAH support (n=10) during their whole clinical follow-up in comparison with control subjects and adult patients receiving Heartmate II or Heartmate III support. We also performed a fluid structure interaction model coupled with computational fluid dynamics simulation to evaluate the A-TAH resulting shear stress and its distribution in the blood volume. RESULTS The cumulative duration of A-TAH support was 2087 days. A-TAH implantation did not affect plasma free hemoglobin over time, and there was no association between plasma free hemoglobin and cardiac output or beat rate. For VWF (von Willebrand factor) evaluation, A-TAH implantation did not modify multimers profile of VWF in contrast to Heartmate II and Heartmate III. Furthermore, fluid structure interaction coupled with computational fluid dynamics showed a gradually increase of blood damage according to increase of cardiac output (P<0.01), however, the blood volume fraction that endured significant shear stresses was always inferior to 0.03% of the volume for both ventricles in all regimens tested. An inverse association between cardiac output, beat rate, and high-molecular weight multimers ratio was found. CONCLUSIONS We demonstrated that A-TAH does not cause hemolysis or AWVS. However, relationship between HMWM and cardiac output depending flow confirms relevance of VWF as a biological sensor of blood flow, even in normal range.
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Affiliation(s)
- Bastien Poitier
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France (B.P., A.C., C.L.).,Cardiac Surgery Department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (B.P., A.C., C.L.).,Carmat SAS, Velizy-Villacoublay, France (B.P., U.R., M.G., A.C., P.J.)
| | - Richard Chocron
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Emergency department, AP-HP, Georges Pompidou European Hospital, France (R.C.)
| | - Christophe Peronino
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France, Hematology department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (C.P., A.P., N.R., U.R., N.G., J.B., J.R., D.M.S.)
| | - Aurélien Philippe
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France, Hematology department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (C.P., A.P., N.R., U.R., N.G., J.B., J.R., D.M.S.)
| | - Yuri Pya
- National Research Cardiac, Surgery Center, Nur-Sultan, Kazakhstan (Y.P., M.B.)
| | - Nadia Rivet
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France, Hematology department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (C.P., A.P., N.R., U.R., N.G., J.B., J.R., D.M.S.)
| | - Ulysse Richez
- Carmat SAS, Velizy-Villacoublay, France (B.P., U.R., M.G., A.C., P.J.).,Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France, Hematology department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (C.P., A.P., N.R., U.R., N.G., J.B., J.R., D.M.S.)
| | | | - Nicolas Gendron
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France, Hematology department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (C.P., A.P., N.R., U.R., N.G., J.B., J.R., D.M.S.)
| | - Marc Grimmé
- Carmat SAS, Velizy-Villacoublay, France (B.P., U.R., M.G., A.C., P.J.)
| | - Marie Cécile Bories
- Université de Paris, Cardiac Surgery Department, AP-HP, Georges Pompidou European Hospital, France (M.C.B.)
| | - Julie Brichet
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France, Hematology department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (C.P., A.P., N.R., U.R., N.G., J.B., J.R., D.M.S.)
| | - Antoine Capel
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France (B.P., A.C., C.L.).,Cardiac Surgery Department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (B.P., A.C., C.L.)
| | - Jeanne Rancic
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France, Hematology department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (C.P., A.P., N.R., U.R., N.G., J.B., J.R., D.M.S.)
| | - Benoit Vedie
- AP-HP, Biochemistry Department, Georges Pompidou European Hospital, France (B.V.)
| | - Jean Christian Roussel
- Cardiac and thoracic Surgery Department, CHU de Nantes, hôpital Nord Laënnec, boulevard Jacques-Monod, France (J.C.R.)
| | - Anne-Sophie Jannot
- Department of Bioinformatics, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France (A.-S.J.)
| | | | - Alain Carpentier
- Carmat SAS, Velizy-Villacoublay, France (B.P., U.R., M.G., A.C., P.J.)
| | - Peter Ivak
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.I., I.N.)
| | - Christian Latremouille
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France (B.P., A.C., C.L.).,Cardiac Surgery Department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (B.P., A.C., C.L.)
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (P.I., I.N.)
| | - David M Smadja
- Université de Paris, Innovative Therapies in Hemostasis, INSERM, F-75006 Paris, France, Hematology department and Biosurgical Research lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, France (C.P., A.P., N.R., U.R., N.G., J.B., J.R., D.M.S.)
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6
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Netuka I, Pya Y, Poitier B, Ivak P, Konarik M, Perlès JC, Blažejová Z, Riha H, Bekbossynova M, Medressova A, Bousquet F, Latrémouille C, Jansen P. First Clinical Experience With the Pressure Sensor-Based Autoregulation of Blood Flow in an Artificial Heart. ASAIO J 2021; 67:1100-1108. [PMID: 34138778 PMCID: PMC8478302 DOI: 10.1097/mat.0000000000001485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The CARMAT-Total Artificial Heart (C-TAH) is designed to provide heart replacement therapy for patients with end-stage biventricular failure. This report details the reliability and efficacy of the autoregulation device control mechanism (auto-mode), designed to mimic normal physiologic responses to changing patient needs. Hemodynamic data from a continuous cohort of 10 patients implanted with the device, recorded over 1,842 support days in auto-mode, were analyzed with respect to daily changing physiologic needs. The C-TAH uses embedded pressure sensors to regulate the pump output. Right and left ventricular outputs are automatically balanced. The operator sets target values and the inbuilt algorithm adjusts the stroke volume and beat rate, and hence cardiac output, automatically. Auto-mode is set perioperatively after initial postcardiopulmonary bypass hemodynamic stabilization. All patients showed a range of average inflow pressures of between 5 and 20 mm Hg during their daily activities, resulting in cardiac output responses of between 4.3 and 7.3 L/min. Operator adjustments were cumulatively only required on 20 occasions. This report demonstrates that the C-TAH auto-mode effectively produces appropriate physiologic responses reflective of changing patients' daily needs and represents one of the unique characteristics of this device in providing almost physiologic heart replacement therapy.
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Affiliation(s)
- Ivan Netuka
- From the Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Yuriy Pya
- National Research Cardiac Surgery Center (NRCSC), Nur-Sultan (Astana), Kazakhstan
| | | | - Peter Ivak
- From the Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Miroslav Konarik
- From the Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jean-Christophe Perlès
- Carmat SA, Vélizy, France; and ¶Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Zuzana Blažejová
- From the Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hynek Riha
- From the Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Makhabbat Bekbossynova
- From the Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Assel Medressova
- From the Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Fabien Bousquet
- Carmat SA, Vélizy, France; and ¶Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Piet Jansen
- Carmat SA, Vélizy, France; and ¶Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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7
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An Intra-Cycle Optimal Control Framework for Ventricular Assist Devices Based on Atrioventricular Plane Displacement Modeling. Ann Biomed Eng 2021; 49:3508-3523. [PMID: 34549343 PMCID: PMC8671277 DOI: 10.1007/s10439-021-02848-2] [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: 04/10/2021] [Accepted: 08/04/2021] [Indexed: 12/04/2022]
Abstract
A promising treatment for congestive heart failure is the implementation of a left ventricular assist device (LVAD) that works as a mechanical pump. Modern LVADs work with adjustable constant rotor speed and provide therefore continuous blood flow; however, recently undertaken efforts try to mimic pulsatile blood flow by oscillating the pump speed. This work proposes an algorithmic framework to construct and evaluate optimal pump speed policies with respect to generic objectives. We use a model that captures the atrioventricular plane displacement, which is a physiological indicator for heart failure. We employ mathematical optimization to adapt this model to patient specific data and to find optimal pump speed policies with respect to ventricular unloading and aortic valve opening. To this end, we reformulate the cardiovascular dynamics into a switched system and thereby reduce nonlinearities. We consider system switches that stem from varying the constant pump speed and that are state dependent such as valve opening or closing. As a proof of concept study, we personalize the model to a selected patient with respect to ventricular pressure. The model fitting results in a root-mean-square deviation of about 6 mmHg. The optimization that considers aortic valve opening and ventricular unloading results in speed modulation akin to counterpulsation. These in silico findings demonstrate the potential of personalized hemodynamical optimization for the LVAD therapy.
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8
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Kaliyev R, Lesbekov T, Bekbossynov S, Nurmykhametova Z, Bekbossynova M, Novikova S, Medressova A, Smagulov N, Faizov L, Samalavicius R, Pya Y. Heart transplantation of patients with ventricular assist devices: impact of normothermic ex-vivo preservation using organ care system compared with cold storage. J Cardiothorac Surg 2020; 15:323. [PMID: 33109229 PMCID: PMC7590799 DOI: 10.1186/s13019-020-01367-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/18/2020] [Indexed: 01/09/2023] Open
Abstract
Background Organ Care System (OCS) minimizes the cold ischemic time and allows for optimization of logistics and meticulous recipient preparation. Impact of normothermic ex-vivo preservation using OCS compared with cold storage (CS) for prolonged heart preservation especially beneficial for high-risk recipients bridged to transplantation with Mechanical Circulatory Support (MCS). Methods Between 2012 and 2018, we performed a retrospective single-center review of prospectively collected data. All patients who underwent heart transplantation with MCS using the OCS Heart (n = 25) versus standard cold storage (n = 10) were included in this study. Results During this period, 353 patients were implanted with left ventricular assisted device (LVAD) and 35 (10%) were bridged to heart transplantation. There was no significant difference in donor and recipient characteristics and risk factors. The Index for Mortality Prediction after Cardiac Transplantation (IMPACT) score was a trend towards higher estimated risk of death at 1y in the OCS group (14.2 vs. 10.8% p = 0.083). Mean total ischemic time during preservation was statistically significantly longer in CS vs OCS group (210 (23) Vs 74.6 (13) min p = 0.001). Median ex vivo normothermic heart perfusion time in OCS was 348.4(132; 955) min. There was significant difference in total out of body time between OCS group 423(67) Vs CS group 210(23) min p = 0.002). All patients were alive on the 30th days post implant in CS groups and 96% in OCS group (p = 0.5). Conclusion Normothermic ex-vivo preservation of the allograft during transportation with the organ care system might be beneficial for long-time out of body organ preservation in comparison of cold storage especially for recipients on mechanical circulatory support.
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Affiliation(s)
- Rymbay Kaliyev
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Timur Lesbekov
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Serik Bekbossynov
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | | | | | - Svetlana Novikova
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Assel Medressova
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Nurlan Smagulov
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Linar Faizov
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | | | - Yuriy Pya
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
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9
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Smadja DM, Chocron R, Rossi E, Poitier B, Pya Y, Bekbossynova M, Peronino C, Rancic J, Roussel JC, Kindo M, Gendron N, Migliozzi L, Capel A, Perles JC, Gaussem P, Ivak P, Jansen P, Girard C, Carpentier A, Latremouille C, Guerin C, Netuka I. Autoregulation of Pulsatile Bioprosthetic Total Artificial Heart is Involved in Endothelial Homeostasis Preservation. Thromb Haemost 2020; 120:1313-1322. [PMID: 32688422 DOI: 10.1055/s-0040-1713751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pulsatile Carmat bioprosthetic total artificial heart (C-TAH) is designed to be implanted in patients with biventricular end-stage heart failure. Since flow variation might contribute to endothelial dysfunction, we explored circulating endothelial biomarkers after C-TAH implantation in seven patients and compared the manual and autoregulated mode. Markers of endothelial dysfunction and regeneration were compared before and during a 6- to 9-month follow-up after implantation. The follow-up was divided into three periods (< 3, 3-6, and > 6 months) and used to estimate the temporal trends during the study period. A linear mixed model was used to analyze repeated measures and association between tested parameters according to the mode of C-TAH and the time. Relevance of soluble endoglin (sEndoglin) level increase has been tested on differentiation and migration potential of human vasculogenic progenitor cells (endothelial colony forming cells [ECFCs]). Normal sEndoglin and soluble endothelial protein C receptor (sEPCR) levels were found in patients after implantation with autoregulated C-TAH, whereas they significantly increased in the manual mode, as compared with pretransplant values (p = 0.005 and 0.001, respectively). In the autoregulated mode, a significant increase in the mobilization of cytokine stromal cell-derived factor 1 was found (p = 0.03). After adjustment on the mode of C-TAH, creatinine or C-reactive protein level, sEndoglin, and sEPCR, were found significantly associated with plasma total protein levels. Moreover, a significant decrease in pseudotubes formation and migration ability was observed in vitro in ECFCs receiving sEndoglin activation. Our combined analysis of endothelial biomarkers confirms the favorable impact of blood flow variation achieved with autoregulation in patients implanted with the bioprosthetic total artificial heart.
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Affiliation(s)
- David M Smadja
- Inserm UMR-S 1140, Innovative Therapies in Haemostasis, Service d'Hématologie et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), Université de Paris, Georges Pompidou European Hospital, Paris, France
| | - Richard Chocron
- Inserm UMR-S 970 PARCC, Service d'urgences, Université de Paris, Georges Pompidou European Hospital, Paris, France
| | - Elisa Rossi
- Innovative Therapies in Haemostasis, Université de Paris, Paris, France
| | - Bastien Poitier
- Innovative Therapies in Haemostasis, Service de Chirurgie Cardiaque et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), Université de Paris, Georges Pompidou European Hospital, Paris, France
| | - Yuri Pya
- National Research Cardiac Surgery Center, Astana, Kazakhstan
| | | | - Christophe Peronino
- Inserm UMR-S 1140, Innovative Therapies in Haemostasis, Service d'Hématologie et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), Université de Paris, Georges Pompidou European Hospital, Paris, France
| | - Jeanne Rancic
- Inserm UMR-S 1140, Innovative Therapies in Haemostasis, Service d'Hématologie et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), Université de Paris, Georges Pompidou European Hospital, Paris, France
| | - Jean Christian Roussel
- Service de Chirurgie Thoracique et Cardiovasculaire, Unité de transplantation thoracique, CHU de Nantes, Hôpital Nord Laënnec, Saint-Herblain, Nantes Cedex 1, France
| | - Michel Kindo
- Service de Chirurgie Cardiovasculaire, NHC - Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1, Place de L'Hôpital, Strasbourg, Cedex, France
| | - Nicolas Gendron
- Inserm UMR-S 1140, Innovative Therapies in Haemostasis, Service d'Hématologie et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), Université de Paris, Georges Pompidou European Hospital, Paris, France
| | - Ludovica Migliozzi
- Innovative Therapies in Haemostasis, Service de Chirurgie Cardiaque et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), Université de Paris, Georges Pompidou European Hospital, Paris, France
| | | | | | - Pascale Gaussem
- Innovative Therapies in Haemostasis, Service d'Hématologie, Université de Paris, Georges Pompidou European Hospital, Paris, France
| | - Peter Ivak
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Claude Girard
- Unité d'Anesthesie Réanimation Cardio-Vasculaire, CHU François Mitterrand, Dijon Cedex, France
| | - Alain Carpentier
- Innovative Therapies in Haemostasis, Université de Paris, Paris, France
| | - Christian Latremouille
- Innovative Therapies in Haemostasis, Service de Chirurgie Cardiaque et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), Université de Paris, Georges Pompidou European Hospital, Paris, France
| | - Coralie Guerin
- Innovative Therapies in Haemostasis, Plateforme de Cytométrie, Institut Curie, Université de Paris, Paris, France
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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10
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Luraghi G, De Gaetano F, Rodriguez Matas JF, Dubini G, Costantino ML, De Castilla H, Griffaton N, Vignale D, Palmisano A, Gentile G, Esposito A, Migliavacca F. A numerical investigation to evaluate the washout of blood compartments in a total artificial heart. Artif Organs 2020; 44:976-986. [DOI: 10.1111/aor.13717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/28/2020] [Accepted: 04/23/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Giulia Luraghi
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta” Politecnico di Milano Milan Italy
| | - Francesco De Gaetano
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta” Politecnico di Milano Milan Italy
| | - José Félix Rodriguez Matas
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta” Politecnico di Milano Milan Italy
| | - Gabriele Dubini
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta” Politecnico di Milano Milan Italy
| | - Maria Laura Costantino
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta” Politecnico di Milano Milan Italy
| | | | | | - Davide Vignale
- Experimental Imaging Center IRCCS Ospedale San Raffaele Milan Italy
- Università Vita‐Salute San Raffaele Milan Italy
| | - Anna Palmisano
- Experimental Imaging Center IRCCS Ospedale San Raffaele Milan Italy
- Università Vita‐Salute San Raffaele Milan Italy
| | - Giuseppe Gentile
- Experimental Imaging Center IRCCS Ospedale San Raffaele Milan Italy
| | - Antonio Esposito
- Experimental Imaging Center IRCCS Ospedale San Raffaele Milan Italy
- Università Vita‐Salute San Raffaele Milan Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta” Politecnico di Milano Milan Italy
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11
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Richez U, De Castilla H, Guerin CL, Gendron N, Luraghi G, Grimme M, Wu W, Taverna M, Jansen P, Latremouille C, Migliavacca F, Dubini G, Capel A, Carpentier A, Smadja DM. Hemocompatibility and safety of the Carmat Total Artifical Heart hybrid membrane. Heliyon 2019; 5:e02914. [PMID: 31867454 PMCID: PMC6906674 DOI: 10.1016/j.heliyon.2019.e02914] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/12/2019] [Accepted: 11/21/2019] [Indexed: 11/25/2022] Open
Abstract
The Carmat bioprosthetic total artificial heart (C-TAH) is a biventricular pump developed to minimize drawbacks of current mechanical assist devices and improve quality of life during support. This study aims to evaluate the safety of the hybrid membrane, which plays a pivotal role in this artificial heart. We investigated in particular its blood-contacting surface layer of bovine pericardial tissue, in terms of mechanical aging, risks of calcification, and impact of the hemodynamics shear stress inside the ventricles on blood components. Hybrid membranes were aged in a custom-designed endurance bench. Mechanical, physical and chemical properties were not significantly modified from 9 months up to 4 years of aging using a simulating process. Exploration of erosion areas did not show no risk of oil diffusion through the membrane. Blood contacting materials in the ventricular cavities were subcutaneously implanted in Wistar rats for 30 days as a model for calcification and demonstrated that the in-house anti-calcification pretreatment with Formaldehyde-Ethanol-Tween 80 was able to significantly reduce the calcium concentration from 132 μg/mg to 4.42 μg/mg (p < 0.001). Hemodynamic simulations with a computational model were used to reproduce shear stress in left and right ventricles and no significant stress was able to trigger hemolysis, platelet activation nor degradation of the von Willebrand factor multimers. Moreover, explanted hybrid membranes from patients included in the feasibility clinical study were analyzed confirming preclinical results with the absence of significant membrane calcification. At last, blood plasma bank analysis from the four patients implanted with C-TAH during the feasibility study showed no residual glutaraldehyde increase in plasma and confirmed hemodynamic simulation-based results with the absence of hemolysis and platelet activation associated with normal levels of plasma free hemoglobin and platelet microparticles after C-TAH implantation. These results on mechanical aging, calcification model and hemodynamic simulations predicted the safety of the hybrid membrane used in the C-TAH, and were confirmed in the feasibility study.
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Affiliation(s)
- Ulysse Richez
- Université de Paris, Innovative Therapies in Haemostasis, INSERM UMR-S1140, F-75006, Paris, France.,et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), AH-HP, Georges Pompidou European Hospital, F-75015, Paris, France.,Carmat SA, Vélizy-Villacoublay, France
| | | | - Coralie L Guerin
- Institut Curie, Flow Cytometry Department, F-75006, Paris, France.,National Cytometry Platform, Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg
| | - Nicolas Gendron
- Service D'Hématologie et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), AH-HP, Georges Pompidou European Hospital, F-75015, Paris, France
| | - Giulia Luraghi
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | | | - Wei Wu
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Myriam Taverna
- PNAS, Institut Galien de Paris-Sud, Faculté de Pharmacie, Université Paris-Sud, CNRS UMR8612, 5 Rue JB Clément, Chatenay Malabry, France
| | | | - Christian Latremouille
- Service Chirurgie Cardique et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), AH-HP, Georges Pompidou European Hospital, F-75015, Paris, France
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Gabriele Dubini
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | | | - Alain Carpentier
- Service Chirurgie Cardique et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), AH-HP, Georges Pompidou European Hospital, F-75015, Paris, France
| | - David M Smadja
- Service D'Hématologie et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), AH-HP, Georges Pompidou European Hospital, F-75015, Paris, France
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12
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Melton N, Soleimani B, Dowling R. Current Role of the Total Artificial Heart in the Management of Advanced Heart Failure. Curr Cardiol Rep 2019; 21:142. [DOI: 10.1007/s11886-019-1242-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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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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14
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Jhun CS, Siedlecki C, Xu L, Lukic B, Newswanger R, Yeager E, Reibson J, Cysyk J, Weiss W, Rosenberg G. Stress and Exposure Time on von Willebrand Factor Degradation. Artif Organs 2018; 43:199-206. [PMID: 30374981 DOI: 10.1111/aor.13323] [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: 03/27/2018] [Revised: 05/14/2018] [Accepted: 06/22/2018] [Indexed: 12/13/2022]
Abstract
Despite the prevailing use of the continuous flow left ventricular assist devices (cf-LVAD), acquired von Willebrand syndrome (AvWS) associated with cf-LVAD still remains a major complication. As AvWS is known to be dependent on shear stress (τ) and exposure time (texp ), this study examined the degradation of high molecular weight multimers (HMWM) of von Willebrand factor (vWF) in terms of τ and texp . Two custom apparatus, i.e., capillary-tubing-type degrader (CTD) and Taylor-Couette-type degrader (TCD) were developed for short-term (0.033 sec ≤ texp ≤ 1.05 s) and long-term (10 s ≤ texp ≤ 10 min) shear exposures of vWF, respectively. Flow conditions indexed by Reynolds number (Re) for CTD were 14 ≤ Re ≤ 288 with corresponding laminar stress level of 52 ≤ τ CTD ≤ 1042 dyne/cm2 . Flow conditions for TCD were 100 ≤ Re ≤ 2500 with corresponding rotor speed of 180 ≤ o ≤ 4000 RPM and laminar stress level of 50 ≤ τ TCD ≤ 1114 dyne/cm2 . Due to transitional and turbulent flows in TCD at Re > 1117, total stress (i.e., τ total = laminar + turbulent) was also calculated using a computational fluid dynamics (CFD) solver, Converge CFD (Converge Science Inc., Madison, WI, USA). Inhibition of ADAMTS13 with different concentration of EDTA (5 mM and 10 mM) was also performed to investigate the mechanism of cleavage in terms of mechanical and enzymatic aspects. Degradation of HMWM with CTD was negligible at all given testing conditions. Although no degradation of HMWM was observed with TCD at Re < 1117 ( τ total = 1012 dyne/cm2 ), increase in degradation of HMWM was observed beyond Re of 1117 for all given exposure times. At Re ~ 2500 ( τ total = 3070 dyne/cm2 ) with texp = 60 s, a severe degradation of HMWM (90.7 ± 3.8%, abnormal) was observed, and almost complete degradation of HMWM (96.1 ± 1.9%, abnormal) was observed with texp = 600 s. The inhibition studies with 5 mM EDTA at Re ~ 2500 showed that loss of HMWM was negligible (<10%, normal) for all given exposure times except for texp = 10 min (39.5 ± 22.3%, borderline-abnormal). With 10 mM EDTA, no degradation of HMWM was observed (11.1 ± 4.4%, normal) even for texp = 10 min. This study investigated the effect of shear stress and exposure time on the HMWM of vWF in laminar and turbulent flows. The inhibition study by EDTA confirms that degradation of HMWM is initiated by shear-induced unfolding followed by enzymatic cleavage at given conditions. Determination of magnitude of each mechanism needs further investigation. It is also important to note that the degradation of vWF is highly dependent on turbulence regardless of the time exposed within our testing conditions.
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Affiliation(s)
- Choon-Sik Jhun
- Division of Applied Biomedical Engineering, Department of Surgery, Penn State College of Medicine, Hershey PA, USA
| | - Christopher Siedlecki
- Division of Applied Biomedical Engineering, Department of Surgery, Penn State College of Medicine, Hershey PA, USA.,Department of Biomedical Engineering, Penn State University, University Park, PA, USA
| | - Lichong Xu
- Division of Applied Biomedical Engineering, Department of Surgery, Penn State College of Medicine, Hershey PA, USA
| | - Branka Lukic
- Division of Applied Biomedical Engineering, Department of Surgery, Penn State College of Medicine, Hershey PA, USA
| | - Raymond Newswanger
- Division of Applied Biomedical Engineering, Department of Surgery, Penn State College of Medicine, Hershey PA, USA
| | - Eric Yeager
- Division of Applied Biomedical Engineering, Department of Surgery, Penn State College of Medicine, Hershey PA, USA
| | - John Reibson
- Division of Applied Biomedical Engineering, Department of Surgery, Penn State College of Medicine, Hershey PA, USA
| | - Joshua Cysyk
- Division of Applied Biomedical Engineering, Department of Surgery, Penn State College of Medicine, Hershey PA, USA
| | - William Weiss
- Division of Applied Biomedical Engineering, Department of Surgery, Penn State College of Medicine, Hershey PA, USA.,Department of Biomedical Engineering, Penn State University, University Park, PA, USA
| | - Gerson Rosenberg
- Division of Applied Biomedical Engineering, Department of Surgery, Penn State College of Medicine, Hershey PA, USA.,Department of Biomedical Engineering, Penn State University, University Park, PA, USA
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15
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Kalmanovich E, Audurier Y, Akodad M, Mourad M, Battistella P, Agullo A, Gaudard P, Colson P, Rouviere P, Albat B, Ricci JE, Roubille F. Management of advanced heart failure: a review. Expert Rev Cardiovasc Ther 2018; 16:775-794. [PMID: 30282492 DOI: 10.1080/14779072.2018.1530112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Heart failure (HF) has become a global pandemic. Despite recent developments in both medical and device treatments, HF incidences continues to increase. The current definition of HF restricts itself to stages at which clinical symptoms are apparent. In advanced heart failure (AdHF), it is universally accepted that all patients are refractory to traditional therapies. As the number of HF patients increase, so does the need for additional treatments, with an increased proportion of patients requiring advanced therapies. Areas covered: This review discusses extensive evidence for the effect of medical treatment on HF, although the data on the effect on AdHF is scare. Authors review the relevant literature for treating AdHF patients. Furthermore, mechanical circulatory devices (MCD) have emerged as an alternative to heart transplantation and have been shown to enhance quality of life and reduce mortality therefore authors also review the current literature on the different MCD and technologies. Expert commentary: More patients will need advanced therapies, as the access to heart transplantation is limited by the number of available donors. AdHF patients should be identified timely since the window of opportunities for advanced therapy is narrow as their morbidity is progressive and survival is often short.
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Affiliation(s)
- Eran Kalmanovich
- a Department of Cardiology , Montpellier University Hospital , Montpellier , France
| | - Yohan Audurier
- b Pharmacy Department , University Hospital of Montpellier , Montpellier , France
| | - Mariama Akodad
- a Department of Cardiology , Montpellier University Hospital , Montpellier , France
| | - Marc Mourad
- c Department of Anesthesiology and Critical Care Medicine , Arnaud de Villeneuve Hospital , Montpellier , France.,d PhyMedExp , University of Montpellier , Montpellier , France
| | - Pascal Battistella
- a Department of Cardiology , Montpellier University Hospital , Montpellier , France
| | - Audrey Agullo
- a Department of Cardiology , Montpellier University Hospital , Montpellier , France
| | - Philippe Gaudard
- c Department of Anesthesiology and Critical Care Medicine , Arnaud de Villeneuve Hospital , Montpellier , France.,d PhyMedExp , University of Montpellier , Montpellier , France
| | - Pascal Colson
- c Department of Anesthesiology and Critical Care Medicine , Arnaud de Villeneuve Hospital , Montpellier , France.,d PhyMedExp , University of Montpellier , Montpellier , France
| | - Philippe Rouviere
- e Department of Cardiovascular Surgery , University Hospital of Montpellier, University of Montpellier , Montpellier , France
| | - Bernard Albat
- e Department of Cardiovascular Surgery , University Hospital of Montpellier, University of Montpellier , Montpellier , France
| | - Jean-Etienne Ricci
- f Department of Cardiology , Nîmes University Hospital, University of Montpellier , Nîmes , France
| | - François Roubille
- a Department of Cardiology , Montpellier University Hospital , Montpellier , France.,d PhyMedExp , University of Montpellier , Montpellier , France
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16
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Luraghi G, Wu W, De Castilla H, Rodriguez Matas JF, Dubini G, Dubuis P, Grimmé M, Migliavacca F. Numerical Approach to Study the Behavior of an Artificial Ventricle: Fluid-Structure Interaction Followed By Fluid Dynamics With Moving Boundaries. Artif Organs 2018; 42:E315-E324. [DOI: 10.1111/aor.13316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Giulia Luraghi
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”; Politecnico di Milano; Milan Italy
| | - Wei Wu
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”; Politecnico di Milano; Milan Italy
- Department of Mechanical Engineering; University of Texas at San Antonio; San Antonio TX USA
| | | | - José Félix Rodriguez Matas
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”; Politecnico di Milano; Milan Italy
| | - Gabriele Dubini
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”; Politecnico di Milano; Milan Italy
| | | | | | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”; Politecnico di Milano; Milan Italy
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17
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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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18
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Vincent F, Rauch A, Loobuyck V, Robin E, Nix C, Vincentelli A, Smadja DM, Leprince P, Amour J, Lemesle G, Spillemaeker H, Debry N, Latremouille C, Jansen P, Capel A, Moussa M, Rousse N, Schurtz G, Delhaye C, Paris C, Jeanpierre E, Dupont A, Corseaux D, Rosa M, Sottejeau Y, Barth S, Mourran C, Gomane V, Coisne A, Richardson M, Caron C, Preda C, Ung A, Carpentier A, Hubert T, Denis C, Staels B, Lenting PJ, Van Belle E, Susen S. Arterial Pulsatility and Circulating von Willebrand Factor in Patients on Mechanical Circulatory Support. J Am Coll Cardiol 2018; 71:2106-2118. [DOI: 10.1016/j.jacc.2018.02.075] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 01/25/2018] [Accepted: 02/25/2018] [Indexed: 01/27/2023]
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19
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A bioprosthetic total artificial heart for end-stage heart failure: Results from a pilot study. J Heart Lung Transplant 2017; 37:33-37. [PMID: 28986001 DOI: 10.1016/j.healun.2017.09.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/05/2017] [Accepted: 09/11/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The electro-hydraulically actuated Carmat total artificial heart (C-TAH) is designed to replace the heart in patients with end-stage heart failure, either as bridge to transplant or destination therapy. It provides pulsatile flow and contains bio-prosthetic blood contacting materials. A clinical feasibility study was conducted to evaluate the C-TAH safety and performance. METHODS Hospitalized patients, at imminent risk of death from irreversible biventricular failure despite optimal medical management, and not eligible for transplant or eligible but on extracorporeal life support, were enrolled. The primary endpoint was 30-days survival. RESULTS Four patients were implanted with the C-TAH, three as destination therapy (ages 76, 68, 74) and one as bridge to transplant (age 58). They had implant times of 74, 270, 254 and 20 days respectively. All patients were free from hemolysis, clinical neurologic events, clinical evidence of thrombus and device-related infections. Hemodynamic and physical recovery allowed two patients to be discharged home for a cumulative duration of 7 months. The anticoagulation management strategy comprised initial unfractionated heparin, from postoperative day 2, followed by low molecular weight heparin and aspirin. An increased D-dimer level was observed in all patients during months 1 to 4. Temporary suspension of heparin anticoagulation resulted in thrombocytopenia and increased fibrin monomer, reversed by resuming anticoagulation with heparin. Causes of death were device-related (2 cases), respiratory failure and multi-organ failure. CONCLUSIONS Preliminary clinical results with the C-TAH demonstrated good safety and performance profiles in patients suffering from biventricular failure, which need to be confirmed in a pivotal study.
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