Development of a flexible inflow cannula with titanium inflow tip for the NEDO biventricular assist device

Ex Vivo Assessment of a Parabolic-Tip Inflow Cannula for Pediatric Continuous-Flow VADs

To address the challenge of unloading the left ventricle during pediatric mechanical circulatory support using next-generation rotary blood pumps, a novel inflow cannula was developed. This unique inflow cannula for pediatric, continuous-flow, left ventricular assist devices (VADs) with a parabolic-shaped inlet entrance was evaluated alongside a bevel-tip and fenestrated-tip cannula via an ex vivo, isolated-heart experimental setup. Performance was characterized using two clinical scenarios of over-pumping and hypovolemia, created by varying pump speed and filling preload pressure, respectively, at ideal and off-axis cannula placement to assess ventricular unloading and positional sensitivity. Quantitative and qualitative assessments were performed on the resultant hemodynamics and intra-ventricular boroscopic images to classify conditions of nonsuction, partial, gradual or severe entrainment, and ventricular collapse. The parabolic-tip cannula was found to be significantly less sensitive to placement position (p < 0.001) than the bevel-tip cannula under all conditions, while not statistically different from the fenestrated cannula. Visual analysis of the parabolic-tip cannula showed complete resistance to entrainment, whereas the fenestrated-tip had partial entrainment in 90% and 87% of the over-pumping and hypovolemic studies, respectively. We conclude that future pediatric VAD designs may benefit from incorporating the parabolic-tip inflow cannula design to maximize unloading of the left ventricle in ideal and nonoptimal conditions.

In-vitro Evaluation of Ventricular Cannulation for Rotodynamic Cardiac Assist Devices

The influence of positioning and geometry of ventricular cannulas for contemporary continuous flow Left Ventricular Assist Devices (LVADs) was evaluated in a non-beating isolated heart preparation with borescopic visualization. Preload and LVAD flow were varied to evaluate degrees of ventricular decompression up to the point of ventricular collapse. The performance of a flanged cannula was compared to a conventional bevel-tipped cannula: quantitatively by the maximal flow attainable, and qualitatively by visualization of fluid tracer particles within the ventricular chamber. Three forms of ventricular suck-down occurred: concentric collapse, gradual entrainment and instantaneous entrainment. In some circumstances, unstable oscillations of the ventricle were observed prior to complete collapse. Under conditions of low preload, the flanged cannula demonstrated less positional sensitivity, provided greater flow, and exhibited fewer areas of stagnation than the beveled cannula. These observations warrant further consideration of a flanged ventricular cannula to mitigate complications encountered with conventional cannulae.

Performance of extracorporeally adjustable ventricular assist device inflow cannula

PURPOSE

This study evaluated the feasibility and efficacy of a newly developed adjustable left ventricular assist device inflow cannula in a short-term calf model.

DESCRIPTION

In this inflow cannula, the angle between the cannula body and the inflow cannula tip can be altered extracorporeally by manipulating 2 externalized cables connected to the cannula. The cannula tip is adjustable in any plane to a maximum of ±15 degrees.

EVALUATION

After initial prototyping in 4 calf cadavers, a Cleveland Heart left ventricular assist device was implanted with the adjustable inflow cannula placed in the left ventricular apex and the outlet to the descending aorta. Under hypovolemic conditions, the angle of the cannula tip could be changed to induce varying degrees of ventricular suction and then eliminate it, as evidenced by recorded pump and native left ventricular flows. Epicardial echocardiography and fluoroscopy in the closed-chest condition documented extracorporeal adjustments of the inflow cannula position.

CONCLUSIONS

This extracorporeally adjustable inflow cannula was effective in preventing or controlling left ventricular suction.

Computational fluid dynamics analysis of thrombosis potential in left ventricular assist device drainage cannulae

Cannulation is necessary when blood is removed from the body, for example in hemodialysis, cardiopulmonary bypass, blood oxygenators, and ventricular assist devices. Artificial blood contacting surfaces are prone to thrombosis, especially in the presence of stagnant or recirculating flow. In this work, computational fluid dynamics was used to investigate the blood flow fields in three clinically available cannulae (Medtronic DLP 12, 16, and 24 F), used as drainage for pediatric circulatory support and to calculate parameters that may be indicative of thrombosis potential. The results show that using the 24 F cannula below flow rates of about 0.75 L/min produces hemodynamic conditions, which may increase the risk of blood clotting within the cannula. No reasons are indicated for not using the 12 or 16 F cannulae with flow rates between 0.25 and 3.0 L/min.