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Smith PA, Wang Y, Frazier OH. The Evolution of Durable, Implantable Axial-Flow Rotary Blood Pumps. Tex Heart Inst J 2023; 50:492012. [PMID: 37011366 PMCID: PMC10178652 DOI: 10.14503/thij-22-7908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Left ventricular assist devices (LVADs) are increasingly used to treat patients with end-stage heart failure. Implantable LVADs were initially developed in the 1960s and 1970s. Because of technological constraints, early LVADs had limited durability (eg, membrane or valve failure) and poor biocompatibility (eg, driveline infections and high rates of hemolysis caused by high shear rates). As the technology has improved over the past 50 years, contemporary rotary LVADs have become smaller, more durable, and less likely to result in infection. A better understanding of hemodynamics and end-organ perfusion also has driven research into the enhanced functionality of rotary LVADs. This paper reviews from a historical perspective some of the most influential axial-flow rotary blood pumps to date, from benchtop conception to clinical implementation. The history of mechanical circulatory support devices includes improvements related to the mechanical, anatomical, and physiologic aspects of these devices. In addition, areas for further improvement are discussed, as are important future directions-such as the development of miniature and partial-support LVADs, which are less invasive because of their compact size. The ongoing development and optimization of these pumps may increase long-term LVAD use and promote early intervention in the treatment of patients with heart failure.
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Affiliation(s)
- P Alex Smith
- Innovative Design and Engineering Applications Laboratory, The Texas Heart Institute, Houston, Texas
| | - Yaxin Wang
- Innovative Design and Engineering Applications Laboratory, The Texas Heart Institute, Houston, Texas
| | - O H Frazier
- Innovative Design and Engineering Applications Laboratory, The Texas Heart Institute, Houston, Texas
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2
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Guidetti F, Arrigo M, Frank M, Mikulicic F, Sokolski M, Aser R, Wilhelm MJ, Flammer AJ, Ruschitzka F, Winnik S. Treatment of Advanced Heart Failure-Focus on Transplantation and Durable Mechanical Circulatory Support: What Does the Future Hold? Heart Fail Clin 2021; 17:697-708. [PMID: 34511216 DOI: 10.1016/j.hfc.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Heart transplantation (HTx) is the treatment of choice in patients with late-stage advanced heart failure (Advanced HF). Survival rates 1, 5, and 10 years after transplantation are 87%, 77%, and 57%, respectively, and the average life expectancy is 9.16 years. However, because of the donor organ shortage, waiting times often exceed life expectancy, resulting in a waiting list mortality of around 20%. This review aims to provide an overview of current standard, recent advances, and future developments in the treatment of Advanced HF with a focus on long-term mechanical circulatory support and HTx.
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Affiliation(s)
- Federica Guidetti
- Department of Cardiology, University Hospital of Zürich, Rämistrasse 100, Zürich 8091, Switzerland.
| | - Mattia Arrigo
- Department of Internal Medicine, Triemli Hospital Zürich, Birmensdorferstrasse 497, 8063 Zürich, Switzerland
| | - Michelle Frank
- Department of Cardiology, University Hospital of Zürich, Rämistrasse 100, Zürich 8091, Switzerland
| | - Fran Mikulicic
- Department of Cardiology, University Hospital of Zürich, Rämistrasse 100, Zürich 8091, Switzerland
| | - Mateusz Sokolski
- Department of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Raed Aser
- Department of Cardiac Surgery, University Hospital of Zürich, Rämistrasse 100, Zürich 8091, Switzerland
| | - Markus J Wilhelm
- Department of Cardiac Surgery, University Hospital of Zürich, Rämistrasse 100, Zürich 8091, Switzerland
| | - Andreas J Flammer
- Department of Cardiology, University Hospital of Zürich, Rämistrasse 100, Zürich 8091, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital of Zürich, Rämistrasse 100, Zürich 8091, Switzerland
| | - Stephan Winnik
- Department of Cardiology, University Hospital of Zürich, Rämistrasse 100, Zürich 8091, Switzerland
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3
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Vargo PR, Soltesz EG. Catheter and Surgical Therapies for Right Heart Failure: Current and Future Options. Semin Thorac Cardiovasc Surg 2020; 32:389-395. [DOI: 10.1053/j.semtcvs.2020.02.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 02/21/2020] [Indexed: 11/11/2022]
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4
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A Novel Control Method for Rotary Blood Pumps as Left Ventricular Assist Device Utilizing Aortic Valve State Detection. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1732160. [PMID: 31886175 PMCID: PMC6927030 DOI: 10.1155/2019/1732160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/29/2019] [Accepted: 08/08/2019] [Indexed: 12/28/2022]
Abstract
A novel control method for rotary blood pumps is proposed relying on two different objectives: regulation of pump flow in accordance with desired value and the maintenance of partial support with an open aortic valve by the variation of pump speed. The estimation of pump flow and detection of aortic valve state was performed with mathematical models describing the first- and second generation of Sputnik rotary blood pumps. The control method was validated using a cardiovascular system model. The state of the aortic valve was detected with a mean accuracy of 91% for Sputnik 1 and 96.2% for Sputnik 2 when contractility, heart rate, and systemic vascular resistance was changed. In silico results for both pumps showed that the proposed control method can achieve the desired pump flow level and maintain the open state of the aortic valve by periodically switching between two objectives under contractility, heart rate, and systemic vascular resistance changes. The proposed method showed its potential for safe operation without adverse events and for the improvement of chances for myocardial recovery.
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5
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Stoiber M, Aigner P, Grasl C, Röhrich M, Moscato F, Schima H. Dynamic measurement of centering forces on transvalvular cannulas. Artif Organs 2019; 44:E150-E160. [PMID: 31693191 PMCID: PMC7154544 DOI: 10.1111/aor.13597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/29/2019] [Accepted: 10/29/2019] [Indexed: 01/04/2023]
Abstract
In heart failure therapy, minimally invasive devices (transcatheter valves, catheter‐based cannulas or pumps) are increasingly used. The interaction with the valve is of special importance as valve damage, backflow, and thrombus formation are known complications. Therefore, the aim of this in vitro study was to characterize the forces acting on different sized transvalvular cannulas at various transvalvular pressures for four different valves. In a pulsatile setup radial and tangential forces on transvalvular cannulas were measured for bioprosthetic, artificial pericardial tissue, fresh, and fixated porcine valves. The cannula position was varied from a central position to the wall in 10° rotational steps for the whole circular range and the use of different cannula diameters (4, 6, and 8 mm) and transvalvular pressures (40‐100 mmHg). Centering forces of four different aortic valve types were identified and the three leaflets were visible in the force distribution. At the mid of the cusps and at the largest deflection the forces were highest (up to 0.8 N) and lowest in the commissures (up to 0.2 N). Whereas a minor influence of the cannula diameter was found, the transvalvular pressure linearly increased the forces but did not alter the force patterns. Centering forces that act on transvalvular cannulas were identified in an in vitro setup for several valves and valve types. Lowest centering forces were found in the commissures and highest forces were found directly at the cusps. At low pressures, low centering forces and an increased cannula movement can be expected.
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Affiliation(s)
- Martin Stoiber
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ludwig-Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Philipp Aigner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ludwig-Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Christian Grasl
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ludwig-Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Michael Röhrich
- Department of Anesthesia, Critical Care and Pain Therapy, Medical University of Vienna, Vienna, Austria
| | - Francesco Moscato
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ludwig-Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Heinrich Schima
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ludwig-Boltzmann Institute for Cardiovascular Research, Vienna, Austria.,Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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6
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Urban M, Woods A, Robinson-Smith N, MacGowan G, Roysam C, Schueler S. First-in-man use of the MVAD axial-flow pump: Long-term outcome. J Heart Lung Transplant 2018; 37:933-936. [DOI: 10.1016/j.healun.2018.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/06/2018] [Accepted: 04/18/2018] [Indexed: 10/17/2022] Open
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7
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Chatterjee A, Feldmann C, Dogan G, Hanke JS, Ricklefs M, Deniz E, Haverich A, Schmitto JD. Clinical overview of the HVAD: a centrifugal continuous-flow ventricular assist device with magnetic and hydrodynamic bearings including lateral implantation strategies. J Thorac Dis 2018; 10:S1785-S1789. [PMID: 30034853 DOI: 10.21037/jtd.2018.04.148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Growing worldwide incidences of end-stage heart failure and declining rates of cardiac transplants have given rise to the need for alternative treatment options, based on mechanical circulatory support (MCS) devices such as left ventricular assist devices (LVADs). Technologically advanced LVADs such as the HVAD® (HeartWare®, Medtronic) facilitate safe and efficient treatment of heart failure patients with reduced post-operative complications, which is attributed to their considerably miniaturized size. This also facilitates the development and implementation of novel, minimally-invasive surgical techniques. The HVAD is a centrifugal pump, manufactured by HeartWare Inc., (Framingham, MA, USA) and subsequently by Medtronic Inc., (Minnesota, MN, USA), and has been approved for clinical application after receiving the CE Mark approval in 2008 and the FDA approval in 2012. Current research efforts are focused on further miniaturization alongside optimization of electronic and software controllers as well as implementation of the transcutaneous energy transfer (TET) technology. Salient features of the HVAD pump technology, clinical applications and future optimization strategies have been discussed in this article.
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Affiliation(s)
- Anamika Chatterjee
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christina Feldmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Guenes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Marcel Ricklefs
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ezin Deniz
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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8
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Telyshev D, Denisov M, Pugovkin A, Selishchev S, Nesterenko I. The Progress in the Novel Pediatric Rotary Blood Pump Sputnik Development. Artif Organs 2018; 42:432-443. [DOI: 10.1111/aor.13109] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/23/2017] [Accepted: 12/12/2017] [Indexed: 01/29/2023]
Affiliation(s)
- Dmitry Telyshev
- National Research University of Electronic Technology, Biomedical Systems Department; Zelenograd, Moscow Russia
| | - Maxim Denisov
- National Research University of Electronic Technology, Biomedical Systems Department; Zelenograd, Moscow Russia
| | - Alexander Pugovkin
- National Research University of Electronic Technology, Biomedical Systems Department; Zelenograd, Moscow Russia
| | - Sergey Selishchev
- National Research University of Electronic Technology, Biomedical Systems Department; Zelenograd, Moscow Russia
| | - Igor Nesterenko
- National Research University of Electronic Technology, Biomedical Systems Department; Zelenograd, Moscow Russia
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9
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Clinical Implications of Physiologic Flow Adjustment in Continuous-Flow Left Ventricular Assist Devices. ASAIO J 2018; 63:241-250. [PMID: 28459742 DOI: 10.1097/mat.0000000000000477] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
There is increasing evidence for successful management of end-stage heart failure with continuous-flow left ventricular assist device (CF-LVAD) technology. However, passive flow adjustment at fixed CF-LVAD speed is susceptible to flow balancing issues as well as adverse hemodynamic effects relating to the diminished arterial pulse pressure and flow. With current therapy, flow cannot be adjusted with changes in venous return, which can vary significantly with volume status. This limits the performance and safety of CF-LVAD. Active flow adjustment strategies have been proposed to improve the synchrony between the pump and the native cardiovascular system, mimicking the Frank-Starling mechanism of the heart. These flow adjustment strategies include modulation by CF-LVAD pump speed by synchrony and maintenance of constant flow or constant pressure head, or a combination of these variables. However, none of these adjustment strategies have evolved sufficiently to gain widespread attention. Herein we review the current challenges and future directions of CF-LVAD therapy and sensor technology focusing on the development of a physiologic, long-term active flow adjustment strategy for CF-LVADs.
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10
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Meng ML, Spellman J. Anesthetic management of the patient with a ventricular assist device. Best Pract Res Clin Anaesthesiol 2017; 31:215-226. [PMID: 29110794 DOI: 10.1016/j.bpa.2017.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/12/2017] [Accepted: 06/19/2017] [Indexed: 12/25/2022]
Abstract
The use of long- and short-term mechanical circulatory support in the form of ventricular assist device (VAD) has increased over the last decade. Although cardiothoracic anesthesiologists care for these patients during device placement, increasingly higher numbers of general anesthesiologists are involved in the management of VAD patients during noncardiac surgery and procedures. An understanding of devices, their indications, and complications is essential to the anesthesiologists caring for these patients. We review the anesthetic considerations for the implantation of these devices and concerns when caring for patients with durable and short-term devices already in place.
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Affiliation(s)
- Marie-Louise Meng
- Columbia University Medical Center, 622 W 168th Street, PH5, New York, NY 10032, USA.
| | - Jessica Spellman
- Columbia University Medical Center, 622 W 168th Street, PH5, New York, NY 10032, USA.
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11
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Current State and Future Perspectives of Energy Sources for Totally Implantable Cardiac Devices. ASAIO J 2017; 62:639-645. [PMID: 27442857 DOI: 10.1097/mat.0000000000000412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
There is a large population of patients with end-stage congestive heart failure who cannot be treated by means of conventional cardiac surgery, cardiac transplantation, or chronic catecholamine infusions. Implantable cardiac devices, many designated as destination therapy, have revolutionized patient care and outcomes, although infection and complications related to external power sources or routine battery exchange remain a substantial risk. Complications from repeat battery replacement, power failure, and infections ultimately endanger the original objectives of implantable biomedical device therapy - eliminating the intended patient autonomy, affecting patient quality of life and survival. We sought to review the limitations of current cardiac biomedical device energy sources and discuss the current state and trends of future potential energy sources in pursuit of a lifelong fully implantable biomedical device.
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12
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Adachi I, Burki S, Horne D, Costas GG, Spangler T, Jarvik R, Teal J, Baldwin JT, Dasse K, Massicotte MP, Conger J, Cohn WE, Fraser CD. The miniaturized pediatric continuous-flow device: Preclinical assessment in the chronic sheep model. J Thorac Cardiovasc Surg 2017; 154:291-300. [DOI: 10.1016/j.jtcvs.2016.12.070] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/21/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
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13
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Left Ventricular Assist Devices: Challenges Toward Sustaining Long-Term Patient Care. Ann Biomed Eng 2017; 45:1836-1851. [DOI: 10.1007/s10439-017-1858-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/22/2017] [Indexed: 11/25/2022]
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14
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Sunagawa G, Koprivanac M, Karimov JH, Moazami N, Fukamachi K. Current status of mechanical circulatory support for treatment of advanced end-stage heart failure: successes, shortcomings and needs. Expert Rev Cardiovasc Ther 2017; 15:377-387. [PMID: 28351172 DOI: 10.1080/14779072.2017.1313114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Heart failure (HF) remains a major global burden in terms of morbidity and mortality. Despite advances in pharmacological and resynchronization device therapy, many patients worsen to end-stage HF. Although the gold-standard treatment for such patients is heart transplantation, there will always be a shortage of donor hearts. Areas covered: A left ventricular assist device (LVAD) is a valuable option for these patients as a bridge measure (to recovery, to candidacy for transplant, or to transplant itself) or as destination therapy. This review describes the current indications for and complications of the most commonly implanted LVADs. In addition, we review the potential and promising new LVADs, including the HeartMate 3, MVAD, and other LVADs. Studies investigating each were identified through a combination of online database and direct extraction of studies cited in previously identified articles. Expert commentary: The goal of LVADs has been to fill the gap between patients with end-stage HF who would likely not benefit from heart transplantation and those who could benefit from a donor heart. As of now, the use of LVADs has been limited to patients with end-stage HF, but next-generation LVAD therapy may improve both survival and quality of life in less sick patients.
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Affiliation(s)
- Gengo Sunagawa
- a Department of Biomedical Engineering , Lerner Research Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Marijan Koprivanac
- b Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure , Cardiac Transplantation and Mechanical Circulatory Support, Miller Family Heart and Vascular Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Jamshid H Karimov
- a Department of Biomedical Engineering , Lerner Research Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Nader Moazami
- a Department of Biomedical Engineering , Lerner Research Institute, Cleveland Clinic , Cleveland , OH , USA.,b Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure , Cardiac Transplantation and Mechanical Circulatory Support, Miller Family Heart and Vascular Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Kiyotaka Fukamachi
- a Department of Biomedical Engineering , Lerner Research Institute, Cleveland Clinic , Cleveland , OH , USA
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15
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Telyshev DV, Denisov MV, Selishchev SV. The Effect of Rotor Geometry on the H−Q Curves of the Sputnik Implantable Pediatric Rotary Blood Pump. BIOMEDICAL ENGINEERING-MEDITSINSKAYA TEKNIKA 2017. [DOI: 10.1007/s10527-017-9669-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Sharp MK, Gregg M, Brock G, Nair N, Sahetya S, Austin EH, Mascio C, Slaughter MD, Pantalos GM. Comparison of Blood Viscoelasticity in Pediatric and Adult Cardiac Patients. Cardiovasc Eng Technol 2017; 8:182-192. [PMID: 28283942 DOI: 10.1007/s13239-017-0300-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/27/2017] [Indexed: 11/30/2022]
Abstract
Evidence is accumulating that blood flow patterns in the cardiovascular system and in cardiovascular devices do, in some instances, depend on blood viscoelasticity. Thus, to better understand the challenges to providing circulatory support and surgical therapies for pediatric and adult patients, viscous and elastic components of complex blood viscoelasticity of 31 pediatric patients were compared to those of 29 adult patients with a Vilastic-3 rheometer. A random effects model with categorical age covariates found statistically significant differences between pediatric and adult patients for log viscosity (p = 0.005). Log strain (p < 0.0001) and hematocrit (p < 0.0001) effects were also significant, as were the hematocrit-by-log-strain (p = 0.0006) and age-by-log strain (p = 0.001) interactions. The hematocrit-by-age interaction was not significant. For log elasticity, age differences were insignificant (p = 0.39). The model for log elasticity had significant log strain (p < 0.0001), log strain squared (p < 0.0001) and hematocrit (p < 0.0001) effects, as well as hematocrit-by-log-strain and hematocrit-by-log-strain-squared interactions (p = 0.014). A model for log viscosity with continuous age was also fit to the data, which can be used to refine cardiovascular device design and operation to the age of the patient. We conclude that there are distinct differences between pediatric and adult blood viscosity, as well as substantial variation within the pediatric population, that may impact the performance of devices and procedures.
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Affiliation(s)
- M Keith Sharp
- Department of Mechanical Engineering, University of Louisville, 200 Sackett Hall, Louisville, KY, 40292, USA.
| | - Mary Gregg
- School of Public Health, University of Louisville, Louisville, KY, USA
| | - Guy Brock
- School of Public Health, University of Louisville, Louisville, KY, USA
| | - Neema Nair
- Department of Mechanical Engineering, University of Louisville, 200 Sackett Hall, Louisville, KY, 40292, USA
| | - Sarina Sahetya
- Cardiovascular Innovation Institute, University of Louisville, Louisville, KY, USA
| | - Erle H Austin
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Christopher Mascio
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Mark D Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - George M Pantalos
- Cardiovascular Innovation Institute, University of Louisville, Louisville, KY, USA.,Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
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18
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Development of Medical and Technical Requirements and Simulation of the Flow−Pressure Characteristics of the Sputnik Pediatric Rotary Blood Pump. BIOMEDICAL ENGINEERING-MEDITSINSKAYA TEKNIKA 2017. [DOI: 10.1007/s10527-017-9641-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Debate: creating adequate pulse with a continuous flow ventricular assist device: can it be done and should it be done? Probably not, it may cause more problems than benefits! Curr Opin Cardiol 2017; 31:337-42. [PMID: 26998788 DOI: 10.1097/hco.0000000000000289] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW The feasibility and benefits of creating adequate pulsatility with continuous flow left ventricular assist devices (LVADs) have long been debated. This review discusses recent technical and clinical findings to answer whether such intervention should be implemented in the standard patient management. RECENT FINDINGS Only a limited amount of pulsatility can be generated by periodic speed steps, both considerably smaller in flow increase and in pace rate than the natural circulation. Organ systems are not impeded in their normal function and even not in recovery by a continuous flow. Known problems such as gastrointestinal bleeding are not necessarily due to pulsatility per se, or not important for therapeutic progress, such as minor modifications of the arterial walls. SUMMARY The speculative benefits of augmented pulsatility with continuous flow LVADs could be overrated and are still incompletely evaluated. Potential risks that might arise from this strategy should be carefully weighed before implementing extensive pulsatility as standard patient management.
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Abstract
Purpose Miniaturisation of VADs can offer important benefits, including less invasive implantation techniques and more versatility in patient selection. The aim of this work was to reduce the weight, size, and energy consumption of the Sputnik VAD. Methods The second generation of the Sputnik VAD was developed with a set of changes in construction. The head pressure-flow rate (H-Q) and power consumption-flow rate curves for the Sputnik VADs were measured at different rotational speeds. Computational fluid dynamics (CFD) were used for operating condition simulation and the LVADs were compared under the simulated physiological conditions. Results The slope of the H-Q curves for the Sputnik 1 VAD remains almost invariable over the entire range of the measured flow rate, in contrast to the curves for the Sputnik 2 VAD, which become flat in the high flow-rate region. Despite the design modification, the operating rotor speed remained invariable. The preload sensitivity of the Sputnik VAD is higher than that of the other rotary blood pumps and amounts to 0.111 ± 0.0092 L min−1 mmHg−1. The power consumption for the Sputnik 2 VAD is lower over the entire speed range, except for at 5,000 rpm. Conclusions The pump weight was reduced from 246 to 205 g, the pump length was decreased from 82 to 66 mm, and the pump diameter was decreased from 32 to 29 mm. The total energy consumption of the pump was reduced by 15%.
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Kaufmann F, Krabatsch T. Using medical imaging for the detection of adverse events (“incidents”) during the utilization of left ventricular assist devices in adult patients with advanced heart failure. Expert Rev Med Devices 2016; 13:463-74. [DOI: 10.1586/17434440.2016.1166051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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