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Yang W, Conover TA, Figliola RS, Giridharan GA, Marsden AL, Rodefeld MD. Passive performance evaluation and validation of a viscous impeller pump for subpulmonary fontan circulatory support. Sci Rep 2023; 13:12668. [PMID: 37542111 PMCID: PMC10403595 DOI: 10.1038/s41598-023-38559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/11/2023] [Indexed: 08/06/2023] Open
Abstract
Patients with single ventricle defects undergoing the Fontan procedure eventually face Fontan failure. Long-term cavopulmonary assist devices using rotary pump technologies are currently being developed as a subpulmonary power source to prevent and treat Fontan failure. Low hydraulic resistance is a critical safety requirement in the event of pump failure (0 RPM) as a modest 2 mmHg cavopulmonary pressure drop can compromise patient hemodynamics. The goal of this study is therefore to assess the passive performance of a viscous impeller pump (VIP) we are developing for Fontan patients, and validate flow simulations against in-vitro data. Two different blade heights (1.09 mm vs 1.62 mm) and a blank housing model were tested using a mock circulatory loop (MCL) with cardiac output ranging from 3 to 11 L/min. Three-dimensional flow simulations were performed and compared against MCL data. In-silico and MCL results demonstrated a pressure drop of < 2 mmHg at a cardiac output of 7 L/min for both blade heights. There was good agreement between simulation and MCL results for pressure loss (mean difference - 0.23 mmHg 95% CI [0.24-0.71]). Compared to the blank housing model, low wall shear stress area and oscillatory shear index on the pump surface were low, and mean washout times were within 2 s. This study demonstrated the low resistance characteristic of current VIP designs in the failed condition that results in clinically acceptable minimal pressure loss without increased washout time as compared to a blank housing model under normal cardiac output in Fontan patients.
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Affiliation(s)
- Weiguang Yang
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, USA.
| | - Timothy A Conover
- Departments of Mechanical Engineering, Clemson University, Clemson, SC, USA
| | - Richard S Figliola
- Departments of Mechanical Engineering, Clemson University, Clemson, SC, USA
| | | | - Alison L Marsden
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Mark D Rodefeld
- Section of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Li L, Wang J, Zhao G, Topaz S, Morales D, Yoganathan A, Ballard-Croft C, Zwischenberger JB, Wang D. Percutaneous Cavopulmonary Assist: From Design to 96 Hour Survival in Lethal Cavopulmonary Failure Sheep. ASAIO J 2023; 69:802-808. [PMID: 37084284 DOI: 10.1097/mat.0000000000001939] [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: 04/23/2023] Open
Abstract
We are developing a clinically practical percutaneous double lumen cannula (DLC)-based cavopulmonary assist (CPA) system to support failing Fontan patients. In this study, our CPA DLC was redesigned for even blood flow, minimal recirculation, and easy insertion/deployment. After bench testing, this new CPA system was evaluated for 4 hours (n = 10) and 96 hours (n = 5) in our clinically relevant lethal cavopulmonary failure (CPF) sheep model for ease of cannulation/deployment, reversal of CPF hemodynamics/end-organ hypoperfusion, and durability/biocompatibility. Cavopulmonary failure was achieved in all sheep. All DLCs were successfully inserted/deployed into Fontan anatomy. Cavopulmonary assist reversed CPF with normalized central venous pressure and cardiac output. All survival sheep were ambulatory with normal eating/drinking. One sheep was euthanized after 6 hours from cannula kinking, and one sheep died of hypokalemia after 8 hours. Three sheep survived 96 hours with normal hemodynamics. Free hemoglobin was only 3.7 ± 1.2 mg/dl at 96 hours, indicating negligible hemolysis. Creatinine, blood urea nitrogen, and lactate increased from hypoperfusion but normalized by 72 hours CPA. Necropsy showed only a small, immobilized thrombus ring at umbrella attachment to DLC. Our DLC-based system provided total ambulatory CPA in a lethal CPF sheep model with 96 hour survival and complete reversal of hemodynamics and end-organ hypoperfusion.
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Affiliation(s)
- Li Li
- From the Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Jingkun Wang
- From the Department of Surgery, University of Kentucky, Lexington, Kentucky
| | | | | | - David Morales
- Department of Pediatric Cardiovascular Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Ajit Yoganathan
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | | | | | - Dongfang Wang
- From the Department of Surgery, University of Kentucky, Lexington, Kentucky
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Granegger M, Escher A, Karner B, Kainz M, Schlöglhofer T, Schwingenschlögl H, Roehrich M, Karl Podesser B, Kramer AM, Kertzscher U, Laufer G, Hübler M, Zimpfer D. Feasibility of an Animal Model for Cavopulmonary Support With a Double-Outflow Pump. ASAIO J 2023; 69:673-680. [PMID: 36943696 DOI: 10.1097/mat.0000000000001916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Both single- and double-outflow cavopulmonary assist devices (CPADs) were recently proposed for the Fontan population, whereas single-outflow configurations were evaluated in large animal trials and double-outflow concepts are lacking an equivalent in vivo assessment. The aim of this study was to test the hemodynamic properties of a double-outflow CPAD device in an acute sheep model. The two inflow cannulae of a CPAD were anastomosed to the caval veins. Outflow graft connection was performed via end-to-side anastomosis to the right (RPA) and main pulmonary artery (MPA). Speed ramp protocols were conducted, and hemodynamic effects were monitored in terms of caval flows, cardiac output (CO), central venous pressure (CVP), pulmonary artery pressure (PAP), and left atrial pressure (LAP). Six experiments were conducted (53.35 ± 5.1 kg). In three experiments, the animal model was established, the CPAD was examined, and restoration of biventricular equivalency in terms of venous return was achieved. Venous pressures (CVP) declined linearly with increasing pump speed (r > 0.879), whereas caval flow (r > 0.973), CO (r > 0.993), PAP (r > 0.973), and LAP (r > 0.408) increased. Despite the considerable complexity of the sheep model caused by the sheep pulmonary arterial anatomy that requires substantial graft bending, the CPAD was evaluated in three acute experiments and showed the potential to completely substitute a subpulmonary ventricle.
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Affiliation(s)
- Marcus Granegger
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
- Deutsches Herzzentrum der Charité, Institute of Computer-assisted Cardiovascular Medicine (ICM), Biofluid Mechanics Laboratory, Berlin, Germany
| | - Andreas Escher
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Barbara Karner
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthias Kainz
- Division of Cardiac, Thoracic, and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care Medicine, and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Schlöglhofer
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Michael Roehrich
- Division of Special Anesthesia and Pain Medicine, Department of Anesthesia, Intensive Care Medicine, and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Bruno Karl Podesser
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Vienna, Austria
| | - Anne-Margarethe Kramer
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Vienna, Austria
| | - Ulrich Kertzscher
- Deutsches Herzzentrum der Charité, Institute of Computer-assisted Cardiovascular Medicine (ICM), Biofluid Mechanics Laboratory, Berlin, Germany
| | - Günther Laufer
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael Hübler
- Cardiac Surgery for Congenital Heart Disease, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Zimpfer
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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4
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Computational Modeling of the Penn State Fontan Circulation Assist Device. ASAIO J 2022; 68:1513-1522. [PMID: 35421006 DOI: 10.1097/mat.0000000000001708] [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
To address the increasing number of failing Fontan patients, Penn State University and the Penn State Hershey Medical Center are developing a centrifugal blood pump for long-term mechanical support. Computational fluid dynamics (CFD) modeling of the Penn State Fontan Circulatory Assist Device (FCAD) was performed to understand hemodynamics within the pump and its potential for hemolysis and thrombosis. CFD velocity and pressure results were first validated against experimental data and found to be within the standard deviations of the velocities and within 5% of the pressures. Further simulations performed with a human blood model found that most of the fluid domain was subjected to low shear stress (<50 Pa), with areas of highest stress around the rotor blade tips that increased with pump flow rate and rotor speed (138-178 Pa). However, the stresses compared well to previous CFD studies of commercial blood pumps and remained mostly below common thresholds of hemolysis and platelet activation. Additionally, few regions of low shear rate were observed within the FCAD, signifying minimal potential for platelet adhesion. These results further emphasize the FCAD's potential that has been observed previously in experimental and animal studies.
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Chaudhry A, Selwyn J, Adams E, Bradley EA. Heart Failure in Complex Congenital Heart Disease of the Adult. Curr Cardiol Rep 2022; 24:1727-1735. [PMID: 36197543 PMCID: PMC9901216 DOI: 10.1007/s11886-022-01788-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Adult congenital heart disease (ACHD) patients have demonstrated improved survival, especially those with severely complex disease, mainly single-ventricle/Fontan physiology and those with a systemic right ventricle. We describe the heart failure phenotypes of complex CHD, reversible causes for heart failure, and considerations for advanced therapy. RECENT FINDINGS While initially marketed for application to patients with acquired causes for heart failure, newer devices and technologies have started to be used in the ACHD population. After reversible causes for heart failure in CHD are addressed, it is reasonable to consider use of new device-based technologies and orthotopic heart transplant (OHT) for end-stage disease. New heart failure technology and organ transplant should carefully be considered and applied in complex ACHD, where there may be significant improvement in morbidity and mortality.
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Affiliation(s)
- Anisa Chaudhry
- Division of Cardiovascular Medicine, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Julia Selwyn
- Department of Internal Medicine, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Elizabeth Adams
- Division of Cardiovascular Medicine, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Elisa A. Bradley
- Division of Cardiovascular Medicine, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA,Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Tobin N, Good BC, Plasencia JD, Fogel MA, Weiss WJ, Manning KB. Computational Investigation of Anastomosis Options of a Right-Heart Pump to Patient Specific Pulmonary Arteries. Ann Biomed Eng 2022; 50:929-940. [PMID: 35451680 DOI: 10.1007/s10439-022-02969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
Patients with Fontan circulation have increased risk of heart failure, but are not always candidates for heart transplant, leading to the development of the subpulmonic Penn State Fontan Circulation Assist Device. The aim of this study was to use patient-specific computational fluid dynamics simulations to evaluate anastomosis options for implanting this device. Simulations were performed of the pre-surgical anatomy as well as four surgical options: a T-junction and three Y-grafts. Cases were evaluated based on several fluid-dynamic quantities. The impact of imbalanced left-right pulmonary flow distribution was also investigated. Results showed that a 12-mm Y-graft was the most energy efficient. However, an 8-mm graft showed more favorable wall shear stress distribution, indicating lower risk of thrombosis and endothelial damage. The 8-mm Y-grafts also showed a more balanced pulmonary flow split, and lower residence time, also indicating lower thrombosis risk. The relative performance of the surgical options was largely unchanged whether or not the pulmonary vascular resistance remained imbalanced post-implantation.
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Affiliation(s)
- Nicolas Tobin
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA
| | - Bryan C Good
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA
| | | | - Mark A Fogel
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - William J Weiss
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, 17033, USA
| | - Keefe B Manning
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA. .,Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, 17033, USA.
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Palazzolo T, Hirschhorn M, Garven E, Day S, Stevens RM, Rossano J, Tchantchaleishvili V, Throckmorton AL. Technology Landscape of Pediatric Mechanical Circulatory Support Devices- A Systematic Review 2010-2021. Artif Organs 2022; 46:1475-1490. [PMID: 35357020 PMCID: PMC9256769 DOI: 10.1111/aor.14242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/17/2022] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mechanical circulatory support (MCS) devices, such as ventricular assist devices (VADs) and total artificial hearts (TAHs), have become a vital therapeutic option in the treatment of end-stage heart failure for adult patients. Such therapeutic options continue to be limited for pediatric patients. Clinicians initially adapted or scaled existing adult devices for pediatric patients; however, these adult devices are not designed to support the anatomical structure and varying flow capacities required for this population and are generally operated "off-design", which risks complications such as hemolysis and thrombosis. Devices designed specifically for the pediatric population that seek to address these shortcomings are now emerging and gaining FDA approval. METHODS To analyze the competitive landscape of pediatric MCS devices, we conducted a systematic literature review. Approximately 27 devices were studied in detail: 8 were established or previously approved designs, and 19 were under development (11 VADs, 5 Fontan assist devices, and 3 TAHs). RESULTS Despite significant progress, there is still no pediatric pump technology that satisfies the unique and distinct design constraints and requirements to support pediatric patients, including the wide range of patient sizes, increased cardiovascular demand with growth, and anatomic and physiologic heterogeneity of congenital heart disease. CONCLUSIONS Forward-thinking design solutions are required to overcome these challenges and to ensure the translation of new therapeutic MCS devices for pediatric patients.
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Affiliation(s)
- Thomas Palazzolo
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Matthew Hirschhorn
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Ellen Garven
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Steven Day
- Department of Biomedical Engineering, Kate Gleason College of Engineering, Rochester Institute of Technology, Rochester, NY, USA
| | - Randy M Stevens
- College of Medicine, St. Christopher's Hospital for Children, Drexel University, Philadelphia, PA, USA
| | - Joseph Rossano
- Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Amy L Throckmorton
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
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Escher A, Gobel H, Nicolai M, Schloglhofer T, Hubmann EJ, Laufer G, Messner B, Kertzscher U, Zimpfer D, Granegger M. Hemolytic Footprint of Rotodynamic Blood Pumps. IEEE Trans Biomed Eng 2022; 69:2423-2432. [PMID: 35085069 DOI: 10.1109/tbme.2022.3146135] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE In preclinical examinations, rotodynamic blood pumps (RBPs) are predominantly evaluated at design-point conditions. In clinical practice, however, they run at diversified modes of operation. This study aimed at extending current preclinical evaluation of hemolytic profiles in RBPs toward broader, clinically relevant ranges of operation. METHODS Two implantable RBPs the HeartMate 3 (HM3) and the HeartWare Ventricular Assist Device (HVAD) were analyzed at three pump speeds (HM3: 4300, 5600, 7000rpm; HVAD: 1800, 2760, 3600rpm) with three flow rates (1-9L/min) per speed setting. Hemolysis measurements were performed in heparinized bovine blood. The delta free hemoglobin (dfHb) and the normalized index of hemolysis (NIH) served as hemolytic measures. Statistical analysis was performed by multiple comparison of the 9 operating conditions. Moreover, computational fluid dynamics (CFD) was applied to provide mechanistic insights into the interrelation between hydraulics and hemolysis by correlating numerically computed hydraulic losses with in-vitro hemolytic measures. RESULTS In both devices, dfHb increased toward increasing speeds, particularly during low but also during high flow condition. By contrast, in both RBPs magnitudes of NIH were significantly elevated during low flow operation compared to high flow conditions (p<0.0036). Maps of hemolytic metrics revealed morphologically similar trends to in-silico hydraulic losses (r>0.793). CONCLUSIONS While off-design operation is associated with increased hemolytic profiles, the setting of different operating conditions render a preclinical prediction of clinical impact with current hemolysis metrics difficult. SIGNIFICANCE The identified increase in hemolytic measures during episodes of off-design operation is highlighting the need to consider worst-case operation during preclinical examinations.
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Ponnaluri S, Christensen E, Good B, Kubicki C, Deutsch S, Cysyk J, Weiss WJ, Manning KB. Experimental Hemodynamics within the Penn State Fontan Circulatory Assist Device. J Biomech Eng 2021; 144:1129243. [PMID: 34897373 DOI: 10.1115/1.4053210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Indexed: 11/08/2022]
Abstract
For children born with a single functional ventricle, the Fontan operation bypasses the right ventricle by forming a four-way total cavopulmonary connection adapting the existing ventricle for the systemic circulation. However, upon adulthood, many Fontan patients exhibit low cardiac output and elevated venous pressure, eventually requiring a heart transplantation. Despite efforts to develop a Fontan pump or use an existing ventricular assist device for failing Fontan support, there is still no device designed or tested for subpulmonary support. Penn State University is developing a hydrodynamically levitated Fontan circulatory assist device (FCAD) for bridge-to-transplant or destination therapy. The FCAD hemodynamics, at both steady and pulsatile conditions for three pump operating conditions, were quantified using particle image velocimetry to determine the velocity magnitudes and Reynolds normal and shear stresses. Data were acquired at three planes (0 mm and ±25% of the radius) for the inferior and superior vena cavae inlets and the pulmonary artery outlet. The inlets had a blunt velocity profile that became skewed towards the collecting volute as fluid approached the rotor. At the outlet, regardless of the flow condition, a high-velocity jet exited the volute and moved downstream in a helical pattern. Turbulent stresses observed at the volute exit were influenced by the rotor's rotation. Regardless of inlet conditions, the pump demonstrated advantageous behavior for clinical use with a predictable flow field and a low risk of platelet adhesion and hemolysis based on calculated wall shear rates and turbulent stresses, respectively.
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Affiliation(s)
- Sailahari Ponnaluri
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
| | - Emma Christensen
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
| | - Bryan Good
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
| | - Cody Kubicki
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
| | - Steven Deutsch
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
| | - Joshua Cysyk
- Department of Surgery, Penn State Hershey Medical Center, PA; H151 Surgery Hershey PA 17033, The Milton S. Hershey Medical Center
| | - William J Weiss
- Department of Surgery, Penn State Hershey Medical Center, PA; H151 Surgery Hershey PA 17033, The Milton S. Hershey Medical Center
| | - Keefe B Manning
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, Department of Surgery, Penn State Hershey Medical Center, PA; Suite 122 Chemical and Biomedical Engineering Building, Penn State University, University Park, PA
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Cysyk JP, Lukic B, Joseph Brian C, Newswanger R, Jhun CS, Izer J, Flory H, Reibson J, Doxtater B, Weiss W, Rosenberg G. Miniaturized Fontan Circulation Assist Device: Chronic In Vivo Evaluation. ASAIO J 2021; 67:1240-1249. [PMID: 33883510 DOI: 10.1097/mat.0000000000001439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We have miniaturized and optimized our implantable rotary blood pump developed to provide long-term mechanical right heart support for patients who have failing Fontan circulation. The objective of this study was to evaluate the miniaturized Fontan circulation assist device (mini-FCAD) during 30-day sheep studies (n = 5). A complete right heart bypass was performed and all return flow was supported by the pump. Postoperatively, unfractionated heparin was given to maintain thromboelastography R times of 2× normal. The first two studies were terminated on day 0 and day 4 due to complications. In the final three studies, the animals remained healthy and were electively terminated at 30 ± 2 days. Pump flow was between 5 and 7 lpm, left atrial pressure remained normal, and inlet pressures were between 3 and 18 mm Hg with no incidents of suction. There was no evidence of hemolysis, end organ or pulmonary dysfunction, thromboembolic events, nor thermal damage to the surrounding tissue. Explanted devices from two studies were free of thrombi and in the third study there were unattached thrombi on the SVC inlet of the rotor. The mini-FCAD was successfully tested in vivo as a right heart replacement device demonstrating adequate circulatory support and normal physiologic pulmonary and venous pressures.
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Affiliation(s)
- Joshua P Cysyk
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Branka Lukic
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Clark Joseph Brian
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
- Department of Pediatrics, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Ray Newswanger
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Choon-Sik Jhun
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Jenelle Izer
- Department of Comparative Medicine, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Heidi Flory
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - John Reibson
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Bradley Doxtater
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - William Weiss
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Gerson Rosenberg
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
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Escher A, Strauch C, Hubmann EJ, Hübler M, Bortis D, Thamsen B, Mueller M, Kertzscher U, Thamsen PU, Kolar JW, Zimpfer D, Granegger M. A Cavopulmonary Assist Device for Long-Term Therapy of Fontan Patients. Semin Thorac Cardiovasc Surg 2021; 34:238-248. [PMID: 34166811 DOI: 10.1053/j.semtcvs.2021.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/04/2021] [Indexed: 12/22/2022]
Abstract
Treatment of univentricular hearts remains restricted to palliative surgical corrections (Fontan pathway). The established Fontan circulation lacks a subpulmonary pressure source and is commonly accompanied by progressively declining hemodynamics. A novel cavopulmonary assist device (CPAD) may hold the potential for improved therapeutic management of Fontan patients by chronic restoration of biventricular equivalency. This study aimed at translating clinical objectives toward a functional CPAD with preclinical proof regarding hydraulic performance, hemocompatibility and electric power consumption. A prototype composed of hemocompatible titanium components, ceramic bearings, electric motors, and corresponding drive unit was manufactured for preclinical benchtop analysis: hydraulic performance in general and hemocompatibility characteristics in particular were analyzed in-silico (computational fluid dynamics) and validated in-vitro. The CPAD's power consumption was recorded across the entire operational range. The CPAD delivered pressure step-ups across a comprehensive operational range (0-10 L/min, 0-50 mm Hg) with electric power consumption below 1.5 W within the main operating range. In-vitro hemolysis experiments (N = 3) indicated a normalized index of hemolysis of 3.8 ± 1.6 mg/100 L during design point operation (2500 rpm, 4 L/min). Preclinical investigations revealed the CPAD's potential for low traumatic and thrombogenic support of a heterogeneous Fontan population (pediatric and adult) with potentially accompanying secondary disorders (e.g., elevated pulmonary vascular resistance or systemic ventricular insufficiency) at distinct physical activities. The low power consumption implied adequate settings for a small, fully implantable system with transcutaneous energy transfer. The successful preclinical proof provides the rationale for acute and chronic in-vivo trials aiming at the confirmation of laboratory findings and verification of hemodynamic benefit.
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Affiliation(s)
- Andreas Escher
- Biofluid Mechanics Laboratory, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Carsten Strauch
- Fachgebiet für Fluidsystemdynamik, Technische Universität Berlin, Berlin, Germany
| | - Emanuel J Hubmann
- Power Electronic Systems Laboratory, ETH Zurich, Zurich, Switzerland
| | - Michael Hübler
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominik Bortis
- Power Electronic Systems Laboratory, ETH Zurich, Zurich, Switzerland
| | - Bente Thamsen
- Biofluid Mechanics Laboratory, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marc Mueller
- Institute for Multiphase Processes, Leibniz University Hannover, Hannover, Germany
| | - Ulrich Kertzscher
- Biofluid Mechanics Laboratory, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paul U Thamsen
- Fachgebiet für Fluidsystemdynamik, Technische Universität Berlin, Berlin, Germany
| | - Johann W Kolar
- Power Electronic Systems Laboratory, ETH Zurich, Zurich, Switzerland
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Marcus Granegger
- Biofluid Mechanics Laboratory, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
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Granegger M, Schlöglhofer T, Riebandt J, Schlager G, Skhirtladze-Dworschak K, Kitzmüller E, Michel-Behnke I, Laufer G, Zimpfer D. Mechanical circulatory support in pediatric patients with biventricular and univentricular hearts. JTCVS OPEN 2021; 6:202-208. [PMID: 36003565 PMCID: PMC9390541 DOI: 10.1016/j.xjon.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 11/30/2022]
Abstract
Background Mechanical circulatory support (MCS) in pediatric patients remains challenging because of small body size, limited availability of approved devices, and the variety of etiologies, including biventricular and univentricular physiologies. We report our single-center experience with MCS in pediatric patients in terms of survival and adverse events. Methods Outcome, etiologic, and demographic data of pediatric patients implanted with a long-term MCS device between 2011 and 2019 at the Medical University of Vienna were retrospectively collected and analyzed. Overall survival and freedom of treatment-related adverse events at 1 year were investigated by Kaplan–Meier analyses and stratified for circulation (biventricular vs univentricular), age group (<6 years vs >6 years), and pump technology (pulsatile ventricular assist device [p-VAD] vs continuous flow pump [cf-VAD]). Results One-year survival of all 33 pediatric patients (median, 4 years; interquartile range, 0-13 years) was 73%, with a tendency toward better outcomes in patients with biventricular circulation than in those with univentricular circulation (80%; n = 25 vs 50%; n = 8; P = .063). The trends toward better survival probability in older patients and in patients with cf-VADs did not reach statistical significance (63.2% vs 85.7%; P = .165 and 82.4% vs 62.5%; P = .179, respectively). Freedom from adverse events was higher in older patients (57.1% vs 5.6%; P < .001) and in the cf-VAD group (52.9% vs 0%; P < .001), with pump thrombosis as the main discriminator. Conclusions MCS is a promising therapy for a broad spectrum of pediatric patients, irrespective of heart failure etiology, age, and pump type. With increasing experience, improved devices, and patient selection, MCS may become a valuable treatment option for patients with univentricular hearts.
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Affiliation(s)
- Marcus Granegger
- Department of Cardiac Surgery, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, Austria
- Ludwig–Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Address for reprints: Marcus Granegger, PhD, Department of Cardiac Surgery, Pediatric Heart Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Thomas Schlöglhofer
- Department of Cardiac Surgery, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, Austria
- Ludwig–Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Julia Riebandt
- Department of Cardiac Surgery, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Gerald Schlager
- Division of Neonatology, Pediatric Intensive Care, and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Keso Skhirtladze-Dworschak
- Department of Anaesthesia, Intensive Care Medicine, and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Erwin Kitzmüller
- Division of Pediatric Cardiology, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Ina Michel-Behnke
- Division of Pediatric Cardiology, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Department of Cardiac Surgery, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, Austria
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Manning KB, Deutsch S, Rosenberg G. John M. Tarbell: Artificial Heart and Mechanical Heart Valve Research Contributions. Cardiovasc Eng Technol 2021; 12:9-14. [PMID: 33409858 DOI: 10.1007/s13239-020-00510-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Keefe B Manning
- Department of Biomedical Engineering, The Pennsylvania State University, 122 CBE Building, University Park, PA, 16802, USA. .,Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
| | - Steven Deutsch
- Department of Biomedical Engineering, The Pennsylvania State University, 122 CBE Building, University Park, PA, 16802, USA
| | - Gerson Rosenberg
- Department of Biomedical Engineering, The Pennsylvania State University, 122 CBE Building, University Park, PA, 16802, USA.,Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
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14
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Monaco J, Khanna A, Khazanie P. Transplant and mechanical circulatory support in patients with adult congenital heart disease. Heart Fail Rev 2020; 25:671-683. [PMID: 32472522 PMCID: PMC7811764 DOI: 10.1007/s10741-020-09976-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Advances in surgery and pediatric care over the past decades have achieved improved survival for children born with congenital heart disease (CHD) and have produced a large, growing population of patients with adult congenital heart disease (ACHD). Heart failure has emerged as the leading cause of death and a major cause of morbidity among the ACHD population, while as little evidence supports the efficacy of guideline-directed medical therapies in this population. It is increasingly important that clinicians caring for these patients understand how to utilize mechanical circulatory support (MCS) in ACHD. In this review, we summarize the data on transplantation and MCS in the ACHD-heart failure population and provide a framework for how ACHD patients may benefit from advanced heart failure therapies like transplantation and MCS.
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Affiliation(s)
- James Monaco
- Colorado University Hospital, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
| | - Amber Khanna
- Colorado University Hospital, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Prateeti Khazanie
- Colorado University Hospital, University of Colorado Anschutz Medical Center, Aurora, CO, USA
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15
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Large-Eddy Simulations of Flow in the FDA Benchmark Nozzle Geometry to Predict Hemolysis. Cardiovasc Eng Technol 2020; 11:254-267. [PMID: 32297154 DOI: 10.1007/s13239-020-00461-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Modeling of hemolysis due to fluid stresses faces significant methodological challenges, particularly in geometries with turbulence or complex flow patterns. It is currently unclear how existing phenomenological blood-damage models based on laminar viscous stresses can be implemented into turbulent computational fluid dynamics simulations. The aim of this work is to generalize the existing laminar models to turbulent flows based on first principles, and validate this generalization with existing experimental data. METHODS A novel analytical and numerical framework for the simulation of flow-induced hemolysis based on the intermittency-corrected turbulent viscous shear stress (ICTVSS) is introduced. The proposed large-eddy simulation framework is able to seamlessly transition from laminar to turbulent conditions in a single flow domain by linking laminar shear stresses to dissipation of mechanical energy, accounting for intermittency in turbulent dissipation, and relying on existing power-law hemolysis models. Simulations are run to reproduce previously published hemolysis data with bovine blood in a benchmark geometry. Two sets of experimental data are relied upon to tune power-law parameters and justify that tuning. The first presents hemolysis measurements in a simple laminar flow, and the second is hemolysis in turbulent flow through the FDA benchmark nozzle. Validation is performed by simulation of blood injected into a turbulent jet of phosphate-buffered saline, with modifications made to account for the local concentration of blood. RESULTS Hemolysis predictions are found to be very sensitive to power-law parameters in the turbulent case, though a set of parameters is presented that both matches the turbulent data and is well-justified by the laminar data. The model is shown to be able to predict the general behavior of hemolysis in a second turbulent case. Results suggest that wall shear may play a dominant role in most cases. CONCLUSION The ICTVSS framework of generalizing laminar power-law models to turbulent flows shows promise, but would benefit from further numerical validation and carefully designed experiments.
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16
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Ferrari MR, Di Maria MV, Jacot JG. Review on Mechanical Support and Cell-Based Therapies for the Prevention and Recovery of the Failed Fontan-Kreutzer Circulation. Front Pediatr 2020; 8:627660. [PMID: 33575233 PMCID: PMC7870783 DOI: 10.3389/fped.2020.627660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022] Open
Abstract
Though the current staged surgical strategy for palliation of single ventricle heart disease, culminating in a Fontan circulation, has increased short-term survival, mounting evidence has shown that the single ventricle, especially a morphologic right ventricle (RV), is inadequate for long-term circulatory support. In addition to high rates of ventricular failure, high central venous pressures (CVP) lead to liver fibrosis or cirrhosis, lymphatic dysfunction, kidney failure, and other comorbidities. In this review, we discuss the complications seen with Fontan physiology, including causes of ventricular and multi-organ failure. We then evaluate the clinical use, results, and limitations of long-term mechanical assist devices intended to reduce RV work and high CVP, as well as biological therapies for failed Fontan circulations. Finally, we discuss experimental tissue engineering solutions designed to prevent Fontan circulation failure and evaluate knowledge gaps and needed technology development to realize a more robust single ventricle therapy.
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Affiliation(s)
- Margaret R Ferrari
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Michael V Di Maria
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jeffrey G Jacot
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Granegger M, Thamsen B, Hubmann EJ, Choi Y, Beck D, Valsangiacomo Buechel E, Voutat M, Schweiger M, Meboldt M, Hübler M. A long-term mechanical cavopulmonary support device for patients with Fontan circulation. Med Eng Phys 2019; 70:9-18. [DOI: 10.1016/j.medengphy.2019.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 06/15/2019] [Accepted: 06/19/2019] [Indexed: 12/28/2022]
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