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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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Good BC, Weiss WJ, Deutsch S, Manning KB. Asynchronous Pumping of a Pulsatile Ventricular Assist Device in a Pediatric Anastomosis Model. World J Pediatr Congenit Heart Surg 2017; 8:511-519. [PMID: 28696878 DOI: 10.1177/2150135117713697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Both pulsatile and continuous flow ventricular assist devices are being developed for pediatric congenital heart defect patients. Pulsatile devices are often operated asynchronously with the heart in either an "automatic" or a fixed beat rate mode. However, most studies have only investigated synchronized ejection. METHODS A previously validated viscoelastic blood solver is used to investigate the parameters of pulsatility, power loss, and graft failure in a pediatric aortic anastomosis model. RESULTS Pulsatility was highest with synchronized flow and lowest at a 90° phase shift. Power loss decreased at 90° and 180° phase shifts but increased at a 270° phase shift. Similar regions of potential intimal hyperplasia and graft failure were seen in all cases but with phase-shifted ejection leading to higher wall shear stress on the anastomotic floor and oscillatory shear index on the anastomotic toe. CONCLUSION The ranges of pulsatility and hemodynamics that can result clinically using asynchronous pulsatile devices were investigated in a pediatric anastomosis model. These results, along with the different postoperative benefits of pump modulation, can be used to design an optimal weaning protocol.
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Affiliation(s)
- Bryan C Good
- 1 Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
| | - William J Weiss
- 1 Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, USA.,2 Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Steven Deutsch
- 1 Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Keefe B Manning
- 1 Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, USA.,2 Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
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Good BC, Deutsch S, Manning KB. Continuous and Pulsatile Pediatric Ventricular Assist Device Hemodynamics with a Viscoelastic Blood Model. Cardiovasc Eng Technol 2016; 7:23-43. [PMID: 26643646 PMCID: PMC4767652 DOI: 10.1007/s13239-015-0252-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/23/2015] [Indexed: 11/25/2022]
Abstract
To investigate the effects of pulsatile and continuous pediatric ventricular assist (PVAD) flow and pediatric blood viscoelasticity on hemodynamics in a pediatric aortic graft model. Hemodynamic parameters of pulsatility, along with velocity and wall shear stress (WSS), are analyzed and compared between Newtonian and viscoelastic blood models at a range of physiological pediatric hematocrits using computational fluid dynamics. Both pulsatile and continuous PVAD flow lead to a decrease in pulsatility (surplus hemodynamic energy, ergs/cm(3)) compared to healthy aortic flow but with continuous PVAD pulsatility up to 2.4 times lower than pulsatile PVAD pulsatility at each aortic outlet. Significant differences are also seen between the two flow modes in velocity and WSS. The higher velocity jet during systole with pulsatile flow leads to higher WSSs at the anastomotic toe and at the aortic branch bifurcations. The lower velocity but continuous flow jet leads to a much different flow field and higher WSSs into diastole. Under a range of physiological pediatric hematocrit (20-60%), both velocity and WSS can vary significantly with the higher hematocrit blood model generally leading to higher peak WSSs but also lower WSSs in regions of flow separation. The large decrease in pulsatility seen from continuous PVAD flow could lead to complications in pediatric vascular development while the high WSSs during peak systole from pulsatile PVAD flow could lead to blood damage. Both flow modes lead to similar regions prone to intimal hyperplasia resulting from low time-averaged WSS and high oscillatory shear index.
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Affiliation(s)
- Bryan C Good
- Department of Biomedical Engineering, The Pennsylvania State University, 205 Hallowell Building, University Park, PA, 16802, USA
| | - Steven Deutsch
- Department of Biomedical Engineering, The Pennsylvania State University, 205 Hallowell Building, University Park, PA, 16802, USA
| | - Keefe B Manning
- Department of Biomedical Engineering, The Pennsylvania State University, 205 Hallowell Building, University Park, PA, 16802, USA.
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, 17033, USA.
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Pan G, Xie ZF, Zhang Y, Long SC, Xu XP, Zhang ZW. Platelet Activation Through the Efficacy of Aspirin in Congenital Heart Disease Patients Undergoing Transcatheter Closure of Atrial Septal Defects or Ventricular Septal Defects. Genet Test Mol Biomarkers 2014; 18:832-8. [PMID: 25330142 DOI: 10.1089/gtmb.2014.0206] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gang Pan
- Department of Cardiovascular Medicine, Southern Medical University, Guangzhou, People's Republic of China
- Department of Cardiovascular Medicine, The First People's Hospital of Yueyang, Yueyang, People's Republic of China
| | - Zhao-Feng Xie
- Department of Cardiovascular Pediatrics, Guangdong General Hospital, Guangzhou, People's Republic of China
| | - Ying Zhang
- Department of Cardiovascular Medicine, Guangdong General Hospital, Guangzhou, People's Republic of China
| | - Sheng-Chun Long
- Department of Cardiovascular Medicine, The First People's Hospital of Yueyang, Yueyang, People's Republic of China
| | - Xi-Ping Xu
- Department of Cardiovascular Medicine, The First People's Hospital of Yueyang, Yueyang, People's Republic of China
| | - Zhi-Wei Zhang
- Department of Cardiovascular Pediatrics, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, People's Republic of China
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Baldwin JT, Borovetz HS, Duncan BW, Gartner MJ, Jarvik RK, Weiss WJ. The national heart, lung, and blood institute pediatric circulatory support program: a summary of the 5-year experience. Circulation 2011; 123:1233-40. [PMID: 21422399 DOI: 10.1161/circulationaha.110.978023] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J Timothy Baldwin
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD 20892-7940, USA.
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Zeng XC, Wu WF, Huang K, Guo SL, Liu TW. Enhanced prothrombin formation and platelet activation in Chinese patients after transcatheter closure of atrial septal defect. Clin Cardiol 2010; 33:E6-9. [PMID: 20552683 DOI: 10.1002/clc.20752] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The objective of this study was to investigate changes in coagulation activation and platelet activation after transcatheter closure of atrial septal defect (ASD) by determining the levels of specific markers over time to provide insight into preventing postprocedural embolism. HYPOTHESIS We hypothesis that the activation status of coagulation and the platelet would be changed after the closure of ASD. METHODS Forty consecutive patients who underwent transcatheter closure of ASD with the Lifetech ASD occluder (Lifetech Scientific, Shenzhen, China) were included in this prospective study. The serum level of prothrombin fragment 1 + 2 (F1 + 2) and expressions of P-selectin (CD62P) and platelet glycoprotein IIb/IIIa receptor (CD41a) on the surface of platelets were evaluated at baseline and at 1 day, 1 month, and 3 months after the closure. RESULTS The median F1 + 2 level was 0.96 nmol/L. This increased to a maximal value of 1.43 nmol/L at 1 day after closure, but gradually returned to the baseline level at 1 month after closure and remained there at 3 months after closure (medians were 0.98 nmol/L and 1.08 nmol/L, respectively). Platelet surface expression of CD62P and CD41a decreased at 1 day, 1 month, and 3 months after closure. For CD62P, average expressions were 8.21% +/- 2.11%, 6.28% +/- 1.72%, 5.29% +/- 1.52%, and 4.41% +/- 1.11%, respectively, for baseline and 1 day, 1 month, and 3 months after closure. For CD41a, average expressions were 79.37% +/- 14.14%, 71.98% +/- 13.77, 56.69% +/- 13.05%, and 54.88% +/- 11.62%, respectively. CONCLUSIONS Transcatheter closure of ASD with the Lifetech ASD occluder was associated with significantly increased coagulation activation and decreased platelet activation. No evidence supporting the use of aspirin to prevent thrombus formation after closure was found.
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Affiliation(s)
- Xiao-Chun Zeng
- Department of Cardiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, People's Republic of China
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Yang N, Deutsch S, Paterson EG, Manning KB. Hemodynamics of an end-to-side anastomotic graft for a pulsatile pediatric ventricular assist device. J Biomech Eng 2010; 132:031009. [PMID: 20459197 DOI: 10.1115/1.4000872] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Numerical simulations are performed to investigate the flow within the end-to-side proximal anastomosis of a pulsatile pediatric ventricular assist device (PVAD) to an aorta. The anastomotic model is constructed from a patient-specific pediatric aorta. The three great vessels originating from the aortic arch--brachiocephalic (innominate), left common carotid, and left subclavian arteries--are included. An implicit large eddy simulation method based on a finite volume approach is used to study the resulting turbulent flow. A resistance boundary condition is applied at each branch outlet to study flow splitting. The PVAD anastomosis is found to alter the aortic flow dramatically. More flow is diverted into the great vessels with the PVAD support. Turbulence is found in the jet impingement area at peak systole for 100% bypass, and a maximum principal normal Reynolds stress of 7081 dyn/cm(2) is estimated based on ten flow cycles. This may be high enough to cause hemolysis and platelet activation. Regions prone to intimal hyperplasia are identified by combining the time-averaged wall shear stress and oscillatory shear index. These regions are found to vary, depending on the percentage of the flow bypass.
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Affiliation(s)
- Ning Yang
- Department of Bioengineering, Pennsylvania State University, University Park, PA 16802, USA
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Yang N, Deutsch S, Paterson EG, Manning KB. Comparative Study of Continuous and Pulsatile Left Ventricular Assist Devices on Hemodynamics of a Pediatric End-to-Side Anastomotic Graft. Cardiovasc Eng Technol 2010; 1:10.1007/s13239-010-0006-6. [PMID: 24348881 PMCID: PMC3859142 DOI: 10.1007/s13239-010-0006-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although there are many studies that focus on understanding the consequence of pumping mode (continuous vs. pulsatile) associated with ventricular assist devices (VADs) on pediatric vascular pulsatility, the impact on local hemodynamics has been largely ignored. Hence, we compare not only the hemodynamic parameters indicative of pulsatility but also the local flow fields in the aorta and the great vessels originating from the aortic arch. A physiologic graft anastomotic model is constructed based on a pediatric, patient specific, aorta with a graft attached on the ascending aorta. The flow is simulated using a previously validated second-order accurate Navier-Stokes flow solver based upon a finite volume approach. The major findings are: (1) pulsatile support provides a greater degree of vascular pulsatility when compared to continuous support, which, however, is still 20% less than pulsatility in the healthy aorta; (2) pulsatile support increases the flow in the great vessels, while continuous support decreases it; (3) complete VAD support results in turbulence in the aorta, with maximum principal Reynolds stresses for pulsatile support and continuous support of 7081 and 249 dyn/cm2, respectively; (4) complete pulsatile support results in a significant increase in predicted hemolysis in the aorta; and (5) pulsatile support causes both higher time-averaged wall shear stresses (WSS) and oscillatory shear indices (OSI) in the aorta than does continuous support. These findings will help to identify the risk of graft failure for pediatric patients with pulsatile and continuous VADs.
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Affiliation(s)
- Ning Yang
- Department of Bioengineering, The Pennsylvania State University, University Park, PA 16802, USA
| | - Steven Deutsch
- Department of Bioengineering, The Pennsylvania State University, University Park, PA 16802, USA
- The Applied Research Laboratory, The Pennsylvania State University, University Park, PA 16802, USA
| | - Eric G. Paterson
- The Applied Research Laboratory, The Pennsylvania State University, University Park, PA 16802, USA
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA 16802, USA
| | - Keefe B. Manning
- Department of Bioengineering, The Pennsylvania State University, University Park, PA 16802, USA
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Current World Literature. Curr Opin Cardiol 2009; 24:95-101. [DOI: 10.1097/hco.0b013e32831fb366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Current World Literature. Curr Opin Support Palliat Care 2008; 2:288-91. [DOI: 10.1097/spc.0b013e32831d29c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Undar A. International conference on pediatric mechanical circulatory support systems and pediatric cardiopulmonary perfusion: outcomes and future directions. ASAIO J 2008; 54:141-6. [PMID: 18356645 PMCID: PMC2646197 DOI: 10.1097/mat.0b013e318167afdd] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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