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Huang X, Shen Y, Liu Y, Zhang H. Current status and future directions in pediatric ventricular assist device. Heart Fail Rev 2024; 29:769-784. [PMID: 38530587 DOI: 10.1007/s10741-024-10396-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
A ventricular assist device (VAD) is a form of mechanical circulatory support that uses a mechanical pump to partially or fully take over the function of a failed heart. In recent decades, the VAD has become a crucial option in the treatment of end-stage heart failure in adult patients. However, due to the lack of suitable devices and more complicated patient profiles, this therapeutic approach is still not widely used for pediatric populations. This article reviews the clinically available devices, adverse events, and future directions of design and implementation in pediatric VADs.
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Affiliation(s)
- Xu Huang
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
| | - Yi Shen
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
| | - Yiwei Liu
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
| | - Hao Zhang
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
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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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Mechanical Circulatory Support of the Right Ventricle for Adult and Pediatric Patients With Heart Failure. ASAIO J 2019; 65:106-116. [DOI: 10.1097/mat.0000000000000815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Simulated Performance of the Cleveland Clinic Continuous-Flow Total Artificial Heart Using the Virtual Mock Loop. ASAIO J 2018; 65:565-572. [PMID: 30074965 DOI: 10.1097/mat.0000000000000857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Our new Virtual Mock Loop (VML) is a mathematical model designed to simulate the human cardiovascular system and gauge performance of mechanical circulatory support devices. We aimed to mimic the hemodynamic performance of Cleveland Clinic's self-regulating continuous-flow total artificial heart (CFTAH) via VML and evaluate VML's accuracy versus bench data from our standard mock circulatory loop. The VML reproduced 23 hemodynamic conditions. Systemic/pulmonary vascular resistances and pump rotational speed were set for VML from bench test data. We compared outputs (pump flow, left/right pump pressure rise, normalized pump performance, and atrial pressure difference) of the two methods. Data from pump flow and left pump pressure rise were similar, but right pump pressure rise slightly differed. Left pump normalized pump performance curves were similar. Right pump VML results were within the same performance range indicated by bench tests. The plots of atrial pressure differences of VML versus bench-test data were similar, but slightly differed in the midrange of systemic/pulmonary gradients. Virtual Mock Loop successfully reproduced results from our mock circulatory loop of CFTAH test conditions. The CFTAH's self-regulation feature of right pump performance was also calculated effectively. We foresee using versions of the VML for training, simulating physiologic cardiac conditions, and patient monitoring.
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Clark JB, Wang S, Palanzo DA, Wise R, Baer LD, Brehm C, Ündar A. Current Techniques and Outcomes in Extracorporeal Life Support. Artif Organs 2015; 39:926-30. [DOI: 10.1111/aor.12527] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Joseph B. Clark
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
- Department of Surgery; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Shigang Wang
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - David A. Palanzo
- Penn State Hershey Heart and Vascular Institute; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Robert Wise
- Penn State Hershey Heart and Vascular Institute; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Larry D. Baer
- Penn State Hershey Heart and Vascular Institute; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Christoph Brehm
- Penn State Hershey Heart and Vascular Institute; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Akif Ündar
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
- Department of Surgery; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
- Department of Bioengineering; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
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Wolfe R, Strother A, Wang S, Kunselman AR, Ündar A. Impact of Pulsatility and Flow Rates on Hemodynamic Energy Transmission in an Adult Extracorporeal Life Support System. Artif Organs 2015; 39:E127-37. [DOI: 10.1111/aor.12484] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Rachel Wolfe
- Penn State Hershey Pediatric Cardiovascular Research Center; Department of Pediatrics; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Ashton Strother
- Penn State Hershey Pediatric Cardiovascular Research Center; Department of Pediatrics; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Shigang Wang
- Penn State Hershey Pediatric Cardiovascular Research Center; Department of Pediatrics; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Allen R. Kunselman
- Public Health and Sciences; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Akif Ündar
- Penn State Hershey Pediatric Cardiovascular Research Center; Department of Pediatrics; Penn State Hershey Children's Hospital; Hershey PA USA
- Surgery and Bioengineering; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
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Patel S, Wang S, Pauliks L, Chang D, Clark JB, Kunselman AR, Ündar A. Evaluation of a Novel Pulsatile Extracorporeal Life Support System Synchronized to the Cardiac Cycle: Effect of Rhythm Changes on Hemodynamic Performance. Artif Organs 2015; 39:67-76. [DOI: 10.1111/aor.12454] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sunil Patel
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
| | - Shigang Wang
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
| | - Linda Pauliks
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
| | - Dennis Chang
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
| | - Joseph B. Clark
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
- Department of Surgery; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
| | - Allen R. Kunselman
- Department of Public Health and Sciences; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
| | - Akif Ündar
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
- Department of Surgery; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
- Department of Bioengineering; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine; Hershey PA USA
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Wang S, Kunselman AR, Clark JB, Ündar A. In Vitro Hemodynamic Evaluation of a Novel Pulsatile Extracorporeal Life Support System: Impact of Perfusion Modes and Circuit Components on Energy Loss. Artif Organs 2015; 39:59-66. [DOI: 10.1111/aor.12430] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Shigang Wang
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Allen R. Kunselman
- Department of Public and Health Sciences; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Joseph B. Clark
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
- Department of Surgery; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Akif Ündar
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
- Department of Surgery; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
- Department of Bioengineering; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
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Adedayo P, Wang S, Kunselman AR, Ündar A. Impact of Pulsatile Flow Settings on Hemodynamic Energy Levels Using the Novel Diagonal Medos DP3 Pump in a Simulated Pediatric Extracorporeal Life Support System. World J Pediatr Congenit Heart Surg 2014; 5:440-8. [DOI: 10.1177/2150135114526760] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 02/10/2014] [Indexed: 11/15/2022]
Abstract
Background: The objective of this study was to evaluate the pump performance of the novel diagonal Medos Deltastream DP3 diagonal pump (MEDOS Medizintechnik AG, , Stolberg, Germany) under nonpulsatile to pulsatile mode with varying differential speed values in a simulated pediatric extracorporeal life support system. Methods: The experimental circuit consisted of a Medos Deltastream DP3 pump head and console, a Medos Hilite 2400 LT hollow fiber membrane oxygenator (MEDOS Medizintechnik AG), a 14F Medtronic DLP arterial cannula (Medtronic Inc, Minnesota), and a 20F Terumo TenderFlow Pediatric venous return cannula (Terumo Corporation, Michigan). Trials were conducted at flow rates ranging from 500 mL/min to 2,000 mL/min (500 mL/min increments) and pulsatile differential speed values ranging from 500 rpm to 2,500 rpm (500 rpm increments) using human blood (hematocrit 35%). The postcannula pressure was maintained constantly at 60 mm Hg. Real-time pressure and flow data were recorded using a custom-made data acquisition system and Labview software. Results: Under all experimental conditions, pulsatile flow (P) generated significantly greater energy equivalent pressure (EEP), surplus hemodynamic energy (SHE), and total hemodynamic energy (THE) than those of nonpulsatile flow (NP). Under NP, SHE was zero. Higher differential speed values generated greater EEP, SHE, and THE values. There was little variation in the oxygenator pressure drop and the cannula pressure drop in P, compared to NP. Conclusions: The novel Medos Deltastream DP3 diagonal pump is able to generate physiological quality of P, without backflow. With increased differential rpm, the pump generated greater EEP, SHE, and THE. Physiological quality of pulsatility may be associated with better microcirculation because of greater EEP, SHE, and THE.
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Affiliation(s)
- Pelumi Adedayo
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Shigang Wang
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Allen R. Kunselman
- Department of Public Health and Sciences, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Akif Ündar
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
- Department of Surgery and Bioengineering, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children’s Hospital, Hershey, PA, USA
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Ündar A, Wang S, Palanzo D, Weaver B, Pekkan K, Agirbasli M, Zahn JD, Luciani GB, Clark JB, Wilson RP, Kunselman AR, Sano S, Belli E, Pierce WS, Myers JL. Outcomes of the ninth international conference on pediatric mechanical circulatory support systems and pediatric cardiopulmonary perfusion. Artif Organs 2014; 38:5-10. [PMID: 24392865 DOI: 10.1111/aor.12213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Akif Ündar
- Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, Surgery and Bioengineering, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA
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