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Abbassy M, Ali MZ, Sharma RM, Irani YP, Dahlan A, Azhar M, Aslam N, Hasan B, Hameed A. Biosensors with left ventricular assist devices. Heart Fail Rev 2024:10.1007/s10741-024-10413-x. [PMID: 38940991 DOI: 10.1007/s10741-024-10413-x] [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] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
Heart failure imposes a significant global health burden, standing as a primary contributor to mortality. Various indicators and physiological shifts within the body may hint at distinct cardiac conditions. Specific biosensors have the capability to identify these changes. Integrating or embedding these biosensors into mechanical circulatory support devices (MCSDs), such as left ventricular assist devices (LVADs), becomes crucial for monitoring alterations in biochemical and physiological factors subsequent to an MCSD implantation. Detecting abnormal changes early in the course of disease progression will allow for improved patient outcomes and prognosis following an MCSD implantation. The aim of this review is to explore the available biosensors that may be coupled or implanted alongside LVADs to monitor biomarkers and changes in physiological parameters. Different fabrication materials for the biosensors are discussed, including their advantages and disadvantages. This review also examines the feasibility of integrating feedback control mechanisms into LVAD systems using data from the biosensors. Challenges facing this emerging technology and future directions for research and development are outlined as well. The overarching goal is to provide an overview of how implanted biosensors may improve the performance and outcomes of LVADs through continuous monitoring and closed-loop control.
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Affiliation(s)
- Mahmoud Abbassy
- School of Medicine, RCSI University of Medicine and Health Sciences, Dublin 2, Dublin, Ireland
| | - Muhammad Zain Ali
- Internal Medicine, Kent Hospital, Brown University, Warwick, Rhode Island, USA
| | - Riya Manas Sharma
- School of Medicine, RCSI University of Medicine and Health Sciences, Dublin 2, Dublin, Ireland
| | - Yohan Porus Irani
- School of Medicine, RCSI University of Medicine and Health Sciences, Dublin 2, Dublin, Ireland
| | - Adil Dahlan
- UCD School of Medicine, University College Dublin, Health Sciences Centre, Dublin 4, Belfield, Dublin, Ireland
| | - Maimoona Azhar
- Graduate Entry Medicine, School of Medicine, RCSI University of Medicine and Health Sciences, Dublin 2, 123 St. Stephen's Green, Dublin, D02 YN77, Ireland
| | - Nadeem Aslam
- Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Babar Hasan
- Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Aamir Hameed
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Dublin, D02 YN77, Ireland.
- Trinity Centre for Biomedical Engineering (TCBE), Trinity College Dublin (TCD), Dublin, Ireland.
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Xiong X, Zhou R, Deng L. Pulmonary embolism after left ventricular assist device implantation. Asian J Surg 2024:S1015-9584(24)00967-9. [PMID: 38796366 DOI: 10.1016/j.asjsur.2024.05.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/10/2024] [Indexed: 05/28/2024] Open
Affiliation(s)
- Xinghui Xiong
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruihao Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lijing Deng
- Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, China.
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Peng J, Devalaraju S, Azab M, Cates WT, Stone M, Reichstein J, Shaha S, Chatterjee S, Civitello AB, Senussi MH, Elmunzer BJ, Volk M, Skef W. Pre-left ventricular assist device endoscopic evaluation does not reduce the risk of later gastrointestinal bleeding: a multicenter study. Ann Gastroenterol 2024; 37:313-320. [PMID: 38779638 PMCID: PMC11107400 DOI: 10.20524/aog.2024.0878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/05/2024] [Indexed: 05/25/2024] Open
Abstract
Background Gastrointestinal bleeding (GIB) is a common complication after placement of a left ventricular assist device (LVAD). Some institutions attempt to mitigate post-LVAD GIB using preoperative endoscopy. Our study evaluated whether preoperative endoscopy was associated with a lower risk of post-LVAD GIB. Methods This was a multicenter cohort study of patients who underwent LVAD insertion from 2010-2019 at 3 academic sites. A total of 398 study participants were categorized based on whether they underwent preoperative endoscopy or not. The follow-up period was 1 year and the primary outcome was GIB. Secondary outcomes were severe bleeding and intraprocedural complications. Results A total of 114 patients experienced GIB within 1 year, with a higher rate in the endoscopy cohort (36.4% vs. 24.8%, P=0.015). After adjusting for covariables, the endoscopy cohort remained at increased risk of GIB (adjusted odds ratio 1.77, 95% confidence interval 1.05-2.976; P=0.032). Severe bleeding was common (47.4%). Arteriovenous malformations (48 cases) and peptic ulcer disease (17 cases) were the most identified sources of GIB. Only 1 minor adverse event occurred during preoperative endoscopy. Conclusions Our study suggests that pre-LVAD endoscopy is associated with a higher risk of GIB post LVAD, despite controlling for confounders. While this was an observational study and may not have captured all confounders, it appears that endoscopic screening may not be warranted.
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Affiliation(s)
- Jiahao Peng
- Center for Health Research, Loma Linda University Health, Loma Linda, California (Jiahao Peng)
| | - Samanthika Devalaraju
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas (Samanthika Devalaraju)
| | - Mohamed Azab
- Department of Gastroenterology, Prevea Health, Hobart, Wisconsin (Mohamed Azab)
| | - William T. Cates
- Department of Anesthesiology, Baylor of College, Houston, Texas (William T. Cates)
| | - Molly Stone
- University of Michigan, Ann Arbor, Michigan (Molly Stone)
| | - Jonathan Reichstein
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina (Jonathan Reichstein, B. Joseph Elmunzer)
| | - Sneha Shaha
- Department of Medicine, University of California, Los Angeles, Los Angeles, California (Sneha Shaha)
| | - Subhasis Chatterjee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas (Subhasis Chatterjee)
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas (Subhasis Chatterjee)
| | - Andrew B Civitello
- Division of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas (Andrew B Civitelloj, Mourad H. Senussi)
| | - Mourad H. Senussi
- Division of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas (Andrew B Civitelloj, Mourad H. Senussi)
- Department of Cardiology, The Texas Heart Institute, Houston, Texas (Mourad H. Senussi)
| | - B. Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina (Jonathan Reichstein, B. Joseph Elmunzer)
| | - Michael Volk
- Department of Medicine, Baylor Scott and White Health, Central Texas Region (Michael Volk)
| | - Wasseem Skef
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas (Wasseem Skef), USA
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Li Y, Liu X, Sun A, Deng X, Chen Z, Fan Y. Multi-Method Investigation of Blood Damage Induced By Blood Pumps in Different Clinical Support Modes. ASAIO J 2024; 70:280-292. [PMID: 38215762 DOI: 10.1097/mat.0000000000002116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
To investigate the effects of blood pumps operated in different modes on nonphysiologic flow patterns, cell and protein function, and the risk of bleeding, thrombosis, and hemolysis, an extracorporeal blood pump (CentriMag) was operated in three clinical modalities including heart failure (HF), venous-venous (V-V) extracorporeal membrane oxygenation (ECMO), and venous-arterial (V-A) ECMO. Computational fluid dynamics (CFD) methods and coupled hemolysis models as well as recently developed bleeding and thrombosis models associated with changes in platelet and von Willebrand factor (vWF) function were used to predict hydraulic performance and hemocompatibility. The V-A ECMO mode had the highest flow losses and shear stress levels, the V-V ECMO mode was intermediate, and the HF mode was the lowest. Different nonphysiologic flow patterns altered cell/protein morphology and function. The V-A ECMO mode resulted in the highest levels of platelet activation, receptor shedding, vWF unfolding, and high molecular weight multimers vWF (HMWM-vWF) degradation, leading to the lowest platelet adhesion and the highest vWF binding capacity, intermediate in the V-V ECMO mode, and opposite in the HF mode. The V-A ECMO mode resulted in the highest risk of bleeding, thrombosis, and hemolysis, with the V-V ECMO mode intermediate and the HF mode lowest. These findings are supported by published experimental or clinical statistics. Further studies found that secondary blood flow passages resulted in the highest risk of blood damage. Nonphysiologic blood flow patterns were strongly associated with cell and protein function changing, blood damage, and complications.
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Affiliation(s)
- Yuan Li
- From the Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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Jahren SE, Martinez T, Walter A, Clavica F, Heinisch PP, Buffle E, Luedi MM, Hörer J, Obrist D, Carrel T, Civet Y, Perriard Y. Novel para-aortic cardiac assistance using a pre-stretched dielectric elastomer actuator. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae027. [PMID: 38419585 PMCID: PMC10955250 DOI: 10.1093/icvts/ivae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/07/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES We propose an evolution of a dielectric elastomer actuator-based cardiac assist device that acts as a counterpulsation system. We introduce a new pre-stretched actuator and implant the device in a graft bypass between the ascending and descending aorta to redirect all blood through the device (ascending aorta clamped). The objective was to evaluate the influence of these changes on the assistance provided to the heart. METHODS The novel para-aortic device and the new implantation technique were tested in vivo in 5 pigs. We monitored the pressure and flow in the aorta as well as the pressure-volume characteristics of the left ventricle. Different activation timings were tested to identify the optimal device actuation. RESULTS The proposed device helps reducing the end-diastolic pressure in the aorta by up to 13 ± 4.0% as well as the peak systolic pressure by up to 16 ± 3.6%. The early diastolic pressure was also increased up to 10 ± 3.5%. With different activation, we also showed that the device could increase or decrease the stroke volume. CONCLUSIONS The new setup and the novel para-aortic device presented here helped improve cardiac assistance compared to previous studies. Moreover, we revealed a new way to assist the heart by actuating the device at different starting time to modify the left ventricular stroke volume and stroke work.
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Affiliation(s)
- Silje Ekroll Jahren
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Thomas Martinez
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Armando Walter
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Francesco Clavica
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Paul Philipp Heinisch
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Eric Buffle
- Department of Cardiology, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Markus Martin Luedi
- Department of Anaesthesiology, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Jürgen Hörer
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Thierry Carrel
- Department of Cardiac Surgery, University of Zurich, Zurich, Switzerland
| | - Yoan Civet
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
| | - Yves Perriard
- Integrated Actuators Laboratory (LAI), École polytechnique fédérale de Lausanne (EPFL), Neuchâtel, Switzerland
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Loardi CM, Zanobini M, Ricciardi G, Vermes E. Current and future options for adult biventricular assistance: a review of literature. Front Cardiovasc Med 2023; 10:1234516. [PMID: 38028456 PMCID: PMC10657899 DOI: 10.3389/fcvm.2023.1234516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
In cardiogenic shock various short-term mechanical assistances may be employed, including an Extra Corporeal Membrane Oxygenator and other non-dischargeable devices. Once hemodynamic stabilization is achieved and the patient evolves towards a persisting biventricular dysfunction or an underlying long-standing end-stage disease is present, aside from Orthotopic Heart Transplantation, a limited number of long-term therapeutic options may be offered. So far, only the Syncardia Total Artificial Heart and the Berlin Heart EXCOR (which is not approved for adult use in the United States unlike in Europe) are available for extensive implantation. In addition to this, the strategy providing two continuous-flow Left Ventricular Assist Devices is still off-label despite its widespread use. Nevertheless, every solution ensures at best a 70% survival rate (reflecting both the severity of the condition and the limits of mechanical support) with patients suffering from heavy complications and a poor quality of life. The aim of the present paper is to summarize the features, implantation techniques, and results of current devices used for adult Biventricular Mechanical Circulatory Support, as well as a glance to future options.
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Affiliation(s)
| | - Marco Zanobini
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Emmanuelle Vermes
- Department of Cardiology, Amiens University Hospital, Amiens, France
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Hemodynamic Evaluation of a Centrifugal Left Atrial Decompression Pump for Heart Failure with Preserved Ejection Fraction. Bioengineering (Basel) 2023; 10:bioengineering10030366. [PMID: 36978757 PMCID: PMC10044772 DOI: 10.3390/bioengineering10030366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/08/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023] Open
Abstract
This article discusses a new continuous flow mini pump that has been developed to improve symptoms and prognosis in patients with Heart Failure with Preserved Ejection Fraction (HFpEF), for which there are currently no established treatments. The pump is designed to discharge a reduced percentage of blood volume from the left atrium to the subclavian artery, clamped at the bifurcation with the aortic arch. The overall specifications, design parameters, and hemodynamics of this new device are discussed, along with data from in vitro circulation loop tests and numerical simulations. The article also compares the results for two configurations of the pump with respect to key indicators of hemocompatibility used in blood pump development.
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Goodman D, Stulak J, Rosenbaum AN. Left ventricular assist devices: A historical perspective at the intersection of medicine and engineering. Artif Organs 2022; 46:2343-2360. [PMID: 35929377 DOI: 10.1111/aor.14371] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/06/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
Over the last half-century, left ventricular assist device (LVAD) technology has progressed from conceptual therapy for failed cardiopulmonary bypass weaning to an accepted destination therapy for advanced heart failure. The history of LVAD engineering is defined by an initial development phase, which demonstrated the feasibility of such an approach, to the more recent three major generations of commercial devices. In this review, we explore the engineering challenges of LVADs, how they were addressed over time, and the clinical outcomes that resulted from each major technological development. The first generation of commercial LVADs were pulsatile devices, which lacked the appropriate durability due to their number of moving components and hemocompatibility. The second generation of LVADs was defined by replacement of complex, pulsatile pumps with primarily axial, continuous-flow systems with an impeller in the blood passageway. These devices experienced significant commercial success, but the presence of excessive trauma to the blood and in-situ bearing resulted in an unacceptable burden of adverse events. Third generation centrifugal-flow pumps use magnetically suspended rotors within the pump chamber. Superior outcomes with this newest generation of devices have been observed, particularly with respect to hemocompatibility-related adverse events including pump thrombosis, with fully magnetically levitated devices. The future of LVAD engineering includes wireless charging foregoing percutaneous drivelines and more advanced pump control mechanisms, including synchronization of the pump flow with the native cardiac cycle, and varying pump output based on degree of physical exertion using sensor or advanced device-level data triggers.
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Affiliation(s)
- Daniel Goodman
- College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa, USA
| | - John Stulak
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew N Rosenbaum
- Department of Cardiovascular Diseases, Mayo Clinic Minnesota, Rochester, Minnesota, USA
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