Electronmicroscopic changes in selected vital organs after long-term total artificial heart pumping in animal experiments

Electronmicroscopic (EM) evaluation of selected vital organs (liver, kidney, lung) informs us about otherwise hardly detectable changes during total artificial heart (TAH) pumping. In our experiments, we compared 2 groups of long-surviving animals in which the TAH TNS-BRNO pneumatic device was implanted (TNS-BRNO-II and VII in 45 experiments, TNS-BRNO-III in 1 experiment, and TNS-BRNO-VIII in 1 experiment). In 4 experiments, the Rostock TAH (NABEL, TAH Research Center, Rostock, Germany) was implanted. One group of 22 animals with an average survival of 162 days (the longest, 293 days) was submitted to an antihypertensive treatment; another 1 of 29 calves with an average survival of 98 days (the longest, 173 days) was untreated. The evaluation was performed using a scale (0 to 3) based on very precisely fixed criteria. EM pathologic changes documented various stages of ischemic damage. Except for the liver, no significant difference was found between both groups, despite the substantially prolonged survival in the treated group. Very important was the general state of mitochondria, endoplasmic reticulum, and nucleus. Further, the state of glomerular podocytes in the kidney and the state of interalveolar septa and of pneumocytes constituting the air-blood barrier for gas exchange in the lungs are especially important. In some animals of both groups, the EM findings were completely normal, especially in the lung.

The importance of pulsatile and nonpulsatile flow in the design of blood pumps

The traditional approach of total artificial heart (TAH) and ventricular assist device (VAD) development has been the mimicking of the native heart. Nonpulsatile flow using cardiopulmonary bypass has provided evidence of short-term physiologic tolerances. The design of nonpulsatile TAHs and VADs has eliminated the need for valves, flexing diaphragms, and large ventricular volumes. However, these devices require high efficiency power sources and reliable bearing seals or electromagnetic bearings while simultaneously attempting to avoid thromboemboli. The physiologic response to nonpulsatile flow is complex and variable. When compared to a pulsatile device, a nonpulsatile TAH or VAD needs to produce increased flow and higher mean intravascular pressures to maintain normal organ function. Despite its maintaining normal organ function, nonpulsatile flow does cause alterations in biochemical functions and organ specific blood flow. The combination of bioengineering superiority and the maintenance of physiologic homeostasis has directed future TAH and VAD research towards nonpulsatile systems.