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Wu T, Khir AW, Kütting M, Du X, Lin H, Zhu Y, Hsu PL. A review of implantable pulsatile blood pumps: Engineering perspectives. Int J Artif Organs 2020; 43:559-569. [PMID: 32037940 DOI: 10.1177/0391398820902470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It has been reported that long-term use of continuous-flow mechanical circulatory support devices (CF-MCSDs) may induce complications associated with diminished pulsatility. Pulsatile-flow mechanical circulatory support devices (PF-MCSDs) have the potential of overcoming these shortcomings with the advance of technology. In order to promote in-depth understanding of PF-MCSD technology and thus encourage future mechanical circulatory support device innovations, engineering perspectives of PF-MCSD systems, including mechanical designs, drive mechanisms, working principles, and implantation strategies, are reviewed in this article. Some emerging designs of PF-MCSDs are introduced, and possible elements for next-generation PF-MCSDs are identified.
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Affiliation(s)
- Tingting Wu
- Artificial Organ Technology Laboratory, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Ashraf W Khir
- Brunel Institute for Bioengineering, Brunel University London, Uxbridge, UK
| | | | - Xinli Du
- Brunel Institute for Bioengineering, Brunel University London, Uxbridge, UK
| | - Hao Lin
- Artificial Organ Technology Laboratory, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Yuxin Zhu
- Artificial Organ Technology Laboratory, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Po-Lin Hsu
- Artificial Organ Technology Laboratory, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
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2
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Crosby JR, DeCook KJ, Tran PL, Betterton E, Smith RG, Larson DF, Khalpey ZI, Burkhof D, Slepian MJ. A Physical Heart Failure Simulation System Utilizing the Total Artificial Heart and Modified Donovan Mock Circulation. Artif Organs 2017; 41:E52-E65. [PMID: 27935084 PMCID: PMC5466504 DOI: 10.1111/aor.12808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/21/2016] [Accepted: 06/30/2016] [Indexed: 01/11/2023]
Abstract
With the growth and diversity of mechanical circulatory support (MCS) systems entering clinical use, a need exists for a robust mock circulation system capable of reliably emulating and reproducing physiologic as well as pathophysiologic states for use in MCS training and inter-device comparison. We report on the development of such a platform utilizing the SynCardia Total Artificial Heart and a modified Donovan Mock Circulation System, capable of being driven at normal and reduced output. With this platform, clinically relevant heart failure hemodynamics could be reliably reproduced as evidenced by elevated left atrial pressure (+112%), reduced aortic flow (-12.6%), blunted Starling-like behavior, and increased afterload sensitivity when compared with normal function. Similarly, pressure-volume relationships demonstrated enhanced sensitivity to afterload and decreased Starling-like behavior in the heart failure model. Lastly, the platform was configured to allow the easy addition of a left ventricular assist device (HeartMate II at 9600 RPM), which upon insertion resulted in improvement of hemodynamics. The present configuration has the potential to serve as a viable system for training and research, aimed at fostering safe and effective MCS device use.
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Affiliation(s)
- Jessica R. Crosby
- Biomedical Engineering GIDP, University of Arizona, Tucson, Arizona 85724
| | - Katrina J. DeCook
- Biomedical Engineering GIDP, University of Arizona, Tucson, Arizona 85724
| | - Phat L. Tran
- Biomedical Engineering GIDP, University of Arizona, Tucson, Arizona 85724
- Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, Arizona 85724 43Artificial Heart Department, Banner University Medical Center, University of Arizona, Tucson, Arizona 85724
| | | | - Richard G. Smith
- Biomedical Engineering GIDP, University of Arizona, Tucson, Arizona 85724
- Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, Arizona 85724 43Artificial Heart Department, Banner University Medical Center, University of Arizona, Tucson, Arizona 85724
- Department of Surgery, University of Arizona, Tucson, AZ 85724
| | | | - Zain I. Khalpey
- Department of Surgery, University of Arizona, Tucson, AZ 85724
| | | | - Marvin J. Slepian
- Biomedical Engineering GIDP, University of Arizona, Tucson, Arizona 85724
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona 85724
- Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, Arizona 85724 43Artificial Heart Department, Banner University Medical Center, University of Arizona, Tucson, Arizona 85724
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3
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Payne CJ, Wamala I, Abah C, Thalhofer T, Saeed M, Bautista-Salinas D, Horvath MA, Vasilyev NV, Roche ET, Pigula FA, Walsh CJ. An Implantable Extracardiac Soft Robotic Device for the Failing Heart: Mechanical Coupling and Synchronization. Soft Robot 2017; 4:241-250. [PMID: 29182083 DOI: 10.1089/soro.2016.0076] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Soft robotic devices have significant potential for medical device applications that warrant safe synergistic interaction with humans. This article describes the optimization of an implantable soft robotic system for heart failure whereby soft actuators wrapped around the ventricles are programmed to contract and relax in synchrony with the beating heart. Elastic elements integrated into the soft actuators provide recoiling function so as to aid refilling during the diastolic phase of the cardiac cycle. Improved synchronization with the biological system is achieved by incorporating the native ventricular pressure into the control system to trigger assistance and synchronize the device with the heart. A three-state electro-pneumatic valve configuration allows the actuators to contract at different rates to vary contraction patterns. An in vivo study was performed to test three hypotheses relating to mechanical coupling and temporal synchronization of the actuators and heart. First, that adhesion of the actuators to the ventricles improves cardiac output. Second, that there is a contraction-relaxation ratio of the actuators which generates optimal cardiac output. Third, that the rate of actuator contraction is a factor in cardiac output.
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Affiliation(s)
- Christopher J Payne
- 1 John A. Paulson Harvard School of Engineering and Applied Science, Harvard University , Cambridge, Massachusetts
- 2 Wyss Institute for Biologically Inspired Engineering, Harvard University , Cambridge, Massachusetts
| | - Isaac Wamala
- 3 Boston Children's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Colette Abah
- 1 John A. Paulson Harvard School of Engineering and Applied Science, Harvard University , Cambridge, Massachusetts
- 2 Wyss Institute for Biologically Inspired Engineering, Harvard University , Cambridge, Massachusetts
| | - Thomas Thalhofer
- 1 John A. Paulson Harvard School of Engineering and Applied Science, Harvard University , Cambridge, Massachusetts
- 2 Wyss Institute for Biologically Inspired Engineering, Harvard University , Cambridge, Massachusetts
- 4 Department of Mechanical Engineering, Technical University of Munich , Munich, Germany
| | - Mossab Saeed
- 3 Boston Children's Hospital , Harvard Medical School, Boston, Massachusetts
| | | | - Markus A Horvath
- 1 John A. Paulson Harvard School of Engineering and Applied Science, Harvard University , Cambridge, Massachusetts
- 2 Wyss Institute for Biologically Inspired Engineering, Harvard University , Cambridge, Massachusetts
- 5 Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology , Cambridge, Massachusetts
| | - Nikolay V Vasilyev
- 3 Boston Children's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Ellen T Roche
- 1 John A. Paulson Harvard School of Engineering and Applied Science, Harvard University , Cambridge, Massachusetts
- 2 Wyss Institute for Biologically Inspired Engineering, Harvard University , Cambridge, Massachusetts
- 6 Discipline of Biomedical Engineering, College of Engineering and Informatics, National University of Ireland , Galway, Ireland
| | - Frank A Pigula
- 3 Boston Children's Hospital , Harvard Medical School, Boston, Massachusetts
- 7 Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine , Louisville, Kentucky
| | - Conor J Walsh
- 1 John A. Paulson Harvard School of Engineering and Applied Science, Harvard University , Cambridge, Massachusetts
- 2 Wyss Institute for Biologically Inspired Engineering, Harvard University , Cambridge, Massachusetts
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Abstract
Mechanical circulatory support has become an increasingly used management strategy for patients with both acute and chronic ventricular failure. This article briefly reviews the current state of mechanical circulatory support with a focus on indications, contraindications, and complications of currently available devices. Perioperative considerations for ventricular assist device implantation are discussed, including the decision-making process underlying the use of univentricular versus biventricular support, specific anesthetic considerations, and the role of transesophageal echocardiography where ventricular assist devices are concerned. The anesthetic considerations for the patient already supported by a ventricular assist device presenting for noncardiac surgery are also reviewed. The work concludes with a discussion of the rationale behind the next generation of continuous flow devices currently in human clinical trials.
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Affiliation(s)
- Marc E Stone
- Mount Sinai School of Medicine, New York, New York 10029-6574, USA.
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Florescu MC, Sacks AR, Um JY. Cardiac Assist Devices and Hemodialysis Catheter Procedures - What Do the Nephrologists Need to Know? Semin Dial 2015; 28:670-5. [PMID: 26133515 DOI: 10.1111/sdi.12404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The use of ventricular assist devices (VAD) and total artificial heart (TAH) is increasing rapidly, and a large proportion of these device recipients already have or will develop severe renal dysfunction at the time of device implantation. As a consequence, nephrologists are becoming more and more involved in the care of this challenging population. As nephrologists take upon themselves many aspects of dialysis vascular access care, they need to be familiar with the special circumstances of performing hemodialysis catheter procedures in these patients. This review describes the important characteristics of these devices that have serious implications for the technique of placing or replacing dialysis catheters. These implications apply for both tunneled and nontunneled dialysis catheters and so concern all nephrologists, not only the interventionalists. We describe the important anatomical factors, anticoagulation management, device management, vascular access management and technical considerations of placing or replacing tunneled and nontunneled hemodialysis catheters from the perspective of a nephrologist establishing and maintaining lifesaving dialysis vascular access. Without a good understanding of these devices, serious consequences such as VAD rotor damage or blockage, or artificial heart valve blockage or damage can occur. These artificial devices are lifesaving, and any such complication is unacceptable. This review describes steps to minimize the risks.
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Affiliation(s)
- Marius C Florescu
- Section of Nephrology and Hypertension, University of Nebraska Medical Center, Omaha, Nebraska
| | - Andrew R Sacks
- Section of Nephrology and Hypertension, University of Nebraska Medical Center, Omaha, Nebraska
| | - John Y Um
- Section of Cardiothoracic Surgery and Heart Transplant, University of Nebraska Medical Center, Omaha, Nebraska
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Marom G, Chiu WC, Slepian MJ, Bluestein D. Numerical model of total artificial heart hemodynamics and the effect of its size on stress accumulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:5651-4. [PMID: 25571277 DOI: 10.1109/embc.2014.6944909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The total artificial heart (TAH) is a bi-ventricular mechanical circulatory support device that replaces the heart in patients with end-stage congestive heart failure. The device acts as blood pump via pneumatic activation of diaphragms altering the volume of the ventricular chambers. Flow in and out of the ventricles is controlled by mechanical heart valves. The aim of this study is to evaluate the flow regime in the TAH and to estimate the thrombogenic potential during systole. Toward that goal, three numerical models of TAHs of differing sizes, that include the deforming diaphragm and the blood flow from the left chamber to the aorta, are introduced. A multiphase model with injection of platelet particles is employed to calculate their trajectories. The shear stress accumulation in the three models are calculated along the platelets trajectories and their probability density functions, which represent the `thrombogenic footprint' of the device are compared. The calculated flow regime successfully captures the mitral regurgitation and the flows that open and close the aortic valve during systole. Physiological velocity magnitudes are found in all three models, with higher velocities and increased stress accumulation predicted for smaller devices.
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7
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Peripheral Adaptation Mechanisms in Physical Training and Cardiac Rehabilitation: The Case of a Patient Supported by a Cardiowest Total Artificial Heart. J Card Fail 2011; 17:670-5. [DOI: 10.1016/j.cardfail.2011.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 04/07/2011] [Accepted: 04/11/2011] [Indexed: 11/24/2022]
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Allen Y, Collins R, Lester C, Savage L, Vijayan S. Managing the Failing Heart: Total Circulatory Assist—A Case Study. Prog Transplant 2009; 19:13-7. [DOI: 10.1177/152692480901900102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Congestive heart failure remains one of the leading causes of cardiac death and disability. As pharmacological therapies have advanced, patients are living longer and more productive lives. However, at some point, these interventions begin to fail. Circulatory assist devices have revolutionized the management of patients with end-stage heart disease. These devices successfully bridge patients to cardiac transplantation. The Syncardia Total Artificial Heart provides biventricular support for the failing heart. This case study illustrates the challenges of caring for patients with such a device.
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Affiliation(s)
- Yvonne Allen
- Virginia Commonwealth University, Medical College of Virginia, Richmond
| | - Rachel Collins
- Virginia Commonwealth University, Medical College of Virginia, Richmond
| | - Charnetta Lester
- Virginia Commonwealth University, Medical College of Virginia, Richmond
| | - Laura Savage
- Virginia Commonwealth University, Medical College of Virginia, Richmond
| | - Sajitha Vijayan
- Virginia Commonwealth University, Medical College of Virginia, Richmond
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Homma A, Taenaka Y, Tatsumi E, Akagawa E, Lee H, Nishinaka T, Takewa Y, Mizuno T, Tsukiya T, Kakuta Y, Katagiri N, Shimosaki I, Hamada S, Mukaibayashi H, Iwaoka W. Development of a compact wearable pneumatic drive unit for a ventricular assist device. J Artif Organs 2009; 11:182-90. [PMID: 19184282 DOI: 10.1007/s10047-008-0433-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 08/30/2008] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to develop a compact wearable pneumatic drive unit for a ventricular assist device (VAD). This newly developed drive unit, 20 x 8.5 x 20 cm in size and weighing approximately 1.8 kg, consists of a brushless DC motor, noncircular gears, a crankshaft, a cylinder-piston, and air pressure regulation valves. The driving air pressure is generated by the reciprocating motion of the piston and is controlled by the air pressure regulation valves. The systolic ratio is determined by the noncircular gears, and so is fixed for a given configuration. As a result of an overflow-type mock circulation test, a drive unit with a 44% systolic ratio connected to a Toyobo VAD blood pump with a 70-ml stroke volume achieved a pump output of more than 7 l/min at 100 bpm against a 120 mmHg afterload. Long-term animal tests were also performed using drive units with systolic ratios of 45% and 53% in two Holstein calves weighing 62 kg and 74 kg; the tests were terminated on days 30 and 39, respectively, without any malfunction. The mean aortic pressure, bypass flow, and power consumption for the first calf were maintained at 90 x 13 mmHg, 3.9 x 0.9 l/min, and 12 x 1 W, and those for the second calf were maintained at 88 x 13 mmHg, 5.0 x 0.5 l/min, and 16 x 2 W, respectively. These results indicate that the newly developed drive unit may be used as a wearable pneumatic drive unit for the Toyobo VAD blood pump.
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Affiliation(s)
- Akihiko Homma
- The Advanced Medical Engineering Center, National Cardiovascular Center Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
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