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Lippy M, Still B, Dhawan R, Moreno-Duarte I, Kitahara H. Stepwise Mechanical Circulatory Support in a Pediatric Patient With Respiratory Failure Facilitating Mobilization and Recovery. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00543-3. [PMID: 39277485 DOI: 10.1053/j.jvca.2024.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 08/16/2024] [Indexed: 09/17/2024]
Affiliation(s)
- Mitchell Lippy
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Brady Still
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Richa Dhawan
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
| | - Ingrid Moreno-Duarte
- University of Texas Southwestern Medical Center and Children's Medical Center in Dallas, Dallas, TX
| | - Hiroto Kitahara
- Department of Surgery, Section of Cardiac and Thoracic Surgery, The University of Chicago, IL
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Weymann A, Foroughi J, Vardanyan R, Punjabi PP, Schmack B, Aloko S, Spinks GM, Wang CH, Arjomandi Rad A, Ruhparwar A. Artificial Muscles and Soft Robotic Devices for Treatment of End-Stage Heart Failure. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2207390. [PMID: 36269015 DOI: 10.1002/adma.202207390] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/19/2022] [Indexed: 05/12/2023]
Abstract
Medical soft robotics constitutes a rapidly developing field in the treatment of cardiovascular diseases, with a promising future for millions of patients suffering from heart failure worldwide. Herein, the present state and future direction of artificial muscle-based soft robotic biomedical devices in supporting the inotropic function of the heart are reviewed, focusing on the emerging electrothermally artificial heart muscles (AHMs). Artificial muscle powered soft robotic devices can mimic the action of complex biological systems such as heart compression and twisting. These artificial muscles possess the ability to undergo complex deformations, aiding cardiac function while maintaining a limited weight and use of space. Two very promising candidates for artificial muscles are electrothermally actuated AHMs and biohybrid actuators using living cells or tissue embedded with artificial structures. Electrothermally actuated AHMs have demonstrated superior force generation while creating the prospect for fully soft robotic actuated ventricular assist devices. This review will critically analyze the limitations of currently available devices and discuss opportunities and directions for future research. Last, the properties of the cardiac muscle are reviewed and compared with those of different materials suitable for mechanical cardiac compression.
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Affiliation(s)
- Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Javad Foroughi
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
- Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Library Rd, Kensington, NSW, 2052, Australia
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, Imperial College Road, London, SW7 2AZ, UK
| | - Prakash P Punjabi
- Department of Cardiothoracic Surgery, Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, 72 Du Cane Rd, London, W12 0HS, UK
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Sinmisola Aloko
- Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Geoffrey M Spinks
- Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Chun H Wang
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Library Rd, Kensington, NSW, 2052, Australia
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, Imperial College Road, London, SW7 2AZ, UK
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
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DeFilippis EM, Topkara VK, Kirtane AJ, Takeda K, Naka Y, Garan AR. Mechanical Circulatory Support for Right Ventricular Failure. Card Fail Rev 2022; 8:e14. [PMID: 35516793 PMCID: PMC9062706 DOI: 10.15420/cfr.2021.11] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022] Open
Abstract
Right ventricular (RV) failure is associated with significant morbidity and mortality, with in-hospital mortality rates estimated as high as 70–75%. RV failure may occur following cardiac surgery in conjunction with left ventricular failure, or may be isolated in certain circumstances, such as inferior MI with RV infarction, pulmonary embolism or following left ventricular assist device placement. Medical management includes volume optimisation and inotropic and vasopressor support, and a subset of patients may benefit from mechanical circulatory support for persistent RV failure. Increasingly, percutaneous and surgical mechanical support devices are being used for RV failure. Devices for isolated RV support include percutaneous options, such as micro-axial flow pumps and extracorporeal centrifugal flow RV assist devices, surgically implanted RV assist devices and veno-arterial extracorporeal membrane oxygenation. In this review, the authors discuss the indications, candidate selection, strategies and outcomes of mechanical circulatory support for RV failure.
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Affiliation(s)
- Ersilia M DeFilippis
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, US
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, US
| | - Ajay J Kirtane
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, US
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, US
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, US
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Kretzschmar D, Möbius-Winkler S, Schulze PC, Ferrari MW. Concept and Design of a Novel Pulsatile Left Heart Assist Device-The PERKAT Left Ventricle System. ASAIO J 2022; 68:28-32. [PMID: 33709987 DOI: 10.1097/mat.0000000000001397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cardiogenic shock is associated with high mortality. Patients often require temporary mechanical circulatory support. We aimed to develop a percutaneously implantable, assist device that unloads the left ventricle (LV) in a pulsatile way. The PERkutane KATheter pump technologie (PERKAT LV) device consists of a nitinol pump chamber, which is covered by foils carrying outflow valves. A flexible tube with a pigtail-shaped tip and inflow holes represents the distal part of the pump. The system is designed for 16F percutaneous implantation. The nitinol chamber is placed in the descending aorta while the flexible tube bypasses aortic arch and ascending aorta with its tip in the LV. An intra-aortic balloon pump is placed into the chamber and connected to a console. Balloon deflation generates a blood flow from the LV into the pump chamber. During balloon inflation, blood leaves the system through the outflow foil valves in the descending aorta. Under different afterload settings using a 30 cc intra-aortic balloon pump and varying inflation/deflations rates, we recorded flow rates up to 3.0 L/min. Based on this, we believe that PERKAT LV is a promising approach for temporary LV support. The proposed design and its excellent performance give basis for in vivo tests in an animal model.
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Affiliation(s)
- Daniel Kretzschmar
- From the Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Sven Möbius-Winkler
- From the Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - P Christian Schulze
- From the Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Markus W Ferrari
- HSK, Clinic of Internal Medicine I, Helios-Kliniken, Wiesbaden, Germany
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Abstract
Percutaneous mechanical circulatory support options include intra-aortic balloon pump, transvalvular axial flow pumps, left atrial to femoral artery pumping, and oxygenated right atrium to femoral artery circuits. Percutaneous mechanical circulatory support devices providing greater support have not proven superiority over the intra-aortic balloon pump. Novel counterpulsation devices target durability and ambulatory capability and direct unloading of left ventricle (LV) and right ventricle. Device innovations in transvalvular axial pumping include miniaturization of partial-support devices and development of larger self-expanding devices for near-complete LV support. Aortic entrainment pumping is a novel mode of blood displacement with potential benefits beyond reduced LV afterload.
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Affiliation(s)
- Sandeep Nathan
- Section of Cardiology, Interventional Cardiology, University of Chicago Medicine, 5841 South Maryland Avenue, MC 5076, Chicago, IL 60637, USA.
| | - Jonathan Grinstein
- Section of Cardiology, Advanced Heart Failure, University of Chicago Medicine, 5841 South Maryland Avenue, Room A621-MC2016, Chicago, IL 60637, USA
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Neuerungen der mechanischen Kurzzeitunterstützung. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2021. [DOI: 10.1007/s00398-021-00425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ferrari MW, Schulze PC, Kretzschmar D. Acute right heart failure: future perspective with the PERKAT RV pulsatile right ventricular support device. Ther Adv Cardiovasc Dis 2020; 14:1753944719895902. [PMID: 31918629 PMCID: PMC7099617 DOI: 10.1177/1753944719895902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Acute right heart failure is associated with impaired prognosis in cardiogenic shock. Since most pharmacological therapies are not evaluated for the failing right ventricle, or even contraindicated, there is a need for rapid minimal invasive circulatory right heart support. The PERKAT RV is such a device for acute therapy in congestive heart failure. It reduces the central venous pooling by pumping blood from the inferior vena cava into the pulmonary artery with flow rates of up to 4 litres/min. The device was evaluated in an animal model of acute pulmonary embolism after careful in vitro tests. PERKAT RV increased cardiac output by 59% in sheep suffering from acute right heart failure. We await the first human implantation in the near future. Based on the PERKAT concept, future devolvement will also focus on left heart support.
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Affiliation(s)
- Markus W Ferrari
- Director of the Clinic Internal Medicine 1, Helios Dr. Horst Schmidt Clinic, Ludwig-Erhard-Strasse 100, Wiesbaden, Hessen, 65199, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital, Friedrich-Schiller-University, Jena, Thüringen, Germany
| | - Daniel Kretzschmar
- Department of Internal Medicine I, University Hospital, Friedrich-Schiller-University, Jena, Thüringen, Germany
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Kretzschmar D, Schulze PC, Ferrari MW. Concept, Evaluation, and Future Perspectives of PERKAT® RV-A Novel Right Ventricular Assist Device. J Cardiovasc Transl Res 2018; 12:150-154. [PMID: 30267328 DOI: 10.1007/s12265-018-9834-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/10/2018] [Indexed: 11/28/2022]
Abstract
Right heart failure (RHF) is a life-threatening condition. Mechanical right heart support offers an option for critically ill patients. The PERKAT® RV device is designed for percutaneous implantation in acute RHF. It consists of a nitinol chamber covered by foils containing inflow valves. An outlet tube is attached to its distal tip. Using an 18F sheath, it is implanted in the inferior vena cava while the tube bypasses the right heart with its tip in the pulmonary trunk. Then, an IABP balloon is inserted in the pump chamber. Balloon deflation generates blood inflow into the chamber; during inflation, blood is pumped into the pulmonary arteries. The device is capable of achieving flow rates of up to 3.5 l/min under in vitro conditions. In vivo, we were able to increase cardiac output by 59% in a sheep model of acute pulmonary embolism. Based on this, our further research will focus on first-in-human implants.
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Affiliation(s)
- Daniel Kretzschmar
- Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, 07740, Jena, Germany.
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, 07740, Jena, Germany
| | - Markus W Ferrari
- HSK, Department of Internal Medicine I, Helios-Clinics, Wiesbaden, Germany
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