1
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Okamoto E, Mitamura Y. Percutaneous intravascular micro-axial blood pump: current state and perspective from engineering view. J Artif Organs 2024:10.1007/s10047-024-01433-3. [PMID: 38662142 DOI: 10.1007/s10047-024-01433-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/10/2024] [Indexed: 04/26/2024]
Abstract
The utilization of a minimally invasively placed catheter-mounted intravascular micro-axial flow blood pump (IMFBP) is increasing in the population with advanced heart failure. The current development of IMFBPs dates back around the 1990s, namely the Hemopump with a wire-drive system and the Valvopump with a direct-drive system. The wire-drive IMFBPs can use a brushless motor in an external console unit to transmit rotational force through the drive wire rotating the impeller inside the body. The direct-drive IMFBPs require an ultra-miniature and high-power brushless motor. Additionally, the direct-drive system necessitates a mechanism to protect against blood immersion into the motor. Therefore, the direct-drive IMFBPs can be categorized into two types of devices: those with seal mechanisms or those with sealless mechanisms using magnetically coupling. The IMFBPs can be classified into two groups depending on their purpose. One group is for cardiogenic shock following a heart attack or for use in high-risk percutaneous coronary intervention (PCI), and the other group serves the purpose of acute decompensated heart failure. Both direct-drive IMFBPs and wire-drive IMFBPs have their own advantages and disadvantages, and efforts are being made to develop and improve, and clinically implement them, leveraging their own strengths. In addition, there is a possibility that innovative new devices may be invented. For researchers in the field of artificial heart development, IMFBPs offer a new area of research and development, providing a novel treatment option for severe heart failure.
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Affiliation(s)
- Eiji Okamoto
- Graduate School of Biology, Tokai University Minami-Sawa, 5-1-1-1, Minami-ku, Sapporo, 005-8601, Japan.
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2
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Georges G, Couture T, Voisine P. Assessment of Large Animal Vascular Dimensions for Intra-Aortic Device Research and Development: A Systematic Review. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:144-151. [PMID: 37029653 PMCID: PMC10159216 DOI: 10.1177/15569845231164134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
Animal studies are often required to evaluate new cardiovascular medical devices before they reach the market. Moreover, first-generation novel devices including aortic endovascular prostheses and circulatory support devices are often larger than later iterations or tested in a limited range of sizes. One of the challenges in evaluating these devices is finding a model that is both accessible and anatomically similar to humans, as there is a paucity of data on vascular dimensions in large animals. We set out to complete a comprehensive review of available reports on vascular dimensions in swine, ovine, and bovine models, with a particular focus on the descending aorta and ilio-femoral arteries. We searched Embase and MEDLINE databases for reports of descending aorta and peripheral vascular dimension in large animal models. Data from swine, ovine, and bovine models were separated by weight into 3 categories: 40 to 60 kg, 61 to 80 kg, and >80 kg. We also incorporate our computed tomography angiography data from 4 large sheep and 9 calves into this review. Swine, sheep, and calf >80 kg may serve as the best models to maximize aortic diameter resemblance to humans. If device implantation can be achieved in aortas of smaller dimensions, care should be taken to ensure access site suitability such as the common femoral artery in these smaller animals.
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Affiliation(s)
- Gabriel Georges
- Cardiac Surgery Division, Quebec Heart
and Lung Institute, QC, Canada
| | - Thomas Couture
- General Surgery Division, Laval
University Hospital Center, Quebec, QC, Canada
| | - Pierre Voisine
- Cardiac Surgery Division, Quebec Heart
and Lung Institute, QC, Canada
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3
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de Oliveira Cardoso C, Elgalad A, Li K, Perin EC. Device-based therapy for decompensated heart failure: An updated review of devices in development based on the DRI2P2S classification. Front Cardiovasc Med 2022; 9:962839. [PMID: 36211544 PMCID: PMC9532699 DOI: 10.3389/fcvm.2022.962839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Congestive heart failure (HF) is a devastating disease leading to prolonged hospitalization, high morbidity and mortality rates, and increased costs. Well-established treatments for decompensated or unstable patients include medications and mechanical cardiac support devices. For acute HF decompensation, new devices are being developed to help relieve symptoms and recover heart and renal function in these patients. A recent device-based classification scheme, collectively classified as DRI2P2S, has been proposed to better describe these new device-based therapies based on their mechanism: dilators (increase venous capacitance), removers (direct removal of sodium and water), inotropes (increase left ventricular contractility), interstitials (accelerate removal of lymph), pushers (increase renal arterial pressure), pullers (decrease renal venous pressure), and selective (selective intrarenal drug infusion). In this review, we describe the new class of medical devices with the most current results reported in preclinical models and clinical trials.
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Affiliation(s)
| | - Abdelmotagaly Elgalad
- Center for Preclinical Surgical and Interventional Research, Texas Heart Institute, Houston, TX, United States
- *Correspondence: Abdelmotagaly Elgalad,
| | - Ke Li
- Center for Preclinical Surgical and Interventional Research, Texas Heart Institute, Houston, TX, United States
| | - Emerson C. Perin
- Center for Clinical Research, Texas Heart Institute, Houston, TX, United States
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4
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Napp LC, Mariani S, Ruhparwar A, Schmack B, Keeble TR, Reitan O, Hanke JS, Dogan G, Hiss M, Bauersachs J, Haverich A, Schmitto JD. First-in-Man Use of the Percutaneous 10F Reitan Catheter Pump for Cardiorenal Syndrome. ASAIO J 2022; 68:e99-e101. [PMID: 35649225 DOI: 10.1097/mat.0000000000001498] [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
Cardiorenal syndrome worsens outcome in patients with decompensated chronic heart failure, and complicates recompensation by medical therapy. Mechanical circulatory support has the potential to improve renal function, and likely mitigates diuretic resistance in patients with severe cardiorenal syndrome. The Reitan catheter pump (RCP) is a novel temporary percutaneous circulatory support system for reducing cardiac afterload and increasing renal preload. Here, we report on the first-in-man use of the 10F-version of the RCP device, which was associated with favorable effects on hemodynamics and diuresis. Further investigation to evaluate safety and efficacy of this promising approach is warranted.
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Affiliation(s)
- Lars Christian Napp
- From the Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Thomas R Keeble
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals, Basildon, United Kingdom
- Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Faculty of Health, Education, Medicine & Social Care, Anglia Ruskin University, Chelmsford, Essex, United Kingdom
| | - Oyvind Reitan
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Guenes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Marcus Hiss
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- From the Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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5
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A Glimpse Into the Future of Transcatheter Interventional Heart Failure Therapies. JACC Basic Transl Sci 2022; 7:181-191. [PMID: 35257045 PMCID: PMC8897161 DOI: 10.1016/j.jacbts.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 01/09/2023]
Abstract
HF affects millions of patients every year, adding a significant financial burden to global health care systems. This review discusses the role of novel transcatheter-based therapies for the management of HF. Ongoing clinical trials will provide answers on the potential clinical benefits of these technologies in HF outcomes.
Chronic heart failure is one of the most debilitating chronic conditions affecting millions of people and adding a significant financial burden to health care systems worldwide. Despite the significant therapeutic advances achieved over the last decade, morbidity and mortality remain high. Multiple catheter-based interventional therapies targeting different physiological and anatomical targets are already under different stages of clinical investigation. The present paper provides a technical overview of the most relevant catheter-based interventional therapies under clinical investigation.
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Key Words
- CI, confidence interval
- COVID-19, coronavirus disease 2019
- CS, coronary sinus
- CVP, central venous pressure
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- HR, hazard ratio
- LA, left atrium/atrial
- LAP, left atrial pressure
- LV, left ventricular
- LVEDV, left ventricular end-diastolic volume
- LVEF, left ventricular ejection fraction
- LVESV, left ventricular end-systolic volume
- LVESVi, left ventricular end-systolic volume index
- NYHA, New York Heart Association
- PCWP, pulmonary capillary wedge pressure
- RA, right atrium/atrial
- RAP, right atrial pressure
- SVC, superior vena cava
- catheter-based therapies
- heart failure
- interventional heart failure
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6
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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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7
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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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8
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Kapur NK, Esposito ML, Whitehead E. Aortix™: a novel intra-aortic entrainment pump. Future Cardiol 2020; 17:283-291. [PMID: 33353421 DOI: 10.2217/fca-2020-0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Use of short-term mechanical circulatory support pumps for cardiogenic shock, decompensated heart failure and high-risk coronary intervention is growing. The Aortix™ device (Procyrion, TX, USA) is the first axial-flow pump positioned in the aorta and is designed to provide short-term hemodynamic support. This review discusses the field of continuous flow aortic pumps and focuses specifically on emerging preclinical and clinical data supporting the development of these technologies.
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Affiliation(s)
- Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Michele L Esposito
- The Cardiovascular Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Evan Whitehead
- The Cardiovascular Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
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9
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Regamey J, Barras N, Rusca M, Hullin R. A role for the Reitan catheter pump for percutaneous cardiac circulatory support of patients presenting acute congestive heart failure with low output and renal dysfunction? Future Cardiol 2020; 16:159-164. [DOI: 10.2217/fca-2019-0080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Outcomes in acute decompensated heart failure remain poor, in particular when patients present with impaired renal function. Recent results indicate that treatment of acute decompensated heart failure patients with the Reitan catheter pump not only increases cardiac index, but also improves renal function resulting in maintained increase of diuresis. These favorable effects were achieved without significant hemolysis, bleeding or vascular complications suggesting that Reitan catheter pump treatment has the potential to facilitate recovery from acute decompensated heart failure with low output and complicated by renal dysfunction.
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Affiliation(s)
- Julien Regamey
- Cardiology, Cardiovascular Department, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Nicolas Barras
- Cardiology, Cardiovascular Department, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Marco Rusca
- Department of Intensive Care, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Roger Hullin
- Cardiology, Cardiovascular Department, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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10
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Shah AH, Puri R, Kalra A. Management of cardiogenic shock complicating acute myocardial infarction: A review. Clin Cardiol 2019; 42:484-493. [PMID: 30815887 PMCID: PMC6712338 DOI: 10.1002/clc.23168] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/15/2019] [Accepted: 02/26/2019] [Indexed: 12/21/2022] Open
Abstract
Despite advances in percutaneous coronary interventions and their widespread use, mortality in patients presenting with acute myocardial infarction (MI) complicated by cardiogenic shock (CS) has remained very high, and treatment options are limited. Limited evidences exist, supporting many of the routinely used therapies in treating these patients. In the present article, we discuss CS complicating MI in general and an update on the currently available treatment options, including inotropes and vasopressor, coronary revascularization, mechanical circulatory support devices, mechanical complications, and long‐term outcomes.
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Affiliation(s)
- Ashish H Shah
- St Boniface Hospital and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rishi Puri
- Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ankur Kalra
- Cleveland Clinic Foundation, Cleveland, Ohio
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11
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Keeble TR, Karamasis GV, Rothman MT, Ricksten SE, Ferrari M, Hullin R, Scherstén F, Reitan O, Kirking ST, Cleland JG, Smith EJ. Percutaneous haemodynamic and renal support in patients presenting with decompensated heart failure: A multi-centre efficacy study using the Reitan Catheter Pump (RCP). Int J Cardiol 2019; 275:53-58. [DOI: 10.1016/j.ijcard.2018.09.085] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 09/07/2018] [Accepted: 09/24/2018] [Indexed: 01/11/2023]
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12
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[Mechanical circulatory support in cardiogenic shock]. Med Klin Intensivmed Notfmed 2018; 114:77-90. [PMID: 30402731 DOI: 10.1007/s00063-018-0497-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/17/2018] [Accepted: 06/20/2018] [Indexed: 10/27/2022]
Abstract
Acute revascularization is of utmost importance in acute heart failure and infarct-related cardiogenic shock. Besides this therapy of the underlying disease, methods for rapid restoration of arterial blood pressure and sufficient organ perfusion are at the forefront. If conventional means such as volume management, inotropic support, or infusion of vasopressors fail in this situation, mechanical circulatory support may be indicated in selected cases. Noninvasive systems for automatic thorax compression are used for extended cardiopulmonary resuscitation. Intra-aortic balloon counter pulsation (IABP) and axial turbine pumps provide circulatory support and left ventricular unloading. Extracorporeal membrane oxygenation (ECMO) devices consisting of a membrane oxygenator in combination with a centrifugal pump also support the gas exchange in cases of acute pulmonary failure. Using mechanical circulatory support allows lifesaving further diagnostic and therapeutic measures in selected cases, despite limited evidence. They help to restore sufficient arterial blood pressure and therefore organ perfusion in acute heart failure and cardiogenic shock.
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13
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Hemodynamic Benefits of Counterpulsation, Implantable, Percutaneous, and Intraaortic Rotary Blood Pumps: An In-Silico and In Vitro Study. Cardiovasc Eng Technol 2017; 8:439-452. [PMID: 28707188 DOI: 10.1007/s13239-017-0314-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 06/17/2017] [Indexed: 10/19/2022]
Abstract
Mechanical circulatory support (MCS) devices have become a standard therapy for heart failure (HF) patients. MCS device designs may differ by level of support, inflow and/or outflow cannulation sites, and mechanism(s) of cardiac unloading and blood flow delivery. Investigation and direct comparison of hemodynamic parameters that help characterize performance of MCS devices has been limited. We quantified cardiac and vascular hemodynamic responses for different types of MCS devices. Continuous flow (CF) left ventricular (LV) assist devices (LVAD) with LV or left atrial (LA) inlet, counterpulsation devices, percutaneous CF LVAD, and intra-aortic rotary blood pumps (IARBP) were quantified using established computer simulation and mock flow loop models. Hemodynamic data were analyzed on a beat-to-beat basis at baseline HF and over a range of MCS support. Results demonstrated that all LVAD greatly diminished vascular pulsatility (P) and LV external work (LVEW). LVAD with LA inflow provided a greater reduction in LVEW compared to LVAD with LV inflow, but at the potential risk for blood stasis/thrombosis in the LV at high support. Counterpulsation provided greater coronary flow (CoF) augmentation, but had a lower reduction in LVEW compared to partial percutaneous LVAD support. IARBP diminished LVEW, but at the expense of diminished CoF due to coronary steal. The hemodynamic benefits for each type of mechanical circulatory support system are unique and clinical decisions on device selection to maximize end organ perfusion and minimize invasiveness needs to be considered for an individual patients' presentation.
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14
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Murphy C, Zafar H, Sharif F. An updated review of cardiac devices in heart failure. Ir J Med Sci 2017; 186:909-919. [DOI: 10.1007/s11845-017-1597-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/14/2017] [Indexed: 01/13/2023]
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15
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Rezaienia MA, Paul G, Avital EJ, Mozafari S, Rothman M, Korakianitis T. In-vitro investigation of the hemodynamic responses of the cerebral, coronary and renal circulations with a rotary blood pump installed in the descending aorta. Med Eng Phys 2016; 40:2-10. [PMID: 28040435 DOI: 10.1016/j.medengphy.2016.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/02/2016] [Accepted: 11/13/2016] [Indexed: 02/08/2023]
Abstract
This study investigates the hemodynamic responses of the cardiovascular system when a rotary blood pump is operating in the descending aorta, with a focus on the cerebral, coronary and renal autoregulation, using our in-house cardiovascular emulator. Several improvements have been made from our previous studies. A novel coronary system was developed to replicate the native coronary perfusion. Three pinch valves actuated by stepper motors were used to simulate the regional autoregulation systems of the native cerebral, coronary and renal circulations. A rotary pump was installed in the descending aorta, in series with the heart, and the hemodynamic responses of the cardiovascular system were investigated with a focus on cerebral, coronary and renal circulation over a wide range of pump rotor speeds. Experiments were performed twice, once with the autoregulation systems active and once with the autoregulation systems inactive, to reflect that there will be some impairment of autoregulatory systems in a patient with heart failure. It was shown that by increasing the rotor speed to 3000 rpm, the cardiac output was improved from 2.9 to 4.1 L/min as a result of an afterload reduction induced by the pressure drop upstream of the pump. The magnitudes of changes in perfusion in the cerebral, coronary and renal circulations were recorded with regional autoregulation systems active and inactive.
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Affiliation(s)
- M A Rezaienia
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - G Paul
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - E J Avital
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - S Mozafari
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - M Rothman
- Department of Cardiology, London Chest Hospital, Barts and the London NHS Trust, London E2 9JX, UK
| | - T Korakianitis
- Parks College of Engineering, Aviation and Technology, Saint Louis University, St. Louis, Missouri 63103, USA.
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16
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In-vitro investigation of cerebral-perfusion effects of a rotary blood pump installed in the descending aorta. J Biomech 2016; 49:1865-1872. [PMID: 27155746 DOI: 10.1016/j.jbiomech.2016.04.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/19/2016] [Accepted: 04/24/2016] [Indexed: 11/21/2022]
Abstract
This study describes use of a cardiovascular simulator to replicate the hemodynamic responses of the cerebrovascular system with a mechanical circulatory support device operating in the descending aorta. To do so, a cerebral autoregulation unit was developed which replicates the dilation and constriction of the native cerebrovascular resistance system and thereby regulates the cerebral flow rate within defined limits. The efficacy of the replicated autoregulation mechanism was investigated by introducing a number of step alterations in mean aortic pressure and monitoring the cerebral flow. The steady responses of the cerebral flow to changes in mean aortic pressure were in good agreement with clinical data. Next, a rotary pump, modeling a mechanical circulatory support device, was installed in the descending aorta and the hemodynamic responses of the cerebral system were investigated over a wide range of pump operating conditions. Insertion of a mechanical circulatory support device in the descending aorta presented an improved cardiac output as a result of afterload reduction. It was observed that the primary drop in cerebral flow, caused by the pump in the descending aorta, was compensated over the course of five seconds due to a gradual decrease in cerebrovascular resistance. The experimental results suggest that the implantation of a mechanical circulatory support device in the descending aorta, a less invasive procedure than typical mechanical circulatory support implantation, will not have an adverse effect on the cognitive function, provided that the cerebral autoregulation is largely unimpaired.
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17
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Rezaienia MA, Rahideh A, Alhosseini Hamedani B, Bosak DEM, Zustiak S, Korakianitis T. Numerical and In Vitro Investigation of a Novel Mechanical Circulatory Support Device Installed in the Descending Aorta. Artif Organs 2015; 39:502-13. [DOI: 10.1111/aor.12431] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Akbar Rahideh
- School of Electrical and Electronic Engineering; Shiraz University of Technology; Shiraz Iran
| | | | | | - Silviya Zustiak
- Parks College of Engineering, Aviation and Technology; Saint Louis University; St. Louis MO USA
| | - Theodosios Korakianitis
- Parks College of Engineering, Aviation and Technology; Saint Louis University; St. Louis MO USA
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18
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Abstract
PURPOSE OF REVIEW To provide a comprehensive update on the current state of short-term, continuous-flow ventricular assist devices (CF-VADs) in the treatment of refractory cardiogenic shock in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 1 patients. RECENT FINDINGS The mortality rate associated with refractory cardiogenic shock remains markedly elevated, with INTERMACS 1 profile repeatedly demonstrating the worst outcomes. Recent innovations in continuous-flow pump technology have not only contributed to improved outcomes with long-term left ventricular assist device technology, but have also led to the development of various short-term, percutaneous, and surgical CF-VADs. Short-term CF-VADs have several favorable features, but, most notably, they allow the effective temporary stabilization of otherwise refractory cardiogenic shock and serve as a bridge-to-decision therapy. SUMMARY Clinical evidence supporting the use of CF-VADs still remains at the level of small case series, but the data appear promising. However, further rigorous clinical investigation is necessary in order to prove the overall clinical efficacy of these devices in refractory cardiogenic shock.
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19
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An insight into short- and long-term mechanical circulatory support systems. Clin Res Cardiol 2014; 104:95-111. [PMID: 25349064 DOI: 10.1007/s00392-014-0771-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022]
Abstract
Cardiogenic shock due to acute myocardial infarction, postcardiotomy syndrome following cardiac surgery, or manifestation of heart failure remains a clinical challenge with high mortality rates, despite ongoing advances in surgical techniques, widespread use of primary percutaneous interventions, and medical treatment. Clinicians have, therefore, turned to mechanical means of circulatory support. At present, a broad range of devices are available, which may be extracorporeal, implantable, or percutaneous; temporary or long term. Although counter pulsation provided by intra-aortic balloon pump (IABP) and comprehensive mechanical support for both the systemic and the pulmonary circulation through extracorporeal membrane oxygenation (ECMO) remain a major tool of acute care in patients with cardiogenic shock, both before and after surgical or percutaneous intervention, the development of devices such as the Impella or the Tandemheart allows less invasive forms of temporary support. On the other hand, concerning mid-, or long-term support, left ventricular assist devices have evolved from a last resort life-saving therapy to a well-established viable alternative for thousands of heart failure patients caused by the shortage of donor organs available for transplantation. The optimal selection of the assist device is based on the initial consideration according to hemodynamic situation, comorbidities, intended time of use and therapeutic options. The present article offers an update on currently available mechanical circulatory support systems (MCSS) for short and long-term use as well as an insight into future perspectives.
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20
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Rezaienia MA, Rahideh A, Rothman MT, Sell SA, Mitchell K, Korakianitis T. In vitro comparison of two different mechanical circulatory support devices installed in series and in parallel. Artif Organs 2014; 38:800-9. [PMID: 24721023 DOI: 10.1111/aor.12288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study investigates the novel approach of placing a ventricular assist pump in the descending aorta in series configuration with the heart and compares it with the two traditional approaches of left-ventricle-to-ascending-aorta (LV-AA) and left-ventricle-to-descending-aorta (LV-DA) placement in parallel with the heart. Experiments were conducted by using the in-house simulator of the cardiovascular blood-flow loop (SCVL). The results indicate that the use of the LV-AA in-parallel configuration leads to a significant improvement in the systemic and pulmonic flow as the level of continuous flow is increased; however, this approach is considered highly invasive. The use of the LV-DA in-parallel configuration leads to an improvement in the systemic and pulmonic flow at lower levels of continuous flow but at higher levels of pump support leads to retrograde flow. In both in-parallel configurations, increasing the level of pump continuous flow leads to a decrease in pulsatility to a certain extent. The results of placing the pump in the descending aorta in series configuration show that the pressure drop upstream of the pump facilitates cardiac output as a result of afterload reduction. In addition, the pressure rise downstream of the pump may assist with renal perfusion. However, at the same time, the pressure drop generated at the proximal part of the descending aorta induces a slight drop in carotid perfusion, which would be autoregulated by the brain in a native cardiovascular system. The pulse wave analysis shows that placing the pump in the descending aorta leads to improved pulsatility in comparison with the traditional in-parallel configurations.
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Engström AE, Piek JJ, Henriques JPS. Percutaneous left ventricular assist devices for high-risk percutaneous coronary intervention. Expert Rev Cardiovasc Ther 2014; 8:1247-55. [DOI: 10.1586/erc.10.93] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Ruiz P, Rezaienia MA, Rahideh A, Keeble TR, Rothman MT, Korakianitis T. In vitro cardiovascular system emulator (bioreactor) for the simulation of normal and diseased conditions with and without mechanical circulatory support. Artif Organs 2013; 37:549-60. [PMID: 23758568 DOI: 10.1111/aor.12109] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article presents a new device designed to simulate in vitro flow rates, pressures, and other parameters representing normal and diseased conditions of the human cardiovascular system. Such devices are sometimes called bioreactors or "mock" simulator of cardiovascular loops (SCVLs) in literature. Most SCVLs simulate the systemic circulation only and have inherent limitations in studying the interaction of left and right sides of circulation. Those SCVLs that include both left and right sides of the circulation utilize header reservoirs simulating cycles with constant atrial pressures. The SCVL described in this article includes models for all four chambers of the heart, and the systemic and pulmonary circulation loops. Each heart chamber is accurately activated by a separate linear motor to simulate the suction and ejection stages, thus capturing important features in the perfusion waveforms. Four mechanical heart valves corresponding to mitral, pulmonary, tricuspid, and aortic are used to control the desired unidirectional flow. This SCVL can emulate different physiological and pathological conditions of the human cardiovascular system by controlling the different parameters of blood circulation through the vascular tree (mainly the resistance, compliance, and elastance of the heart chambers). In this study, four cases were simulated: healthy, congestive heart failure, left ventricular diastolic dysfunction conditions, and left ventricular dysfunction with the addition of a mechanical circulatory support (MCS) device. Hemodynamic parameters including resistance, pressure, and flow have been investigated at aortic sinus, carotid artery, and pulmonary artery, respectively. The addition of an MCS device resulted in a significant reduction in mean blood pressure and re-establishment of cardiac output. In all cases, the experimental results are compared with human physiology and numerical simulations. The results show the capability of the SCVL to replicate various physiological and pathological conditions with and without MCS.
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Affiliation(s)
- Paula Ruiz
- School of Engineering and Materials Science, Queen Mary University of London, UK
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23
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Hsu PL, Wang Y, Amaral F, Parker J, Schmitz-Rode T, Autschbach R, Steinseifer U. Design Method of a Foldable Ventricular Assist Device for Minimally Invasive Implantation. Artif Organs 2013; 38:298-308. [DOI: 10.1111/aor.12145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Po-Lin Hsu
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute; RWTH Aachen University; Aachen Germany
| | - Yaxin Wang
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute; RWTH Aachen University; Aachen Germany
| | - Felipe Amaral
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute; RWTH Aachen University; Aachen Germany
| | - Jack Parker
- Department of Cardiothoracic and Vascular Surgery; University Hospital Aachen; Aachen Germany
| | - Thomas Schmitz-Rode
- Institute of Applied Medical Engineering, Helmholtz Institute; RWTH Aachen University; Aachen Germany
| | - Rüdiger Autschbach
- Department of Cardiothoracic and Vascular Surgery; University Hospital Aachen; Aachen Germany
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute; RWTH Aachen University; Aachen Germany
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Lockie T, Redwood S. Future Directions for Percutaneous Mechanical Circulatory Support Devices. Interv Cardiol Clin 2013; 2:485-494. [PMID: 28582108 DOI: 10.1016/j.iccl.2013.03.004] [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: 06/07/2023]
Abstract
Outcomes of patients in cardiogenic shock remain high, but the development of novel percutaneous mechanical circulatory support devices offers additional therapeutic options. Hand in hand with innovations in device technology, however, must also come development of integrated circulatory support networks focusing on rapid assessment of patients, multidisciplinary discussion, and timely therapeutic intervention. This article summarizes some of the recent developments in device technology; potential procedures for patient risk stratification, device selection, and response to therapy; management of vascular access to reduce insertion point complications; and some of the expanding potential roles of percutaneous mechanical circulatory support devices.
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Affiliation(s)
- Tim Lockie
- Cardiothoracic Centre, St Thomas' Hospital, Guys & St Thomas' NHS Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Simon Redwood
- King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St Thomas' Hospital Campus, London, UK.
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Wadke R, Sanborn TA. Cardiogenic Shock: Background, Shock Trial/Registry, Evolving Data, Changing Survival, Best Medical Therapy. Interv Cardiol Clin 2013; 2:397-406. [PMID: 28582101 DOI: 10.1016/j.iccl.2013.03.002] [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: 11/29/2022]
Abstract
Cardiogenic shock remains associated with unacceptably high mortality, but recent improvements with early revascularization, continued support with pharmacologic agents, and use of an intra-aortic balloon pump have led to improvements in the rate of mortality. Timely intervention with cardiac surgery in patients with mechanical complications, 3-vessel disease, and left main disease is beneficial. Continued research and ever-improving understanding of this once deadly condition have helped further in improving prognosis. Cutting-edge technologies, such as myocyte cell implantation and the use of a cooling system, will help in pushing the boundaries farther.
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Affiliation(s)
- Rahul Wadke
- Hospitalist Division, Department of Internal Medicine, Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA.
| | - Timothy A Sanborn
- Head Cardiology Division, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, 2650 Ridge Avenue, Walgreen Building, Third Floor, Evanston, IL 60201, USA
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Flow Modulation Algorithms for Intra-Aortic Rotary Blood Pumps to Minimize Coronary Steal. ASAIO J 2013; 59:261-8. [DOI: 10.1097/mat.0b013e31828fd6c8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Mao H, Giuliani A, Blanca-Martos L, Kim JC, Nayak A, Virzi G, Brocca A, Scalzotto E, Neri M, Katz N, Ronco C. Effect of Percutaneous Ventricular Assist Devices on Renal Function. Blood Purif 2013; 35:119-26. [DOI: 10.1159/000346096] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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28
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Abstract
Thousands of mechanical blood pumps are currently providing circulatory support, and the incidence of their use continues to increase each year. As the use of blood pumps becomes more pervasive in the treatment of those patients with congestive heart failure, critical advances in design features to address known limitations and the integration of novel technologies become more imperative. To advance the current state-of-the-art in blood pump design, this study investigates the inclusion of pitch-adjusting blade features in intravascular blood pumps as a means to increase energy transfer; an approach not explored to date. A flexible impeller prototype was constructed with a configuration to allow for a variable range of twisted blade geometries of 60-250°. Hydraulic experiments using a blood analog fluid were conducted to characterize the pressure-flow performance for each of these twisted positions. The flexible, twisted impeller was able to produce 1-25 mmHg for 0.5-4 L/min at rotational speeds of 5,000-8,000 RPM. For a given twisted position, the pressure rise was found to decrease as a function of increasing flow rate, as expected. Generally, a steady increase in the pressure rise was observed as a function of higher twisted degrees for a constant rotational speed. Higher rotational speeds for a specific twisted impeller configuration resulted in a more substantial pressure generation. The findings of this study support the continued exploration of this unique design approach in the development of intravascular blood pumps.
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Sharma AB, Kovacic JC, Kini AS. Percutaneous Left Ventricular Assist Devices. Interv Cardiol Clin 2012; 1:609-622. [PMID: 28581973 DOI: 10.1016/j.iccl.2012.07.003] [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: 06/07/2023]
Abstract
Percutaneous left ventricular assist devices (P-LVADs) can be life saving and may permit the stabilization of a patient in cardiovascular collapse who would otherwise face imminent demise. For specific patients and clinical indications, or where a greater degree of hemodynamic support is required, numerous studies have demonstrated the feasibility and safety of the newer generation P-LVADs. The potential applications for P-LVADs have continued to expand, now including diverse uses such as support for cardiogenic shock, bridge to and following cardiac surgery, and more novel applications such as complex electrophysiologic mapping and ablation studies of unstable ventricular rhythms.
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Affiliation(s)
- Amit B Sharma
- Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA
| | - Jason C Kovacic
- Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA
| | - Annapoorna S Kini
- Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
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30
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Bartoli CR, Dowling RD. The future of adult cardiac assist devices: novel systems and mechanical circulatory support strategies. Cardiol Clin 2012; 29:559-82. [PMID: 22062206 DOI: 10.1016/j.ccl.2011.08.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The recent, widespread success of mechanical circulatory support has prompted the development of numerous implantable devices to treat advanced heart failure. It is important to raise awareness of novel device systems, the mechanisms by which they function, and implications for patient management. This article discusses devices that are being developed or are in clinical trials. Devices are categorized as standard full support, less-invasive full support, partial support: rotary pumps, partial support: counterpulsation devices, right ventricular assist device, and total artificial heart. Implantation strategy, mechanism of action, durability, efficacy, hemocompatibility, and human factors are considered. The feasibility of novel strategies for unloading the failing heart is examined.
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Affiliation(s)
- Carlo R Bartoli
- Department of Physiology and Biophysics, University of Louisville School of Medicine, Louisville, KY, USA
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31
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Arroyo D, Cook S. Percutaneous ventricular assist devices: new deus ex machina? Minim Invasive Surg 2011; 2011:604397. [PMID: 22091361 PMCID: PMC3197007 DOI: 10.1155/2011/604397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 05/22/2011] [Accepted: 05/25/2011] [Indexed: 11/26/2022] Open
Abstract
The development of ventricular assist devices has broadened the means with which one can treat acute heart failure. Percutaneous ventricular assist devices (pVAD) have risen from recent technological advances. They are smaller, easier, and faster to implant, all important qualities in the setting of acute heart failure. The present paper briefly describes the functioning and assets of the most common devices used today. It gives an overview of the current evidence and indications for left ventricular assist device use in cardiogenic shock and high-risk percutaneous coronary intervention. Finally, extracorporeal life support devices are dealt with in the setting of hemodynamic support.
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Affiliation(s)
- Diego Arroyo
- Cardiology Unit, University Medical Center, University of Fribourg, 1708 Fribourg, Switzerland
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32
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Brown JR, Thompson CA. Contrast-induced acute kidney injury: the at-risk patient and protective measures. Curr Cardiol Rep 2011; 12:440-5. [PMID: 20640537 DOI: 10.1007/s11886-010-0129-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Contrast-induced acute kidney injury (CI-AKI) is a major complication following radiocontrast procedures. In this review, we characterize the recent literature on CI-AKI, risk factors, prevention, biomarkers, and new technologies. The premise of CI-AKI prophylaxis should focus on implementing mandatory standing orders before and after cardiac catheterization for hydration with normal saline or sodium bicarbonate and use of high-dose (1200-mg) N-acetylcysteine. Contrast agents may play a role in preventing CI-AKI. Implement catheter-laboratory technology and awareness to limit the amount of contrast dye used for any patient.
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Affiliation(s)
- Jeremiah R Brown
- The Dartmouth Institute for Health Policy and Clinical Practice, Section of Cardiology, Dartmouth Medical School, Hanover, NH, USA
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Throckmorton AL, Kapadia JY, Carr JP, Powell CM, Tate RD, Traynham DV. Flexible Impeller Blades in an Axial Flow Pump for Intravascular Cavopulmonary Assistance of the Fontan Physiology. Cardiovasc Eng Technol 2010. [DOI: 10.1007/s13239-010-0026-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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