An implantable centrifugal blood pump with a recirculating purge system (Cool-Seal system)

Comparison of the Hemocompatibility of an Axial and a Centrifugal Left Ventricular Assist Device in an In Vitro Test Circuit

BACKGROUND

Hemocompatibility of left ventricular assist devices is essential for preventing adverse events. In this study, we compared the hemocompatibility of an axial-flow (Sputnik) to a centrifugal-flow (HeartMate 3) pump.

METHODS

Both pumps were integrated into identical in vitro test circuits, each filled with 75 mL heparinized human blood of the same donor. During each experiment (n = 7), the pumps were operated with equal flow for six hours. Blood sampling and analysis were performed on a regular schedule. The analytes were indicators of hemolysis, coagulation activation, platelet count and activation, as well as extracellular vesicles.

RESULTS

Sputnik induced higher hemolysis compared to the HeartMate 3 after 360 min. Furthermore, platelet activation was higher for Sputnik after 120 min onward. In the HeartMate 3 circuit, the platelet count was reduced within the first hour. Furthermore, Sputnik triggered a more pronounced increase in extracellular vesicles, a potential trigger for adverse events in left ventricular assist device application. Activation of coagulation showed a time-dependent increase, with no differences between both groups.

CONCLUSIONS

This experimental study confirms the hypothesis that axial-flow pumps may induce stronger hemolysis compared to centrifugal pumps, coming along with larger amounts of circulating extracellular vesicles and a stronger PLT activation.

Advancements in left ventricular assist devices to prevent pump thrombosis and blood coagulopathy

Mechanical circulatory support (MCS) devices, such as left ventricular assist devices (LVADs) are very useful in improving outcomes in patients with advanced-stage heart failure. Despite recent advances in LVAD development, pump thrombosis is one of the most severe adverse events caused by LVADs. The contact of blood with artificial materials of LVAD pumps and cannulas triggers the coagulation cascade. Heat spots, for example, produced by mechanical bearings are often subjected to thrombus build-up when low-flow situations impair washout and thus the necessary cooling does not happen. The formation of thrombus in an LVAD may compromise its function, causing a drop in flow and pumping power leading to failure of the LVAD, if left unattended. If a clot becomes dislodged and circulates in the bloodstream, it may disturb the flow or occlude the blood vessels in vital organs and cause internal damage that could be fatal, for example, ischemic stroke. That is why patients with LVADs are on anti-coagulant medication. However, the anti-coagulants can cause a set of issues for the patient-an example of gastrointestinal (GI) bleeding is given in illustration. On account of this, these devices are only used as a last resort in clinical practice. It is, therefore, necessary to develop devices with better mechanics of blood flow, performance and hemocompatibility. This paper discusses the development of LVADs through landmark clinical trials in detail and describes the evolution of device design to reduce the risk of pump thrombosis and achieve better hemocompatibility. Whilst driveline infection, right heart failure and arrhythmias have been recognised as LVAD-related complications, this paper focuses on complications related to pump thrombosis, especially blood coagulopathy in detail and potential strategies to mitigate this complication. Furthermore, it also discusses the LVAD implantation techniques and their anatomical challenges.

Surface Coatings for Rotary Ventricular Assist Devices: A Systematic Review

Rotary ventricular assist devices (VADs) are frequently used to provide mechanical circulatory support to patients suffering from end-stage heart failure. Therefore, these devices and especially their pump impeller and housing components have stringent requirements on wear resistance and hemocompatibility. Various surface coatings have been investigated to improve the wear resistance or hemocompatibility of these devices. The aim of the present systematic review was to build a comprehensive understanding of these coatings and provide potential future research directions. A Boolean search for peer-reviewed studies was conducted in online databases (Web of Science, Scopus, PubMed, and ScienceDirect), and a preferred reporting items for systematic reviews and meta-analyses (PRISMA) process was followed for selecting relevant papers for analysis. A total of 45 of 527 publications were included for analysis. Eighteen coatings were reported to improve wear resistance or hemocompatibility of rotary VADs with the most common coatings being diamond-like carbon (DLC), 2-methacryloyloxyethyl phosphorylcholine (MPC), and heparin. Ninety-three percent of studies focused on hemocompatibility, whereas only 4% of studies focused on wear properties. Thirteen percent of studies investigated durability. This review provides readers with a systematic catalogue and critical review of surface coatings for rotary VADs. The review has identified that more comprehensive studies especially investigations on wear properties and durability are needed in future work.

The Biocompatibility Challenges in the Total Artificial Heart Evolution

There are limited therapeutic options for final treatment of end-stage heart failure. Among them, implantation of a total artificial heart (TAH) is an acceptable strategy when suitable donors are not available. TAH development began in the 1930s, followed by a dramatic evolution of the actuation mechanisms operating the mechanical pumps. Nevertheless, the performance of TAHs has not yet been optimized, mainly because of the low biocompatibility of the blood-contacting surfaces. Low hemocompatibility, calcification, and sensitivity to infections seriously affect the success of TAHs. These unsolved issues have led to the withdrawal of many prototypes during preclinical phases of testing. This review offers a comprehensive analysis of the pathophysiological events that may occur in the materials that compose TAHs developed to date. In addition, this review illustrates bioengineering strategies to prevent these events and describes the most significant steps toward the achievement of a fully biocompatible TAH.

Evaluation of Subretinal Implants Coated with Amorphous Aluminum Oxide and Diamond-like Carbon

Retinal prostheses may be used to support patients suffering from age-related macular degeneration (AMD) or retinitis pigmentosa (RP). A hermetic encapsulation of the poly(imide) (PI)-based prosthesis is important in order to prevent the leakage of water and ions into the electric circuitry embedded in the poly(imide) matrix. The deposition of amorphous aluminum oxide (by sputtering) and diamond like carbon (by pulsed laser ablation) were made for applications in retinal prostheses. The thin films obtained were characterized for composition, thickness, adhesion and smoothness by scanning electron microscopy-energy dispersive spectroscopy, atomic force microscopy, profilometry and light microscopy. Biocompatibility was tested in vivo by implanting coated specimen subretinally in the eye of Yucatan pigs. While amorphous aluminum oxide is more readily deposited with sufficient adhesion quality, superior biocompatibility behavior was shown by diamond-like carbon. Amorphous aluminum oxide had more adverse effects and caused more severe damage to the retinal tissue.

Investigation on Surface and Biological Properties of Silver Containing Diamond Like Carbon Films on Polyethylene Terephthalate Film Surface by Hybrid Reactive Sputtering Method

Silver containing diamond like carbon films were coated on the surface of polyethylene film (PET) using novel hybrid sputtering method. Polymeric substrates can create soft, flexible, highly absorbent and cost-effective materials by selecting or controlling their molecular structures. The material silver is known to be a potential antibacterial material. The silver containing coating has been potentially recommended for synthesis biomedical materials. In the present work, we discussed the antibacterial activity of the silver containing DLC film coated PET film surfaces which was coated as a function of deposition power level. The surface morphology of the Ag-DLC was analysed by atomic force microscopy (AFM) and scanning electron microscopy (SEM). The atomic concentration and structure of the Ag-DLC was measured by energy dispersive X-ray (EDX) and Raman spectroscopy. The hydrophilicity of the films was measured by contact angle analysis. The antibacterial activity of Ag–DLC films were evaluated by bacterial eradication tests withEscherichia coliat incubation time of one day. In addition, blood compatibility of the Ag-DLC films were studied byIn Vitroblood compatibility tests. It was found that the surface of the obtained Ag-DLC decreases with increasing the deposition power level. The antibacterial and hemocompatibility of the silver containing DLC film increase gradually with increase of deposition power level. Our results revealed that the Ag-incorporated DLC films are potentially useful as biomedical devices having good antibacterial and hemocompatibility.

Evaluation of optical propagation in blood for noninvasive detection of prethrombus blood condition

This article evaluates the optical propagation to detect a "prethrombus" blood noninvasively. Thrombosis is still an inevitable issue in use of blood pumps, and it is required to predict thrombus formation as early as possible. We focused on the red blood cell (RBC) aggregation that is one of the features of thrombogenic process. First, by using a computer simulation, we calculated the optical propagations in blood for the RBC aggregation and nonaggregation blood. This simulation is based on the Monte-Carlo method and attempts to calculate the optical characteristics of the blood stochastically. In our simulation, the optical propagation with the RBC aggregation showed a different characteristic from that of the nonaggregation. Next, we examined the optical propagation in bovine blood with various activated whole blood clotting time (ACT). The blood mixed with sodium citrate was circulated by a blood pump. The ACT was adjusted between 1,000 and 50 seconds by controlling the ratio of calcium chloride solution to sodium citrate. We confirmed the RBC aggregation by using microscopic images and microthromboses in the pump directly. As a result, we evaluated that the change of the optical propagation has a correlation with thrombogenic process just as it was observed in our computer simulation. Our data indicate that the measurement of optical propagation can detect a prethrombous blood condition with RBC aggregation. Our study will help to establish optical technologies to detect prethrombous continuously and noninvasively.

Surface coatings for ventricular assist devices

This article focuses on the surface engineering of ventricular assist devices (VADs) for the treatment of heart failure patients, which involves the modification of surfaces contacting blood in order to improve the blood compatibility (hemocompatibility) of the VADs. Following an introduction to the categorization and the complications of VADs, this article pays attention on the hemocompatibility, applications and limitations of six types of surface coatings for VADs: titanium nitride coatings, diamond-like carbon coatings, 2-methacryloyloxyethyl phosphorylcholine polymer coatings, heparin coatings, textured surfaces and endothelial cell linings. In particular, diamond-like coatings and heparin coatings are the most commonly used for VADs owing to their excellent hemocompatibility, durability and technical maturity. For high performance and a long lifetime of VADs, surface modification with coatings to ensure hemocompatibility is as important as the mechanical design of the device.

Completely pulsatile high flow circulatory support with a constant-speed centrifugal blood pump: mechanisms and early clinical observations

OBJECTIVE

Various types of rotary blood pumps (axial flow, centrifugal) have been introduced into clinical use recently. These pumps have different pressure-flow characteristics, and some investigators have noted that a limited pump flow rate and less pulsatility are the problems with the axial flow devices.

METHODS

A new implantable centrifugal blood pump was developed that has an extremely flat pressure-flow curve and is able to produce a significantly high pump flow rate of 20 l/min at a low pressure of 10-30mmHg. When the pressure difference between the left ventricle and aorta decreases during systole, an instant high peak flow is achieved, which results in a higher peak pressure in the aorta (systolic pressure). During the diastolic phase, the left ventricle-aorta pressure difference increases to maximum, and the pump flow rate decreases to minimum. Thus, the pump flow rate becomes completely pulsatile, and the high peak flow provides a higher mean pump flow rate. This pump was applied to two end-stage heart failure patients (dilated cardiomyopathy, New York Heart Association (NYHA) class IV, inotrope-dependent).

RESULTS

The pump was observed to provide completely pulsatile high flow assistance of 6-9 l/min with a constant pump speed. Both patients are currently in NYHA class I after 1 year on the device with no major adverse events.

CONCLUSION

The new centrifugal blood pump provides completely pulsatile high-flow circulatory support with a constant pump speed, which solves the current clinical problems with rotary blood pumps.

Leukocyte-platelet aggregates and monocyte tissue factor expression in bovines implanted with ventricular assist devices

Infection and thromboembolism remain significant complications associated with ventricular assist device (VAD) support, including the newer rotary VADs, limiting wider adoption of this promising technology. These complications persist in spite of extensive preclinical testing in large animal models. The amount of biocompatibility information collected during preclinical trials is limited due to a lack of available assays. We thus developed three flow cytometric assays to measure leukocyte-platelet aggregates and monocyte tissue factor expression and applied them to 26 bovines implanted with two types of rotary VADs. All animals displayed low levels of circulating aggregates and monocytes expressing tissue factor prior to device implant. The assay values significantly increased following VAD implant, then usually declined to a lower, yet significantly elevated versus baseline, level indicative of ongoing inflammation. The implementation of more robust biocompatibility assays for the evaluation of cardiovascular device performance and modification might ultimately contribute to the development of safer artificial organs.

Preclinical biocompatibility assessment of the EVAHEART ventricular assist device: Coating comparison and platelet activation

Thromboembolism and bleeding remain significant complications of ventricular assist device (VAD) support. Increasing the amount of biocompatibility data collected during preclinical studies can provide additional criteria to evaluate device refinements, while design changes may be implemented before entering clinical use. Twenty bovines were implanted with the EVAHEART centrifugal VAD for durations from 30 to 196 days. Titanium alloy pumps were coated with either diamond-like carbon or 2-methoxyethyloylphosphoryl choline (MPC). Activated platelets and platelet microaggregates were quantified by flow cytometry, including two new assays to quantify bovine platelets expressing CD62P and CD63. Temporally, all assays were low preoperatively, then significantly increased following VAD implantation, before declining to a lower, but still elevated level over 2-3 weeks. MPC-coated VADs produced significantly fewer activated platelets after implant trauma effects diminished. Three animals receiving no postoperative anticoagulation had similar amounts of circulating activated platelets and platelet microaggregates as animals receiving warfarin anticoagulation. Two new methods to quantify bovine activated platelets using antibodies to CD62P and CD63 were characterized and applied. These measures, along with previously described assays, were able to differentiate between two biocompatible coatings and assess effects of anticoagulation regimen in VAD preclinical testing.

Feasibility of a Miniature Centrifugal Rotary Blood Pump for Low-Flow Circulation in Children and Infants

In this study, a seal-less, tiny centrifugal rotary blood pump was designed for low-flow circulatory support in children and infants. The design was targeted to yield a compact and priming volume of 5 ml with a flow rate of 0.5-4 l/min against a head pressure of 40-100 mm Hg. To meet the design requirements, the first prototype had an impeller diameter of 30 mm with six straight vanes. The impeller was supported with a needle-type hydrodynamic bearing and was driven with a six-pole radial magnetic driver. The external pump dimensions included a pump head height of 20 mm, diameter of 49 mm, and priming volume of 5 ml. The weight was 150 g, including the motor driver. In the mock circulatory loop, using fresh porcine blood, the pump yielded a flow of 0.5-4.0 l/min against a head pressure of 40-100 mm Hg at a rotational speed of 1800-4000 rpm using 1/4" inflow and outflow conduits. The maximum flow and head pressure of 5.25 l/min and 244 mm Hg, respectively, were obtained at a rotational speed of 4400 rpm. The maximum electrical-to-hydraulic efficiency occurred at a flow rate of 1.5-3.5 l/min and at a rotational speed of 2000-4400 rpm. The normalized index of hemolysis, which was evaluated using fresh porcine blood, was 0.0076 g/100 l with the impeller in the down-mode and a bearing clearance of 0.1 mm. Further refinement in the bearing and magnetic coupler are required to improve the hemolytic performance of the pump. The durability of the needle-type hydrodynamic bearing and antithrombotic performance of the pump will be performed before clinical applications. The tiny centrifugal blood pump meets the flow requirements necessary to support the circulation of pediatric patients.

Mechanical circulatory support devices (MCSD) in Japan: current status and future directions

The current status and future directions of mechanical circulatory support devices (MCSDs) in Japan are reviewed. Currently used clinical MCSDs, both domestic and imported systems and continuous flow devices that are coming into the clinical arena are emphasized. Clinical MCSDs include the extracorporeal pulsatile Toyobo and Zeon systems and the implantable Novacor and HeartMate I VE. A thorough review is presented of single-ventricle continuous flow MCSDs such as the Terumo DuraHeart and the SunMedical EVAHEART and the biventricular Miwatec/Baylor systems that are on the horizon. The future directions in management of end-stage cardiac patients with MCSDs are discussed, focusing on (1) device selection - pulsatile versus continuous flow devices; (2) single-ventricle support, biventricular support, or replacement; (3) bridge to transplantation, destination therapy, or bridge to recovery; and (4) government regulatory processes and the medical industry. We hope to promote the quality of life (QOL) of end-stage cardiac patients as well as the medical industry in Japan.

An abutment screw loosening study of a Diamond Like Carbon-coated CP titanium implant

The aim of this study was to quantify the extent of abutment screw loosening and thus understand the role of frictional and wear factors in abutment screw loosening by using a cyclic loading device to compare Diamond Like Carbon (DLC)-coated and non-coated implants. The properties of DLC films, including hardness, wear resistance, chemical stability, and biocompatibility, are similar to those of real diamond materials. In this study, a 1-mum thick DLC film served to protect and lubricate a layer of commercially-pure titanium affixed to the top of a dental implant (external hexagon-shaped implant). A cyclic loading force was then applied to the top of the prosthetic portion of the implants in order to determine the difference in looseness of the titanium abutment screw between ten DLC-coated implants and ten non-coated implants. The abutment screw loosening tests were performed with 100 N of force at a frequency of 20 Hz. Data indicate that implants with a DLC coating are more resistant to an applied force (P = 0.002) than are those without the coating. We hope these results will be useful for preventing implant abutment screw loosening.

Arterial Sound Based Noninvasive Malrotation Detection of Rotary LVAD

A number of advanced cardiovascular assist devices have been developed recently with the capability to prolong the life expectancy of patients with cardiac disease. To allow long-term use, it is necessary to assemble these devices using as few accessories as possible; however, a sensor for mechanical disorder detection is typically included to ensure mechanical reliability. Although a rotary left ventricular assist device (LVAD) has a simple mechanism, a malrotation caused by thrombogenesis can occur at any time. This situation could cause fatal damage to the cardiovascular circulation of the patient. In this study, we propose a simple, noninvasive method based on Korotkoff sounds, which would be able to detect the pressure-flow state during circulation supported by a rotary LVAD. Korotkoff sounds provide a means to noninvasively measure blood pressure in auscultation. We have found that the sounds are directly influenced by the pressure-flow state. We measured the arterial sound generated by an occluded brachial artery, as well as the Korotkoff sound generated during rotary LVAD circulation. To verify the effectiveness of the system, a circulatory simulator, rather than a human subject, was used. The arterial sound of several abnormal pressure-flow conditions was investigated. The simulator consists of a pulsatile blood pump, a compliance chamber, flow valves, a venous reservoir, and a rotary LVAD. Abnormal pressure-flow states are generated by simply changing the rotational speed of the rotary LVAD. We established the relationship between an abnormal pressure-flow state and the characteristics of the arterial sound, thus demonstrating that a malrotation of the rotary LVAD can be detected by the change of the arterial sound.

A Comparative Study Between Flow Visualization and Computational Fluid Dynamic Analysis for the Sun Medical Centrifugal Blood Pump

Flow visualization experiments and computational fluid dynamic (CFD) analyses were performed and the results were compared to clarify the detailed fluid dynamic characteristics for the prototype design of a centrifugal pump, namely, an implantable ventricular assist system from Sun Medical, whose hemocompatibility was previously demonstrated in a series of animal experiments. The flow visualization was conducted with particle tracking velocimetry, and the CFD analysis was performed with STAR-CD software. The findings were as follows: (1). There were no flow separations around the curved open impeller. (2). Antithrombogenic design concepts for the inducer and the vane-shaft clearance were effective in producing axial velocity along the shaft surface and generat-ing suitable shear rates against the stationary fluid. (3). Unsteady vortex shedding in the outlet, which adversely affected the fluid dynamic efficiency, was observed clearly by flow visualization. Comparison of velocity distribution measured by flow visualization and CFD analysis showed reasonably good correlation. Our findings indicate that the impeller is suitable for an implantable artificial heart. The techniques of flow visualization and CFD analysis are complementary evaluation tools in research and development efforts.

Activation of platelets adhered on amorphous hydrogenated carbon (a-C:H) films synthesized by plasma immersion ion implantation-deposition (PIII-D)

Amorphous carbon films have attracted much attention recently due to their good biocompatibility. Diamond-like carbon (DLC), one form of amorphous carbon that is widely used in many kinds of industries, has been proposed for use in blood contacting medical devices. However, the blood coagulation mechanism on DLC in a biological environment is not well understood. Platelet adhesion and activation are crucial events in the interactions between blood and the materials as they influence the subsequent formation of thrombus. In this work, the behavior of platelets adhered onto hydrogenated amorphous carbon films (a-C:H) is investigated. Hydrogenated amorphous carbon films with different hydrogen contents, structures, and chemical bonds were fabricated at room temperature using plasma immersion ion implantation-deposition (PIII-D). The wettability of the films was investigated by contact angle measurements using several common liquids. Platelet adhesion experiments were conducted to examine the interaction of blood with the films in vitro and the activation of adherent platelets. The results show that the behavior of the platelets adhered on the a-C:H films is influenced by their structure and chemical bond, and it appears that protein interaction plays a key role in the activation of the adherent platelets.

In vivo evaluation of a MPC polymer coated continuous flow left ventricular assist system

The aim of this study was the evaluation of the thrombogenicity and the biocompatibility of the SunMedical EVAHEART left ventricular assist system (LVAS) coated with 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer compared to a diamond-like carbon (DLC) coating. Four calves were implanted with the MPC polymer-coated LVAS. Eight calves were implanted with DLC coated LVAS. The thrombogenicity and biocompatibility of the pumps were evaluated. At explant, 60.0 +/- 37.2% (5-85%) of the pump surface area was still coated with MPC polymer after the duration of 45.0 +/- 32.0 days. In 1 out of 4 MPC and 2 out of 8 DLC coated pumps, there was a very small amount of thrombus around the seal ring; otherwise the blood contacting surfaces were free of thrombus. Major organs were normal except for a few lesions in kidneys from both groups. The MPC polymer coated EVAHEART LVAS seems to have low thrombogenicity and high biocompatibility similar to the DLC coated system. The current study demonstrated that the MPC polymer coating shows great promise for being used as an antithrombogenic substrate for the LVAS due to its ease of application, significant cost benefit, and reduction in anticoagulation therapy in acute postoperative period.

EVAHEART: an implantable centrifugal blood pump for long-term circulatory support

OBJECTIVE

We developed "EVAHEART": a compact centrifugal blood pump system as an implantable left ventricular assist device for long-term circulatory support. The 55 x 64 mm pump is made from pure titanium, and weighs 370 g. The entire blood-contacting surface is covered with an anti-thrombogenic coating of diamond like carbon (DLC) or 2-methacryloyloxyethyl phosphorylcholine (MPC) to improve blood compatibility. Flows exceeding 12 L/min against 100 mmHg pressure at 2600 rpm was measured. A low-temperature mechanical seal with recirculating cooling system is used to seal the shaft. EVAHEART demonstrated an acceptably low hemolysis rate with normalized index of hemolysis of 0.005 +/- 0.002 g/100L.

METHODS

We evaluated the pump in long-term in-vivo experiments with seven calves. Via left thoracotomy, we conducted left ventricular apex-descending aorta bypass, placing the pump in the left thoracic cavity.

RESULTS

Pump flow rates was maintained at 5-9 L/min, pump power consumption remained stable at 9-10 W in all cases, plasma free Hb levels were less than 15 mg/dl, and the seal system showed good seal capability throughout the experiments. The calves were sacrificed on schedule on postoperative day 200, 222, 142, 90, 151, 155, and 133. No thrombi formed on the blood contacting surface with either the DLC or MPC coating, and no major organ thromboembolisms occurred except for a few small renal infarcts.

CONCLUSION

EVAHEART centrifugal blood pump demonstrated excellent performance in long-term in-vivo experiments.

Visualization study of the transient flow in the centrifugal blood pump impeller

Rotary blood pumps as a left ventricular assist device have several advantages over the use of existing pulsatile devices used for this purpose. The relative velocity distribution to the rotating impeller was observed by high-speed videography and particle image velocimetry (PIV) with the purpose of characterizing the unsteady fluid motion in the impeller and assessing antithrombogenicity based on the fluid dynamic properties within the flow path. Flow visualization in the present study has clearly shown the existence of drastic transient motion of flows in the impeller. The secondary flows developed in the passage, which are adverse in terms of hydrodynamic efficiency, contributed to the washout conditions on the blood contacting surface.

Mechanical circulatory support for infants and children with cardiac disease

Mechanical circulatory support is assuming an expanding role in the practice of congenital cardiac surgery. Extracorporeal membrane oxygenation and centrifugal ventricular assist devices are still the mainstay of mechanical circulatory support for children; however, newly developed pulsatile, paracorporeal ventricular assist devices designed for pediatric applications are achieving increased utilization. In addition, several new, continuous flow devices that are under development as fully implantable systems for adults, ultimately may be useful for pediatric patients.

Improvement of washout flow in a centrifugal blood pump by a semi-open impeller

To reduce the possible thrombogenicity of the pump studied, pump characteristics and washout conditions were compared between a pump with a semi-open and a pump with a full-open impeller. A difference in hydrodynamic performance was observed between the semi-open impeller and the full-open impeller; the pressure in the former was less by approximately 10%, and the maximum attainable efficiency decreased from 0.41 to 0.34. The flow pattern, as visualized by the oil film method, showed that the washout condition was enhanced by addition of the shroud, especially at the bottom region of the pump where the blood flow tended to be stagnant. The stagnant area was observed in the suction side of the impeller in both models, where the vortices shed from the impeller tip contributed to the washout. It was also shown that the flow entering the bottom region was circumferentially uniform in the full-open impeller, whereas in the semi-open impeller the flow was not uniform and entered primarily from the vicinity of the outlet port. The semi-open impeller, thus, was demonstrated to have better washout conditions than the full-open impeller regardless of a slight decrease in hydrodynamic efficiency.

Design and evaluation of a single-pivot supported centrifugal blood pump

In order to develop a centrifugal blood pump that meets the requirements of a long-term, implantable circulatory support device, in this study a single-pivot bearing supported centrifugal blood pump was designed to evaluate its basic performance. The single-pivot structure consisted of a ceramic ball male pivot mounted on the bottom surface of the impeller and a polyethylene female pivot incorporated in the bottom pump casing. The follower magnet mounted inside the impeller was magnetically coupled to the driver magnet mounted on the shaft of the direct current brushless motor. As the motor rotated, the impeller rotated supported entirely by a single-pivot bearing system. The static pump performance obtained in the mock circulatory loop revealed an acceptable performance as a left ventricular assist device in terms of flow and head pressure. The pump flow of 5 L/min against the head pressure of 100 mm Hg was obtained at rotational speeds of 2,000 to 2,200 rpm. The maximum pump flow was 9 L/min with 2,200 rpm. The maximum electrical-to-hydraulic power conversion efficiency was around 14% at pump flows of 4 to 5 L/min. The stability of the impeller was demonstrated at the pump rpm higher than 1,400 with a single-pivot bearing without an additional support at its top. The single-pivot supported centrifugal pump can provide adequate flow and pressure as a ventricular assist device, but its mechanical stability and hemolytic as well as thrombotic performances must be tested prior to clinical use.

The role of diastolic pump flow in centrifugal blood pump hemodynamics

We tried to verify the hypothesis that increases in pump flow during diastole are matched by decreases in left ventricular (LV) output during systole. A calf (80 kg) was implanted with an implantable centrifugal blood pump (EVAHEART, SunMedical Technology Research Corp., Nagano, Japan) with left ventricle to aorta (LV-Ao) bypass, and parameters were recorded at different pump speeds under general anesthesia. Pump inflow and outflow pressure, arterial pressure, systemic and pulmonary blood flow, and electrocardiogram (ECG) were recorded on the computer every 5 ms. All parameters were separated into systolic and diastolic components and analyzed. The pulmonary flow was the same as the systemic flow during the study (p > 0.1). Systemic flow consisted of pump flow and LV output through the aortic valve. The ratio of systolic pump flow to pulmonary flow (51.3%) did not change significantly at variable pump speeds (p > 0.1). The other portions of the systemic flow were shared by the left ventricular output and the pump flow during diastole. When pump flow increased during diastole, there was a corresponding decrease in the LV output (Y = -1.068X + 51.462; R(insert)(2) = 0.9501). These show that pump diastolic flow may regulate expansion of the left ventricle in diastole.

Relationship of blood pressure and pump flow in an implantable centrifugal blood pump during hypertension

The purpose of this study was to evaluate the real time relationship between pump flow and pump differential pressure (D-P) during experimentally induced hypertension (HT). Two calves (80 and 68 kg) were implanted with the EVA-HEART centrifugal blood pump (SunMedical Technology Research Corp., Nagano, Japan) under general anesthesia. Blood pressure (BP) in diastole was increased to 100 mm Hg by norepinephrine to simulate HT. Pump flow, D-P, ECG, and BP were measured at pump speeds of 1,800, 2,100, and 2,300 rpm. All data were separated into systole and diastole, and pump flow during HT was compared with normotensive (NT) conditions at respective pump speeds. Diastolic BP was increased to 99.3+/-4.1 mm Hg from 66.5+/-4.4 mm Hg (p<0.01). D-P in systole was under 40 mm Hg (range of change was 10 to 40 mm Hg) even during HT. During NT, the average systolic pump flow volume was 60% of the total pump flow. However, during HT, the average systolic pump flow was 100% of total pump flow volume, although the pump flow volume in systole during HT decreased (33.1+/-5.7 vs. 25.9+/-4.0 ml/systole, p<0.01). In diastole, the average flow volume through the pump was 19.6+/-6.9 ml/diastole during NT and -2.2+/-11.1 ml/diastole during HT (p<0.01). The change in pump flow volume due to HT, in diastole, was greater than the change in pump flow in systole at each pump speed (p<0.001). This study suggests that the decrease of mean pump flow during HT is mainly due to the decrease of the diastolic pump flow and, to a much lesser degree, systolic pump flow.

Continuously maintaining positive flow avoids endocardial suction of a rotary blood pump with left ventricular bypass

This study showed the usefulness of maintaining positive pump flow to avoid endocardial suction and as an assist bypass. Three calves were implanted with centrifugal pumps. Hemodynamics and pump parameters were measured at varying pump speeds (from 1,100 to 2,300 rpm). In each test pump, speed was adjusted to create 3 hemodynamic states: both positive and negative flow (PNF), positive and zero flow (PZF), and continuously positive flow (CPF). The pump flow volume was determined during systole (Vs) and diastole (Vd). Vs in PNF was 29.6 ml and was not significantly different from Vs in PZF (p > 0.15). Vd in PNF was significantly different from Vd in PZF (p < 0.05). All bypass rates of PNF were over 30% of pulmonary flow. All PZF bypass rates were between the PNF rate and the CPF rate. These data showed that PZF satisfied the minimum requirement of assist flow and was under 100% bypass. Thus, PZF may avoid endocardial suction.

Future devices and directions

This article summarizes the status of left ventricular assist devices currently in the stages of bench testing, animal experiments, and pilot clinical trials. The major design features and estimate of costs for 17 devices are described under 3 major categories of indications for use: destination therapy, bridge to transplant, and bridge to recovery. A sleeved piston pump located in the aorta and a unique, magnetically suspended centrifugal pump are described in the destination therapy section. Eight centrifugal and 4 axial flow devices are listed in the bridge to transplant category, and an external cup and a very low-cost centrifugal pump with a left atrium-to-aorta circuit are described in the bridge to recovery section. The key design features of the future, which will be required for success in both the clinical and marketplace arenas, will be simplicity, safety, low-power requirements, and low cost.

Rotary blood pump flow spontaneously increases during exercise under constant pump speed: results of a chronic study

Many types of rotary blood pumps and pump control methods have recently been developed with the goal of clinical use. From experiments, we know that pump flow spontaneously increases during exercise without changing pump control parameters. The purpose of this study was to determine the hemodynamics associated with the long-term observation of calves implanted with centrifugal blood pumps (EVAHEART, Sun Medical Technology Research Corporation, Nagano, Japan). Two healthy female Jersey calves were implanted with devices in the left thoracic cavity. A total of 22 treadmill exercise tests were performed after the 50th postoperative day. During exercise, the following parameters were compared with conditions at rest: heart rate, blood pressure, central venous oxygen saturation (SvO2), pump speed, and pump flow. The pump flow in a cardiac cycle was analyzed by separating the systole and diastole. Compared to the base data, statistically significant differences were found in the following interrelated parameters: the heart rate (66.8 +/- 5.2 vs. 106 +/- 9.7 bpm), mean pump flow (4.8 +/- 0.2 vs. 7.0 +/- 0.3 L/min), and volume of pump flow in diastole (26.0 +/- 1.8 vs. 13.5 +/- 2.5 ml). During exercise, the volume of pump flow in systole was 3 times larger than that measured in diastole. Blood pressure, SvO2, and pump speed did not change significantly from rest to exercise. These results suggested that the mean pump flow depends on the systolic pump flow. Therefore, the increase in the mean pump flow during exercise under constant pump speed was caused by an increase in the heart rate.

Long-term in vivo left ventricular assist device study for 284 days with Gyro PI pump

A totally implantable centrifugal artificial heart has been developed. The plastic prototype, the Gyro PI 601, passed 2 day hemodynamic tests as a functional total artificial heart (TAH), 2 week screening tests for anti-thrombogenecity, and a 1 month system feasibility study. Based upon these results, a metallic prototype, the Gyro PI 700 series, was subjected to long-term in vivo left ventricular assist device (LVAD) studies of over 1 month. The Gyro PI 700 series has the same inner dimension and same characteristics of the Gyro PI 601 such as an eccentric inlet port, a double pivot bearing system, and a magnet coupling system. The PI metallic pump is also driven with the Vienna DC brushless motor actuator like the PI 601. The pump-actuator package was implanted in 3 calves in the preperitoneal space, bypassing from the left ventricular (LV) apex to the descending aorta. Case 1 achieved a 284 day survival. Case 2 was euthanized early at 72 postoperative days as a result of the functional obstruction of the inlet port due to the excessive growth of the calf. There was no blood clot inside the pumps of either case. Case 3 is on-going (22 days on July 24, 1998). During these periods, all cases showed no physiological abnormalities. In conclusion, the PI 700 series pump has excellent results as a long-term implantable LVAD.