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Kuroda T, Miyagi C, Polakowski AR, Flick CR, Kuban BD, Fukamachi K, Karimov JH. Cleveland Clinic Continuous-Flow Total Artificial Heart: Progress Report and Technology Update. ASAIO J 2024; 70:116-123. [PMID: 37851000 PMCID: PMC10842968 DOI: 10.1097/mat.0000000000002076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Cleveland Clinic's continuous-flow total artificial heart (CFTAH) is being developed at our institution and has demonstrated system reliability and optimal performance. Based on the results from recent chronic in vivo experiments, CFTAH has been revised, especially to improve biocompatibility. The purpose of this article is to report our progress in developing CFTAH. To improve biocompatibility, the right impeller, the pump housing, and the motor were reviewed for design revision. Updated design features were based on computational fluid dynamics analysis and observations from in vitro and in vivo studies. A new version of CFTAH was created, manufactured, and tested. All hemodynamic and pump-related parameters were observed and found to be within the intended ranges, and the new CFTAH yielded acceptable biocompatibility. Cleveland Clinic's continuous-flow total artificial heart has demonstrated reliable performance, and has shown satisfactory progress in its development.
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Affiliation(s)
- Taiyo Kuroda
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chihiro Miyagi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anthony R. Polakowski
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christine R. Flick
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Barry D. Kuban
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kiyotaka Fukamachi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio, USA
- Kaufman Center for Heart Failure Treatment and Recovery, Section of Heart Failure and Cardiac Transplant Medicine, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, OH
| | - Jamshid H. Karimov
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio, USA
- Kaufman Center for Heart Failure Treatment and Recovery, Section of Heart Failure and Cardiac Transplant Medicine, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, OH
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Bornoff J, Najar A, Fresiello L, Finocchiaro T, Perkins IL, Gill H, Cookson AN, Fraser KH. Fluid-structure interaction modelling of a positive-displacement Total Artificial Heart. Sci Rep 2023; 13:5734. [PMID: 37059748 PMCID: PMC10104863 DOI: 10.1038/s41598-023-32141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/23/2023] [Indexed: 04/16/2023] Open
Abstract
For those suffering from end-stage biventricular heart failure, and where a heart transplantation is not a viable option, a Total Artificial Heart (TAH) can be used as a bridge to transplant device. The Realheart TAH is a four-chamber artificial heart that uses a positive-displacement pumping technique mimicking the native heart to produce pulsatile flow governed by a pair of bileaflet mechanical heart valves. The aim of this work was to create a method for simulating haemodynamics in positive-displacement blood pumps, using computational fluid dynamics with fluid-structure interaction to eliminate the need for pre-existing in vitro valve motion data, and then use it to investigate the performance of the Realheart TAH across a range of operating conditions. The device was simulated in Ansys Fluent for five cycles at pumping rates of 60, 80, 100 and 120 bpm and at stroke lengths of 19, 21, 23 and 25 mm. The moving components of the device were discretised using an overset meshing approach, a novel blended weak-strong coupling algorithm was used between fluid and structural solvers, and a custom variable time stepping scheme was used to maximise computational efficiency and accuracy. A two-element Windkessel model approximated a physiological pressure response at the outlet. The transient outflow volume flow rate and pressure results were compared against in vitro experiments using a hybrid cardiovascular simulator and showed good agreement, with maximum root mean square errors of 15% and 5% for the flow rates and pressures respectively. Ventricular washout was simulated and showed an increase as cardiac output increased, with a maximum value of 89% after four cycles at 120 bpm 25 mm. Shear stress distribution over time was also measured, showing that no more than [Formula: see text]% of the total volume exceeded 150 Pa at a cardiac output of 7 L/min. This study showed this model to be both accurate and robust across a wide range of operating points, and will enable fast and effective future studies to be undertaken on current and future generations of the Realheart TAH.
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Affiliation(s)
- Joseph Bornoff
- Department of Mechanical Engineering, University of Bath, Bath, UK
| | - Azad Najar
- Scandinavian Real Heart AB, Västerås, Sweden
| | - Libera Fresiello
- Faculty of Science and Technology, University of Twente, Twente, The Netherlands
| | | | | | - Harinderjit Gill
- Department of Mechanical Engineering, University of Bath, Bath, UK
- Centre for Therapeutic Innovation, University of Bath, Bath, UK
| | - Andrew N Cookson
- Department of Mechanical Engineering, University of Bath, Bath, UK
- Centre for Therapeutic Innovation, University of Bath, Bath, UK
| | - Katharine H Fraser
- Department of Mechanical Engineering, University of Bath, Bath, UK.
- Centre for Therapeutic Innovation, University of Bath, Bath, UK.
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Karimov JH, Miyagi C, Flick CR, Polakowski AR, Kuban BD, Kuroda T, Horvath DW, Fukamachi K, Starling RC. Biventricular circulatory support using single-device and dual-device configurations: Initial pump characterization in simulated heart failure model. Front Cardiovasc Med 2023; 10:1045656. [PMID: 36910535 PMCID: PMC9994815 DOI: 10.3389/fcvm.2023.1045656] [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: 09/15/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023] Open
Abstract
Objective Severe biventricular heart failure (BHF) can be remedied using a biventricular assist device (BVAD). Two devices are currently in development: a universal ventricular assist device (UVAD), which will be able to assist either the left, right, or both ventricles, and a continuous-flow total artificial heart (CFTAH), which replaces the entire heart. In this study, the in vitro hemodynamic performances of two UVADs are compared to a CFTAH acting as a BVAD. Methods For this experiment, a biventricular mock circulatory loop utilizes two pneumatic pumps (Abiomed AB5000™, Danvers, MA, USA), in conjunction with a dual-output driver, to create heart failure (HF) conditions (left, LHF; right, RHF; biventricular, BHF). Systolic BHF for four different situations were replicated. In each situation, CFTAH and UVAD devices were installed and operated at two distinct speeds, and cannulations for ventricular and atrial connections were evaluated. Results Both CFTAH and UVAD setups achieved our recommended hemodynamic criteria. The dual-UVAD arrangement yielded a better atrial balance to alleviate LHF and RHF. For moderate and severe BHF scenarios, CFTAH and dual UVADs both created excellent atrial pressure balance. Conversely, when CFTAH was atrial cannulated for LHF and RHF, the needed atrial pressure balance was not met. Conclusion Comprehensive in vitro testing of two different BVAD setups exhibited self-regulation and exceptional pump performance for both (single- and dual-device) BHF support scenarios. For treating moderate and severe BHF, UVAD and CFTAH both functioned well with respect to atrial pressure regulation and cardiac output. Though, the dual-UVAD setup yielded a better atrial pressure balance in all BHF testing scenarios.
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Affiliation(s)
- Jamshid H Karimov
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH, United States
| | - Chihiro Miyagi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Christine R Flick
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Anthony R Polakowski
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Barry D Kuban
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Taiyo Kuroda
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Dennis W Horvath
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.,R1 Engineering LLC, Euclid, OH, United States
| | - Kiyotaka Fukamachi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH, United States
| | - Randall C Starling
- Department of Cardiovascular Medicine, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States.,Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, OH, United States
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Kuroda T, Miyamoto T, Miyagi C, Polakowski AR, Flick CR, Kuban BD, Voros GB, Such K, Fukamachi K, Karimov JH. Pulsatility hemodynamics during speed modulation of continuous-flow total artificial heart in a chronic in vivo. Artif Organs 2022; 46:1555-1563. [PMID: 35318688 PMCID: PMC9543567 DOI: 10.1111/aor.14237] [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] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/09/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
Background The evaluation of pulsatile flow created by the new Cleveland Clinic continuous‐flow total artificial heart (CFTAH100), which has a re‐designed right impeller and motor, had not been tested in vivo. The purpose of this study was to evaluate the feasibility of pulsatility with the CFTAH100 during the application of pump speed modulation protocols in a chronic animal model. Methods A 30‐day chronic animal experiment was conducted with a calf. Five pulsatile studies were performed on the alert animal. The mean pump speed was set at 2800 rpm, and modulated sinusoidally within a range of 0 to ± 35% of mean speed, in increments of 5% at 80 beats per minute (bpm). The pressures and pump flow were collected and a pulsatility index (PI) was calculated. Results The calf was supported with the CFTAH100 without any major complications. The maximum and minimum pump flows changed significantly from baseline in all conditions, while the mean pump flow did not change. All flow pulsatility (FP) readings in all conditions significantly increased from baseline, and the percent modulation (%S) and FP had a strong positive correlation (r = 0.99, p < 0.01). The PI also increased significantly in all conditions (maximum at %S of 35%, 2.2 ± 0.05, p < 0.01), and a positive correlation between %S and PI (r = 0.99, p < 0.01) was observed. Conclusion The CFTAH100 showed the feasibility of creating pulsatile circulation with sinusoidal pump speed modulation.
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Affiliation(s)
- Taiyo Kuroda
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Takuma Miyamoto
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Chihiro Miyagi
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Anthony R Polakowski
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Christine R Flick
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Barry D Kuban
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - George B Voros
- Biological Resources Unit, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kimberly Such
- Biological Resources Unit, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kiyotaka Fukamachi
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Jamshid H Karimov
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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