Does CircuLite Synergy assist device as partial ventricular support have a place in modern management of advanced heart failure?

Mohite, Prashant N.; Sabashnikov, Anton; Simon, Andrè; Weymann, Alexander; Patil, Nikhil P.; Unsoeld, Bernhard; Bireta, Christian; Popov, Aron Frederik

doi:10.1586/17434440.2015.985208

Cited by 13 publications

(4 citation statements)

References 44 publications

(55 reference statements)

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“…Furthermore, roughly 5% of LVAD-treated patients experience a full recovery, allowing for reduced support and, in some cases, device explantation ( 10 , 11 ). Recent results show that miniaturized, less invasive, partial-support devices operating at low flow rates may have the potential to be used in more patients, particularly those with INTERMACS classification 4 and greater ( 12 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

Partial LVAD Restores Ventricular Outputs and Normalizes LV but not RV Stress Distributions in the Acutely Failing Heart in Silico

et al. 2016

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Purpose Heart failure is a worldwide epidemic that is unlikely to change as the population ages and life expectancy increases. We sought to detail significant recent improvements to the Dassault Systèmes Living Heart Model (LHM) and use the LHM to compute left ventricular (LV) and right ventricular (RV) myofiber stress distributions under the following 4 conditions: (1) normal cardiac function; (2) acute left heart failure (ALHF); (3) ALHF treated using an LV assist device (LVAD) flow rate of 2 L/min; and (4) ALHF treated using an LVAD flow rate of 4.5 L/min. Methods and Results Incorporating improved systolic myocardial material properties in the LHM resulted in its ability to simulate the Frank-Starling law of the heart. We decreased myocardial contractility in the LV myocardium so that LV ejection fraction decreased from 56% to 28%. This caused mean LV end diastolic (ED) stress to increase to 508% of normal, mean LV end systolic (ES) stress to increase to 113% of normal, mean RV ED stress to decrease to 94% of normal and RV ES to increase to 570% of normal. When ALHF in the model was treated with an LVAD flow rate of 4.5 L/min, most stress results normalized. Mean LV ED stress became 85% of normal, mean LV ES stress became 109% of normal and mean RV ED stress became 95% of normal. However, mean RV ES stress improved less dramatically (to 342% of normal values). Conclusions These simulations strongly suggest that an LVAD is effective in normalizing LV stresses but not RV stresses that become elevated as a result of ALHF.

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Section: Introductionmentioning

confidence: 99%

Partial LVAD Restores Ventricular Outputs and Normalizes LV but not RV Stress Distributions in the Acutely Failing Heart in Silico

et al. 2016

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“…There are some novel devices that employ a similar concept of drawing blood from the LA and returning it to the aorta or subclavian artery. For example, the CircuLite Synergy Micro-Pump Device (Medtronic, Minneapolis, MN) ( 28 ) is a micropump-based form of mechanical circulatory support device, with a pump the size of an AA battery ( 29 ). The implantation can be done with a right mini-thoracotomy without using cardiopulmonary bypass, and the outflow graft is anastomosed to the subclavian artery.…”

Section: Depressurization Of the Left Atriummentioning

confidence: 99%

Novel approaches for left atrial pressure relief: Device-based monitoring and management in heart failure

Miyagi

Kuroda

Karimov

et al. 2022

Front. Cardiovasc. Med.

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The importance of the left atrium (LA) has been emphasized in recent years as the features of heart failure (HF), especially with regard to variability in patient and pathology phenotypes, continue to be uncovered. Of note, among the population with HF with preserved ejection fraction (HFpEF), pressure or size of the LA have become a target for advanced monitoring and a therapeutic approach. In the case of diastolic dysfunction or pulmonary hypertension, which are often observed in patients with HFpEF, a conventional approach with clinical symptoms and physical signs of decompensation turned out to have a poor correlation with LA pressure. Therefore, to optimize HF treatment for these populations, several devices that are applied directly to the LA have been developed. First, two LA pressure (LAP) sensors (Heart POD and V-LAP Device) were developed and may enable patient self-management remotely with LAP-guided and physician-directed style. Second, there are device-based approaches that aim to decompress the LA directly. These include: (1) interatrial shunt devices; (2) left ventricular assist devices with LA cannulation; and (3) the left atrial assist device. While these novel device-based therapies are not yet commercially available, there is expected to be a rise in the proposition and adoption of a wider range of choices for monitoring or treating LA using device-based options, based on LA dimensional reduction and optimization of the clinically significant pressure relief. Further development and evaluation are necessary to establish a more favorable management strategy for HF.

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“…The latter is fueled by the nearly ubiquitous demonstration that left ventricular (LV) unloading provided by LVADs causes reverse remodeling and, in a small percentage of patients, induces myocardial recovery to the point where devices can be explanted (Wohlschlaeger et al, 2005 ; Birks et al, 2006 ; Burkhoff et al, 2006 ; Lampropulos et al, 2014 ; McIlvennan et al, 2014 ; Topkara et al, 2016 ). The introduction of smaller, partial (i.e., low) flow LVADs designed to be implanted at an earlier stage of disease severity has broadened the potential applicability to a currently underserved and large patient population (Mohite et al, 2014 ; Sabashnikov et al, 2014 ; Sack et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Investigating the Role of Interventricular Interdependence in Development of Right Heart Dysfunction During LVAD Support: A Patient-Specific Methods-Based Approach

et al. 2018

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Predictive computation models offer the potential to uncover the mechanisms of treatments whose actions cannot be easily determined by experimental or imaging techniques. This is particularly relevant for investigating left ventricular mechanical assistance, a therapy for end-stage heart failure, which is increasingly used as more than just a bridge-to-transplant therapy. The high incidence of right ventricular failure following left ventricular assistance reflects an undesired consequence of treatment, which has been hypothesized to be related to the mechanical interdependence between the two ventricles. To investigate the implication of this interdependence specifically in the setting of left ventricular assistance device (LVAD) support, we introduce a patient-specific finite-element model of dilated chronic heart failure. The model geometry and material parameters were calibrated using patient-specific clinical data, producing a mechanical surrogate of the failing in vivo heart that models its dynamic strain and stress throughout the cardiac cycle. The model of the heart was coupled to lumped-parameter circulatory systems to simulate realistic ventricular loading conditions. Finally, the impact of ventricular assistance was investigated by incorporating a pump with pressure-flow characteristics of an LVAD (HeartMate II™ operating between 8 and 12 k RPM) in parallel to the left ventricle. This allowed us to investigate the mechanical impact of acute left ventricular assistance at multiple operating-speeds on right ventricular mechanics and septal wall motion. Our findings show that left ventricular assistance reduces myofiber stress in the left ventricle and, to a lesser extent, right ventricle free wall, while increasing leftward septal-shift with increased operating-speeds. These effects were achieved with secondary, potentially negative effects on the interventricular septum which showed that support from LVADs, introduces unnatural bending of the septum and with it, increased localized stress regions. Left ventricular assistance unloads the left ventricle significantly and shifts the right ventricular pressure-volume-loop toward larger volumes and higher pressures; a consequence of left-to-right ventricular interactions and a leftward septal shift. The methods and results described in the present study are a meaningful advancement of computational efforts to investigate heart-failure therapies in silico and illustrate the potential of computational models to aid understanding of complex mechanical and hemodynamic effects of new therapies.

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Does CircuLite Synergy assist device as partial ventricular support have a place in modern management of advanced heart failure?

Cited by 13 publications

References 44 publications

Partial LVAD Restores Ventricular Outputs and Normalizes LV but not RV Stress Distributions in the Acutely Failing Heart in Silico

Partial LVAD Restores Ventricular Outputs and Normalizes LV but not RV Stress Distributions in the Acutely Failing Heart in Silico

Novel approaches for left atrial pressure relief: Device-based monitoring and management in heart failure

Investigating the Role of Interventricular Interdependence in Development of Right Heart Dysfunction During LVAD Support: A Patient-Specific Methods-Based Approach

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