Left atrial assist device to treat patients with heart failure with preserved ejection fraction: Initial in vitro study

Fukamachi, Kiyotaka; Horvath, David J.; Kado, Yuichiro; Miyamoto, Takuma; Kuban, Barry D.; Starling, Randall C.

doi:10.1016/j.jtcvs.2019.12.110

Cited by 24 publications

(30 citation statements)

References 10 publications

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“…A new device, a left atrial assist device (LAAD; Figure 1), has potential as a new treatment for patients with HFpEF. 12,13 The LAAD is a continuous-flow pump and can produce more than 10 L/min of pump flow. It can be implanted at the mitral position to pump blood from the left atrium (LA) to the left ventricle (LV), and relieves the symptoms of HF caused by high LAP and low CO. As a result, the CO is expected to increase because contractility is not impaired in HFpEF.…”

Section: Introductionmentioning

confidence: 99%

Left atrial assist device function at various heart rates using a mock circulation loop

et al. 2020

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We are developing a new left atrial assist device (LAAD) for patients who have heart failure with preserved ejection fraction (HFpEF). This study aimed to assess the hemodynamic effects of the LAAD under both normal heart conditions and various diastolic heart failure (DHF) conditions using a mock circulatory loop. A continuous-flow pump that simulates LAAD, was placed between the left atrial (LA) reservoir and a pneumatic ventricle that simulated a native left ventricle on a pulsatile mock loop. Normal heart (NH) and mild, moderate, and severe DHF conditions were simulated by adjusting the diastolic drive pressures of the pneumatic ventricle. With the LAAD running at 3200 rpm, data were collected at 60, 80, and 120 bpm of the pneumatic ventricle. Cardiac output (CO), mean aortic pressure (AoP), and mean LA pressure (LAP) were compared to evaluate the LAAD performance. With LAAD support, the CO and AoP rose to a sufficient level at all heart rates and DHF conditions (CO; 3.4–3.8 L/min, AoP; 90–105 mm Hg). Each difference in the CO and the AoP among various heart rates was minuscule compared with non-pump support. The LAP decreased from 21–23 to 17–19 mm Hg in all DHF conditions (difference not significant). Furthermore, hemodynamic parameters improved for all DHF conditions, independent of heart rate. The LAAD can provide adequate flow to maintain the circulation status at various heart rates in an in vitro mock circulatory loop.

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Section: Introductionmentioning

confidence: 99%

Left atrial assist device function at various heart rates using a mock circulation loop

et al. 2020

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“…Another MCS device for HFpEF, known as the LAAD, was most recently proposed by Fukamachi et al ( 177 ) . The LAAD is a continuous pump with hybrid magnetic and hydrodynamic bearings designed for implantation at the mitral valve.…”

Section: Device-based Solutions For Hfpefmentioning

confidence: 99%

“…In vitro studies were performed to investigate the hemodynamic effects of this device on an experimental mock circulatory system, configured to simulate various degrees of diastolic dysfunction ( 177 , 178 , 179 ). The performance of the LAAD (ie, left atrium to left ventricle configuration) was compared with that of analogous pumps in 2 other configurations, namely left atrium to aorta and left ventricle to aorta.…”

Section: Device-based Solutions For Hfpefmentioning

confidence: 99%

“…Although the LAAD has been shown to ameliorate the hemodynamics of HFpEF in a variety of studies ( 177 , 178 , 179 , 180 , 181 ), questions remain regarding the site of implantation of the device, as the implications associated with the removal of the mitral valve have yet to be assessed ( 182 ). In addition, although implantation at the supra-valvular level has been suggested to preserve the mitral valve, this configuration has not been studied thoroughly ( 181 ).…”

Section: Device-based Solutions For Hfpefmentioning

confidence: 99%

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Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction

Rosalia

Ozturk

Shoar

et al. 2021

JACC: Basic to Translational Science

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Highlights The prevalence of heart failure with preserved ejection fraction among patients who present with symptoms of heart failure is approximately 50%. Pharmacologic therapy has not conclusively shown benefits in morbidity and mortality in clinical trials. Although it represents an active area of research, no device-based therapy has received regulatory approval for the treatment of heart failure with preserved ejection fraction. Approaches such as atrial shunts, left ventricular expanders, mechanical circulatory support devices, and neurostimulators are at various stages of development.

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“…For longer term use with the unloading of LA to the right axillary artery, Meyns et al showed proof of concept with the partial support LVAD CircuLite Synergy Micro-Pump Device, later acquired by HeartWare (Framingham, Mass) and thereafter by Medtronic (Minneapolis, MN, USA) [30]. A novel impeller device, placed in the mitral position and intended to decrease LA pressure and increase LV preload, has been tested in a mock loop as a treatment principle [31]. A non-pulsatile pump in the mitral position will unload the LA in diastole due to pressure gradients between the LA and the LV; therefore, rotor speed (rpm) must be tuned to avoid retrograde flow through the pump in the systole.…”

Section: Unloading Of the La-consequences For Hfpef Hemodynamicsmentioning

confidence: 99%

Can mechanical circulatory support be an effective treatment for HFpEF patients?

Gude

Fiane

2021

Heart Fail Rev

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Heart failure with preserved ejection fraction (HFpEF) is increasing in prevalence and represents approximately 50% of all heart failure (HF) patients. Patients with this complex clinical scenario, characterized by high filling pressures, and reduced cardiac output (CO) associated with progressive multi-organ involvement, have so far not experienced any significant improvement in quality of life or survival with traditional HF treatment. Left ventricular assist devices (LVAD) have offered a new treatment alternative in terminal heart failure patients with reduced ejection fraction (HFrEF), providing a unique combination of significant pressure and volume unloading together with an increase in CO. The small left ventricular cavity in HFpEF patients challenges left-sided pressure unloading, and new anatomical entry points need to be explored for mechanical pressure and volume unloading. Optimized and pressure/volume-adjusted mechanical circulatory support (MCS) devices for HFrEF patients may conceivably be customized for HFpEF anatomy and hemodynamics. We have developed a long-term MCS device for HFpEF patients with atrial unloading in a pulsed algorithm, leading to a significant reduction of filling pressure, maintenance of pulse pressure, and increase in CO demonstrated in animal testing. In this article, we will discuss HFpEF pathology, hemodynamics, and the principles behind our novel MCS device that may improve symptoms and prognosis in HFpEF patients. Data from mock-loop hemolysis studies, acute, and chronic animal studies will be presented.

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Left atrial assist device to treat patients with heart failure with preserved ejection fraction: Initial in vitro study

Cited by 24 publications

References 10 publications

Left atrial assist device function at various heart rates using a mock circulation loop

Left atrial assist device function at various heart rates using a mock circulation loop

Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction

Can mechanical circulatory support be an effective treatment for HFpEF patients?

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