Mechanical Circulatory Support Devices for Pediatric Patients With Congenital Heart Disease

Chopski, Steven G.; Moskowitz, William B.; Stevens, Randy; Throckmorton, Amy L.

doi:10.1111/aor.12760

Cited by 36 publications

(58 citation statements)

References 96 publications

(160 reference statements)

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“…Patients born with heart defects typically undergo multiple open‐heart surgeries and prematurely develop congestive heart failure (CHF). A large and growing segment of pediatric patients is also developing cardiomyopathies and early‐onset hypertrophy . Pediatric patients with cardiomyopathy, the most common cause of heart failure in children, suffer from severely depressed ventricular function .…”

Section: Motivation and Clinical Significancementioning

confidence: 99%

“…A large and growing segment of pediatric patients is also developing cardiomyopathies and early‐onset hypertrophy . Pediatric patients with cardiomyopathy, the most common cause of heart failure in children, suffer from severely depressed ventricular function . These patients are susceptible to manifest developmental challenges, such as cognitive impairment, growth delays, heart arrhythmias, and CHF …”

Section: Motivation and Clinical Significancementioning

confidence: 99%

“…Due to these challenges, the implementation of mechanical circulatory support (MCS) devices in pediatric patients continues to rise. Ventricular assist devices (VADs) and total artificial hearts (TAHs) have demonstrated success as bridge‐to‐transplant and bridge‐to‐recovery therapies in adults and a small number of pediatric patients . Nevertheless, VAD and TAH technologies, specifically for pediatric patients, continue to lag behind those developed for adults.…”

Section: Motivation and Clinical Significancementioning

confidence: 99%

“…4,5 Pediatric patients with cardiomyopathy, the most common cause of heart failure in children, suffer from severely depressed ventricular function. 5 These patients are susceptible to manifest developmental challenges, such as cognitive impairment, growth delays, heart arrhythmias, and CHF. 6 Current therapeutic strategies include the administration of pharmacologic agents, which lead to sym ptomatic Abstract Mechanical circulatory support (MCS) devices for pediatric patients continue to lag in development behind those for adults.…”

Section: Motivation and Clinical Significancementioning

confidence: 99%

“…blood pump, mechanical circulatory assistance, pediatric circulatory support, rotary blood pump, total artificial heart, ventricular assist device improvement, but do not halt progression to CHF. [5][6][7][8] The shortage of donor organs and the added difficulty of donor/ recipient size matching in pediatric patients complicate cardiac transplantation and extend donor waiting periods. 2,5 Due to these challenges, the implementation of mechanical circulatory support (MCS) devices in pediatric patients continues to rise.…”

Section: Introductionmentioning

confidence: 99%

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New versatile dual‐support pediatric heart pump

et al. 2019

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Mechanical circulatory support (MCS) devices for pediatric patients continue to lag in development behind those for adults. There is no heart pump with the design innovation to support dysfunctional states of heart failure and the anatomic heterogeneity of cardiac defects in pediatric patients. To address this unmet need, we are developing a versatile MCS technology with 2 separate blood pumps under 1 housing, whereby a centrifugal pump rotates around an axial pump. In this study, we advanced the design with a new inducer for the axial pump component and flat inlet volute for the centrifugal pump component. We conducted computational modeling of the design iterations, built prototypes, and tested their performance. The axial pump component was able to generate pressure rises of 1–112 mm Hg for 2–5 L/min at 10 000–14 000 RPM, and the centrifugal pump component produced pressure rises of 1–184 mm Hg for 2–5 L/min at 1750–3000 RPM. Shear stresses and blood damage estimations were less than 490 Pa and 0.5%, respectively. Axial and radial forces were also estimated to be less than 5 N for the axially and radially centered impellers. Data sets were repeatable, and data trends followed theoretical expectations. The new designs for the axial and centrifugal pumps enabled us to reduce the height of the pump while maintaining performance expectations. These findings support the continued development of this new medical device for pediatric patients.

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Section: Motivation and Clinical Significancementioning

confidence: 99%

Section: Motivation and Clinical Significancementioning

confidence: 99%

Section: Motivation and Clinical Significancementioning

confidence: 99%

Section: Motivation and Clinical Significancementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

New versatile dual‐support pediatric heart pump

et al. 2019

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Review and reflections about pulsatile ventricular assist devices from history to future: concerning safety and low haemolysis—still needed

Köhne

2020

J Artif Organs

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Since the first use of a ventricular assist device in 1963 many extracorporeal and implantable pulsatile blood pumps have been developed. After the invention of continuous flow blood pumps the implantable pulsatile pumps are not available anymore. The new rotary pumps spend a better quality of life because many of the patients can go home. Nevertheless, the extracorporeal pulsatile pumps have some advantages. They are low-cost systems, produce less haemolysis and heart-recovery can be tested easily. Pump failure is easy to realize because the pumps can be observed visually. Pump exchange can be done easily without any chirurgic surgery. As volume displacement pumps they can produce high blood pressure, so they are the only ones suitable for pediatric patients. Therefore, they are indispensable for clinical use today and in the future. In this work, nearly all pulsatile blood pumps used in clinical life are described.

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In-vitro performance of a single-chambered total artificial heart in a Fontan circulation

et al. 2021

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An in-vitro study was conducted to investigate the general feasibility of using only one pumping chamber of the SynCardia total artificial heart (TAH) as a replacement of the single ventricle palliated by Fontan circulation. A mock circulation loop was used to mimic a Fontan circulation. The combination of both ventricle sizes (50 and 70 cc) and driver (Freedom Driver and Companion C2 Driver) was investigated. Two clinical relevant scenarios (early Fontan; late Fontan) as derived from literature data were set up in the mock loop. The impact of increased transpulmonary pressure gradient, low atrial pressure, and raised central venous pressure on cardiac output was studied. From a hemodynamic point, the single-chambered TAH performed sufficiently in the setting of the Fontan circulation. Increased transpulmonary pressure gradient, from ideal to pulmonary hypertension, decreased the blood flow in combinations by almost 2 L/min. In the early Fontan scenario, a cardiac output of 3–3.5 L/min was achieved using the 50 cc ventricle, driven by the Companion C2 Driver. Even under pulmonary hypertension, cardiac outputs greater than 4 L/min could be obtained with the 70 cc pump chamber in the late Fontan scenario. In the clinically relevant Fontan scenarios, implementation of the single chambered TAH performed successfully from a hemodynamic point of view. The replacement of the failing univentricular heart by a single chamber of the SynCardia TAH may provide an alternative to a complex biventricular repair procedure or ventricular support in Fontan patients.

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Mechanical Circulatory Support Devices for Pediatric Patients With Congenital Heart Disease

Cited by 36 publications

References 96 publications

New versatile dual‐support pediatric heart pump

New versatile dual‐support pediatric heart pump

Review and reflections about pulsatile ventricular assist devices from history to future: concerning safety and low haemolysis—still needed

In-vitro performance of a single-chambered total artificial heart in a Fontan circulation

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