Systems of conductive skin for power transfer in clinical applications

Abstract

The primary aim of this article is to review the clinical challenges related to the supply of power in implanted left ventricular assist devices (LVADs) by means of transcutaneous drivelines. In effect of that, we present the preventive measures and post-operative protocols that are regularly employed to address the leading problem of driveline infections. Due to the lack of reliable wireless solutions for power transfer in LVADs, the development of new driveline configurations remains at the forefront of different strategies that aim to power LVADs in a less destructive manner. To this end, skin damage and breach formation around transcutaneous LVAD drivelines represent key challenges before improving the current standard of care. For this reason, we assess recent strategies on the surface functionalization of LVAD drivelines, which aim to limit the incidence of driveline infection by directing the responses of the skin tissue. Moreover, we propose a class of power transfer systems that could leverage the ability of skin tissue to effectively heal short diameter wounds. In this direction, we employed a novel method to generate thin conductive wires of controllable surface topography with the potential to minimize skin disruption and eliminate the problem of driveline infections. Our initial results suggest the viability of the small diameter wires for the investigation of new power transfer systems for LVADs. Overall, this review uniquely compiles a diverse number of topics with the aim to instigate new research ventures on the design of power transfer systems for IMDs, and specifically LVADs.

Control of hydrostatic pressure and osmotic stress in 3D cell culture for mechanobiological studies

“…The latter is an important technical and clinical challenge associated with foreign body reactions against biomaterials [129]. Thus, the development of novel material methods with the potential to reduce foreign body reactions [130][131][132][133] shall facilitate the acquisition of local pressure measurements, untainted by the contributions of adverse tissue reactions. Catheters with miniaturized transducers on their tip have also been used for the measurement of interstitial fluid pressure in tumors [134].…”

LVAD as a Bridge to Transplantation—Current Status and Future Perspectives

“…Related to the extracorporeal energy delivery, INTERMACS reported that within 1 year of LVAD implantation, the most common infectious complications are pneumonia (23%), sepsis (20%), and driveline site infections (19%), often caused by skin flora [ 52 , 74 , 75 , 76 ]. In particular, biofilm formation at the interface of the driveline with the injured skin poses a challenge to eradicating bacterial pathogenesis [ 77 ]. According to the European Registry for Patients with Mechanical Circulatory Support, sepsis, along with multiple organ failure, is the leading cause of early mortality in LVAD patients [ 52 , 78 , 79 ].…”

“…Anti-infective therapeutic protocols may include wound dressing in combination with adjunctive therapies such as vacuum-assisted closure therapy, cold atmospheric plasma, or antibiotic beads [ 77 ]. In many cases, however, the therapeutic benefits are negated by recurrent infections associated with biofilm persistence [ 77 ]. Alternatively, severe driveline infections can be treated with surgical intervention, such as driveline repositioning followed by wound debridement [ 77 ].…”

“…In many cases, however, the therapeutic benefits are negated by recurrent infections associated with biofilm persistence [ 77 ]. Alternatively, severe driveline infections can be treated with surgical intervention, such as driveline repositioning followed by wound debridement [ 77 ]. Therefore, preventing infection in the first place remains of paramount importance.…”

Transcutaneous Pulsed RF Energy Transfer Mitigates Tissue Heating in High Power Demand Implanted Device Applications: In Vivo and In Silico Models Results

“…However, LVAD power demand is high, usually 5–30 W. This requires an external power source connected to the LVAD via a percutaneous driveline. The driveline frequently becomes infected, resulting in recurrent hospital admissions and complications including life-threatening sepsis, LVAD failure and premature death [ 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”