The Future of Adult Cardiac Assist Devices: Novel Systems and Mechanical Circulatory Support Strategies

Bartoli, Carlo; Dowling, Robert D.

doi:10.1016/j.ccl.2011.08.013

Cited by 30 publications

(16 citation statements)

References 112 publications

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“…Importantly, partial support may reduce native ventricular workload and augment myocardial blood flow to promote favorable myocardial remodeling before the onset of irreversible myocardial damage. Other potential benefits of less-invasive partial support may include reduced right ventricular failure, shorter hospital stays, and lower costs 16 . Initial clinical results with partial-support devices are encouraging 6, 16-18 .…”

Section: Discussionmentioning

confidence: 99%

“…Other potential benefits of less-invasive partial support may include reduced right ventricular failure, shorter hospital stays, and lower costs 16 . Initial clinical results with partial-support devices are encouraging 6, 16-18 .…”

Section: Discussionmentioning

confidence: 99%

“…Nearly a dozen new devices with novel support strategies are poised for clinical trial 16 . Certain devices are connected to a peripheral artery rather than the aorta.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple devices that operate with different mechanisms of flow are clinically available or poised for clinical trials 16 . Each device produces a unique hemodynamic profile with varying pulsatility, turbulence, shear stress, and flow directionality.…”

Section: Discussionmentioning

confidence: 99%

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Nonphysiologic blood flow triggers endothelial and arterial remodeling in vivo: Implications for novel left ventricular assist devices with a peripheral anastomosis

Bartoli

Spence²,

Sieß

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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Introduction Less-invasive circulatory support devices have been developed that require anastomosis to a peripheral artery. The Symphony Heart Assist System is a volume displacement pump sewn to the subclavian artery to provide partial circulatory support. The surgical configuration produces non-physiologic blood pressure and bidirectional flow in the subclavian artery. Our objective was to identify effects of altered hemodynamics on arterial structure and function. Methods In calves (n=23, 80-100kg), the Symphony pump was sewn end-to-side to the carotid artery. Acutely, carotid blood pressure and flow were recorded to evaluate hemodynamic changes. After medium-term support (1-4 weeks), carotid artery cross sections were studied. Histology and molecular assays evaluated architectural changes. Quantitative real-time PCR evaluated gene expression of matrix metalloproteinase (MMP)-2 and MMP-9 and connective tissue growth factor (CTGF). In vitro carotid arterial-ring studies evaluated physiological responses. Results During Symphony support, carotid arterial pressure was 200/15mmHg. Antegrade flow increased significantly (p<0.05) from 1.40±0.32 to 4.29±0.33L/min. Flow during native cardiac diastole reversed completely from 0.25±0.05 to -4.15±0.38L/min in carotid artery proximal to the anastomosis. After medium-term support, the carotid artery was significantly dilated with significantly thinner tunica media and thicker tunica adventitia versus controls. MMP-9 gene expression decreased significantly, CTGF gene expression increased significantly, and collagen, elastin, and total extracellular matrix increased significantly. Endothelial cells were significantly hypertrophied and produced significantly more von Willebrand factor. Endothelial apoptosis increased significantly. Platelet-endothelial interactions decreased significantly. Endothelial-independent contraction decreased significantly, whereas endothelial-dependant relaxation increased modestly. Conclusions Assisted circulation with a left ventricular assist device (LVAD) triggered arterial remodeling that allowed a peripheral artery to accommodate the altered hemodynamics of a novel partial-support pump. Further delineation of remodeling pathways may be of significance for the emerging field of partial circulatory support.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Nearly a dozen new devices with novel support strategies are poised for clinical trial 16 . Certain devices are connected to a peripheral artery rather than the aorta.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Nonphysiologic blood flow triggers endothelial and arterial remodeling in vivo: Implications for novel left ventricular assist devices with a peripheral anastomosis

Bartoli

Spence²,

Sieß

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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“…Implantable and percutaneous right ventricular assist devices are available for both long-term and temporary support. While current total artificial heart models are bulky and require total resection of the native ventricles, biventricular assist devices consisting of two simultaneous, smaller, continuous-flow devices are becoming available for clinical use [49].…”

Section: Expert Commentary and Five-year Viewmentioning

confidence: 99%

Current concepts in the diagnosis and management of left ventricular assist device infections

Nienaber

Wilhelm

Sohail

2013

Expert Review of Anti-infective Therapy

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Left ventricular assist devices (LVAD) are increasingly being used both as a bridge to transplantation and for long-term myocardial surrogate destination therapy in patients with end-stage heart failure. Primarily owing to the presence of a driveline that connects the device to an external battery through an open skin incision, the rates of LVAD-related infections (LVADRIs) are high, ranging from 30 to 50%. LVADRIs can be broadly classified into driveline infection, pump pocket infection, bloodstream infection and endocarditis/pump or cannula infection. Diagnostic evaluation and management of these complicated infections can be quite challenging for clinicians involved in the care of these patients. Here, the authors summarize the current epidemiology, microbiology, diagnostic approach and management strategies for each type of LVADRI. The authors also review current concepts regarding antibiotic prophylaxis for LVAD implantation. Finally, the authors highlight the gaps in the knowledge of LVADRI and provide directions for future studies.

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Design Method Using Statistical Models for Miniature Left Ventricular Assist Device Hydraulics

Smith

Wang²,

Bieritz

et al. 2018

Ann Biomed Eng

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The Future of Adult Cardiac Assist Devices: Novel Systems and Mechanical Circulatory Support Strategies

Cited by 30 publications

References 112 publications

Nonphysiologic blood flow triggers endothelial and arterial remodeling in vivo: Implications for novel left ventricular assist devices with a peripheral anastomosis

Nonphysiologic blood flow triggers endothelial and arterial remodeling in vivo: Implications for novel left ventricular assist devices with a peripheral anastomosis

Current concepts in the diagnosis and management of left ventricular assist device infections

Design Method Using Statistical Models for Miniature Left Ventricular Assist Device Hydraulics

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