Inflow cannula design for biventricular assist devices

Cardiovascular diseases are a leading cause of death throughout the developed world. With the demand for donor hearts far exceeding the supply, a bridge-to-transplant or permanent solution is required. This is currently achieved with ventricular assist devices (VADs), which can be used to assist the left ventricle (LVAD), right ventricle (RVAD), or both ventricles simultaneously (BiVAD). Earlier generation VADs were large, volume-displacement devices designed for temporary support until a donor heart was found. The latest generation of VADs use rotary blood pump technology which improves device lifetime and the quality of life for end stage heart failure patients. VADs are connected to the heart and greater vessels of the patient through specially designed tubes called cannulae. The inflow cannulae, which supply blood to the VAD, are usually attached to the left atrium or ventricle for LVAD support, and the right atrium or ventricle for RVAD support. Few studies have characterized the haemodynamic difference between the two cannulation sites, particularly with respect to rotary RVAD support. Inflow cannulae are usually made of metal or a semi-rigid polymer to prevent collapse with negative pressures. However suction, and subsequent collapse, of the cannulated heart chamber can be a frequent occurrence, particularly with the relatively preload insensitive rotary blood pumps. Suction events may be associated with endocardial damage, pump flow stoppages and ventricular arrhythmias. While several VAD control strategies are under development, these usually rely on potentially inaccurate sensors or somewhat unreliable inferred data to estimate preload. Fixation of the inflow cannula is usually achieved through suturing the cannula, often via a felt sewing ring, to the cannulated chamber. This technique extends the time on cardiopulmonary bypass which is associated with several postoperative complications. The overall objective of this thesis was to improve the placement and design of rotary LVAD and RVAD inflow cannulae to achieve enhanced haemodynamic performance, reduced incidence of suction events, reduced levels of postoperative bleeding and a faster implantation procedure. Specific objectives were: * in-vitro evaluation of LVAD and RVAD inflow cannula placement, * design and in-vitro evaluation of a passive mechanism to reduce the potential for heart chamber suction, * design and in-vitro evaluation of a novel suture-less cannula fixation device. In order to complete in-vitro evaluation of VAD inflow cannulae, a mock circulation loop (MCL) was developed to accurately replicate the haemodynamics in the human systemic and pulmonary circulations. Validation of the MCL’s haemodynamic performance, including the form and magnitude of pressure, flow and volume traces was completed through comparisons of patient data and the literature. The MCL was capable of reproducing almost any healthy or pathological condition, and provided a useful tool to evaluate VAD cannulation and other cardiovascular devices. The MCL was used to evaluate inflow cannula placement for rotary VAD support. Left and right atrial and ventricular cannulation sites were evaluated under conditions of mild and severe heart failure. With a view to long term LVAD support in the severe left heart failure condition, left ventricular inflow cannulation was preferred due to improved LVAD efficiency and reduced potential for thrombus formation. In the mild left heart failure condition, left atrial cannulation was preferred to provide an improved platform for myocardial recovery. Similar trends were observed with RVAD support, however to a lesser degree due to a smaller difference in right atrial and ventricular pressures. A compliant inflow cannula to prevent suction events was then developed and evaluated in the MCL. As rotary LVAD or RVAD preload was reduced, suction events occurred in all instances with a rigid inflow cannula. Addition of the compliant segment eliminated suction events in all instances. This was due to passive restriction of the compliant segment as preload dropped, thus increasing the VAD circuit resistance and decreasing the VAD flow rate. Therefore, the compliant inflow cannula acted as a passive flow control / anti-suction system in LVAD and RVAD support. A novel suture-less inflow cannula fixation device was then developed to reduce implantation time and postoperative bleeding. The fixation device was evaluated for LVAD and RVAD support in cadaveric animal and human hearts attached to a MCL. LVAD inflow cannulation was achieved in under two minutes with the suture-less fixation device. No leakage through the suture-less fixation device – myocardial interface was noted. Continued development and in-vivo evaluation of this device may result in an improved inflow cannulation technique with the potential for off-bypass insertion. Continued development of this research, in particular the compliant inflow cannula and suture-less inflow cannulation device, will result in improved postoperative outcomes, life span and quality of life for end-stage heart failure patients

From Benchtop to Beside: Patient-specific Outcomes Explained by Invitro Experiment

Study: Recent analyses show that females have higher early postoperative (PO) mortality and right ventricular failure (RVF) than males after left ventricular assist device (LVAD) implantation; and that this association is partially mediated by smaller LV size in females. Benchtop experiments allow us to investigate patient-specific (PS) characteristics in a reproducible way given the fact that the PS anatomy and physiology is mimicked accurately. With multiple heart models of varying LV size, we can directly study the individual effects of titrating the LVAD speed and the resulting bi-ventricular volumes, shedding light on the interplay between LV and RV as well as resulting inter-ventricular septum (IVS) positions, which may cause the different outcomes pertaining to sex. Methods: In vitro, we studied the impact of the heart size to IVS position using two smaller and two larger sized PS silicone heart phantoms derived from clinical CT images (Fig. 1A). With ultrasound crystals that were integrated on a placeholder inflow cannula, the IVS position was measured during LV and RV volume changes (dV) mimicking varying ventricular loading states (Fig. 1B). Figure 1 A Two small (blue) and two large PS heart phantoms (orange) on B benchtop. C Median septum curvature results. LVEDD/LVV/RVV: LV enddiastolic diameter/LV and RV volume. Results: Going from small to large dV, at zero curvature, the septum starts to shift towards the left; for smaller hearts at dV = -40 mL and for larger hearts at dV = -50 mL (Fig. 1C). This result indicates that smaller hearts are more prone to an IVS shift to the left than larger hearts. We conclude that smaller LV size may therefore mediate increased early PO LVAD mortality and RVF observed in females compared to males. Novel 3D silicone printing technology enables us to study accurate, PS heart models across a heterogeneous patient population. PS relationships can be studied simultaneously to clinical assessments and support the decision-making prior to LVAD implantation

Experimental and Computational Assessment of Mechanical Circulatory Assistance of a Patient-Specific Fontan Vessel Configuration

The treatment of single ventricle anomalies is a formidable challenge for clinical teams caring for patients with congenital heart disease. Those patients fortunate to survive surgical palliation contend with lifelong physical limitations and late stage pathophysiology. A mechanical blood pump specifically designed to increase pressure in the great veins would augment flow through the lungs and provide hemodynamic stability until a donor heart is located. To support the development of such medical devices, this research characterized the fluid dynamics of mechanical assistance in the Fontan circulation by performing numerical analyses and particle image velocimetry (PIV) studies in a patient-specific in vitro model. This project investigated the performance of three pump prototype configurations. ANSYS-CFX was used to conduct the computational studies for a range of operating conditions and degrees of Fontan dysfunction. Pressure generation, blood trauma predictions, shear stresses, fluid streamlines, and velocity profiles were examined. Three-dimensional PIV studies were completed and compared to the numerical estimations. Computational findings and experimental data correlated to within literature expectations. Blood damage levels, shear stresses, and fluid residence times remained reasonable or below threshold limits. The blood pump configurations met expectations by achieving target design specifications for clinical application. The pumps enhanced the rate of hydraulic power gain in the cavopulmonary circuit, reduced inferior vena cava pressure, and minimally increased pulmonary arterial pressure. The blood pump with the twisted protective stent produced the most rapid increase in the rate of power gain and the highest pressure generation. The PIV measurements illustrated a strong dependency of the fluid dynamics on the patient-specific vessel geometry and the particular pump design. The pump having the twisted cage outperformed the other designs and had a dominating impact on the blood flow distribution in the cavopulmonary circuit. A strong rotational component in the flow was observed leaving the pumps. These results confirm that mechanical cavopulmonary assistance is a viable therapeutic option. Significant knowledge into a new class of blood pumps and how these pumps interact with a single ventricle physiology was gained, thus advancing the state-of-the-art in mechanical circulatory support and addressing a significant human health problem

A Reproduction of inflow restriction in the mock circulatory system to evaluate a hydrodynamic performance of a ventricular assist device in practical conditions

A novel in vitro mock circulatory system, which enables to reproduce an inflow restriction, simulating blood volume pooling due to heart failure, was developed to evaluate a hydrodynamic performance of a pulsatile ventricular assist device (VAD) in practical conditions. The concept of this development was motivated by a difference of an inflow restriction between in vitro and in vivo environments. The major idea of this study is to reproduce an inflow restriction by using a centrifugal pump placed at an inflow side of a left ventricular model instead of a constant head reservoir in a conventional circuit. In the novel circuit, the maximum flow rate was obtained at lower systolic fraction as compared with a conventional circuit. This similar tendency by the novel one was observed in an acute animal experiment in sheep. This result suggests that a new mock circuit is effective to confirm a practical drive strategy of the VAD for various diseased conditions.6 page(s

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