A less-invasive left atrial assist device concept for diastolic heart failure: First in vitro and in vivo assessmentCentral MessagePerspective
Chihiro Miyagi, MD, PhD,
Taiyo Kuroda, MD,
Barry D. Kuban, BS,
Shengquiang Gao, PhD,
Christine R. Flick, BS, BME,
Anthony R. Polakowski, BS, MEng,
Jamshid H. Karimov, MD, PhD,
Kiyotaka Fukamachi, MD, PhD
Affiliations
Chihiro Miyagi, MD, PhD
Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
Taiyo Kuroda, MD
Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
Barry D. Kuban, BS
Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Medical Device Solutions, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
Shengquiang Gao, PhD
Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
Christine R. Flick, BS, BME
Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Medical Device Solutions, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
Anthony R. Polakowski, BS, MEng
Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Medical Device Solutions, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
Jamshid H. Karimov, MD, PhD
Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Kaufman Center for Heart Failure, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
Kiyotaka Fukamachi, MD, PhD
Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Kaufman Center for Heart Failure, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Address for reprints: Kiyotaka Fukamachi, MD, PhD, Department of Biomedical Engineering/ND20, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195.
Objective: A less-invasive left atrial assist device (LAADx) is a novel and implantable, extracardiac blood pump concept, intended for the treatment of diastolic heart failure, represented by heart failure with preserved ejection fraction. Methods: A mixed-flow pump was used as the working LAADx model. Its performance was evaluated at 3 speeds, using an in vitro pulsatile mock circulatory loop, with a pneumatic pump that can simulate diastolic heart failure conditions by adjusting the diastolic drive pressure. The LAADx model was implanted in 4 healthy calves. The pump's inflow and outflow cannulas were inserted into the left atrium (LA) and left ventricle (LV), respectively, without cardiopulmonary bypass. The LAADx was operated at 3 speeds, and diastolic heart failure-like conditions were induced by inflating a balloon, inserted into the LV. Results: With the in vitro study, diastolic heart failure-like conditions were successfully induced, exhibiting decreased cardiac output and aortic pressure as well as increased mean LA pressure both mitigated with the LAADx support. With regard to the in vivo study, simulated diastolic heart failure conditions showed a decrease in aortic pressure and an increase in LA pressure and LV end-diastolic pressure, which were again mitigated by the LAADx. Echocardiography showed good positioning of the outflow cannula and neither cardiac dysfunction nor mitral interference was observed. Conclusions: Initial in vitro and in vivo results confirmed that the LAADx model, a device concept driven by creating an extracardiac route from the LA to LV, has the potential to mitigate high LA pressure and improve LV filling of heart failure with preserved ejection fraction pathology.
