A versatile intracorporeal ventricular assist device based on the thoratec VAD system.

BACKGROUND

As patients are supported for longer durations with paracorporeal Thoratec left ventricular and biventricular assist devices (longest durations: 515 and 457 days, respectively), there is a need for implantable options.

METHODS

We are developing a small, simple, and versatile intracorporeal ventricular assist device (IVAD) for left, right, or biventricular support as an alternative to the large, implantable, pulsatile left ventricular assist device (LVAD) systems available today. The new device is based on the Thoratec paracorporeal VAD that has been used in more than 1,400 patients weighing from 17 to 144 kg and for durations exceeding 1 year including patient discharge (using the portable driver).

RESULTS

The IVAD has the same blood flow path and Thoralon polyurethane blood pumping sac as the paracorporeal VAD, but the housing is a smooth contoured, polished titanium alloy. The IVAD has a new sensor to detect when the pump is full and empty, and is controlled with the Thoratec TLC-II portable VAD driver, which is a small, briefcase-sized, battery-powered, pneumatic control unit. A small flexible (9 mm OD) percutaneous pneumatic driveline for each VAD is tunneled out of the body from the LVAD or right VAD in a pre- or intraperitoneal position. Small size and simplicity are the major advantages of the new device. The IVAD weight (339 g) and implanted volume (252 mL) are approximately one-half that of the current implantable pulsatile electromechanical LVAD systems.

CONCLUSIONS

The small size of the IVAD should not only allow support of a large range of patient sizes and body habitus, but also provide options for implantable left, right, or biventricular support. By implanting only the mechanically simple blood pump, the more complex control unit is external, where it can be serviced and replaced without surgery. The IVAD with the portable driver will be a viable alternative to large implanted electromechanical systems and should address a larger segment of the physically diverse patient population.