Di Molfetta Arianna, Zielinski Krzysztof, Ferrari Gianfranco, Kozarski Macej, Okrzeja Piotr, Iacobelli Roberta, Filippelli Sergio, Perri Gianluigi, Darowski Marek, Massetti Massimo, Jarvik Robert, Amodeo Antonio
Department of Cardiac Surgery, Policlinico Gemelli Hospital, Rome, Italy.
Nalecz Institute of Biocybernetics and Biomedical Engineering PAS, Warsaw, Poland.
Artif Organs. 2019 Jan;43(1):E1-E8. doi: 10.1111/aor.13302. Epub 2018 Nov 6.
Our aim was to study the feasibility of implanting the Infant Jarvik 2015 in patients weighing less than 8 kg. The Infant Jarvik 2015 left ventricular assist device (LVAD) was tested in a hybrid simulator of the cardiovascular system reproducing specific patients' hemodynamics for different patient weights (2-7 kg). For each weight, the sensitivity of the pump to different circulatory parameters (peripheral resistance, left ventricular elastance, right ventricular elastance, heart rate, and heart filling characteristics) has been tested repeating for each experiment a pump ramp (10 000-18 000 rpm). The increase in the pump speed causes a decrease (increase) in the left (right) atrial pressure, an increase (decrease) in the arterial systemic (pulmonary) pressure, an increase in the right ventricular pressure, a decrease (increase) in the left (right) ventricular volume, a decrease in the left ventricular cardiac output, an increase in the LVAD output and an increase in the right ventricular cardiac output (total cardiac output). Suction was observed for lower weight patients and for higher pump speed in the case of vasodilation, left ventricular recovery, bradycardia, right ventricular failure, and left ventricular hypertrophy. Backflow was observed in the case of left ventricular recovery at lower pump speed. In the hybrid simulator, the Infant Jarvik 2015 could be suitable for the implantation in patients lower than 8 kg because of the stability of the device respect to the cardio/circulatory changes (low frequency of suction and backflow) and because of the capability of the device to maintain adequate patient hemodynamics.
我们的目的是研究将婴儿版贾维克2015型植入体重不足8千克的患者体内的可行性。婴儿版贾维克2015型左心室辅助装置（LVAD）在心血管系统混合模拟器中进行了测试，该模拟器可再现不同体重（2至7千克）特定患者的血流动力学情况。对于每个体重，测试了该泵对不同循环参数（外周阻力、左心室弹性、右心室弹性、心率和心脏充盈特征）的敏感性，每个实验重复进行一次泵转速斜坡测试（10000 - 18000转/分钟）。泵速增加会导致左（右）心房压力降低（升高）、动脉系统（肺）压力升高（降低）、右心室压力升高、左（右）心室容积降低（升高）、左心室心输出量降低、LVAD输出量增加以及右心室心输出量（总心输出量）增加。在体重较轻的患者以及血管舒张、左心室恢复、心动过缓、右心室衰竭和左心室肥大情况下泵速较高时观察到了抽吸现象。在泵速较低且左心室恢复的情况下观察到了回流现象。在混合模拟器中，婴儿版贾维克2015型可能适合植入体重低于8千克的患者，因为该装置相对于心脏/循环变化具有稳定性（抽吸和回流频率低），并且该装置有能力维持患者足够的血流动力学状态。
