Gülcher Oskar J, Vis Annemijn, Peirlinck Mathias, Kluin Jolanda
Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands.
Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
Artif Organs. 2023 Dec;47(12):1809-1817. doi: 10.1111/aor.14641. Epub 2023 Sep 13.
Maintaining balanced left and right cardiac outputs in a total artificial heart (TAH) is challenging due to the need for continuous adaptation to changing hemodynamic conditions. Proper balance in ventricular outputs of the left and right ventricles requires a preload-sensitive response and mechanisms to address the higher volumetric efficiency of the right ventricle.
This review provides a comprehensive overview of various methods used to balance left and right ventricular outputs in pulsatile total artificial hearts, categorized based on their actuation mechanism.
Reported strategies include incorporating compliant materials and/or air cushions inside the ventricles, employing active control mechanisms to regulate ventricular filling state, and utilizing various shunts (such as hydraulic or intra-atrial shunts). Furthermore, reducing right ventricular stroke volume compared to the left often serves to balance the ventricular outputs. Individually controlled actuation of both ventricles in a pulsatile TAH seems to be the simplest and most effective way to achieve proper preload sensitivity and left-right output balance. Pneumatically actuated TAHs have the advantage to respond passively to preload changes.
Therefore, a pneumatic TAH that comprises two individually actuated ventricles appears to be a more desirable option-both in terms of simplicity and efficacy-to respond to changing hemodynamic conditions.
由于需要持续适应不断变化的血流动力学状况，在全人工心脏（TAH）中维持左右心输出量的平衡具有挑战性。左右心室输出量的适当平衡需要对前负荷敏感的反应以及应对右心室更高容积效率的机制。
本综述全面概述了用于平衡搏动性全人工心脏左右心室输出量的各种方法，并根据其驱动机制进行分类。
报道的策略包括在心室内部采用顺应性材料和/或气垫、采用主动控制机制来调节心室充盈状态以及使用各种分流装置（如液压分流或心房内分流）。此外，与左心室相比减少右心室的每搏输出量通常有助于平衡心室输出量。在搏动性TAH中对两个心室进行单独控制驱动似乎是实现适当前负荷敏感性和左右输出量平衡的最简单、最有效的方法。气动驱动的TAH具有被动响应前负荷变化的优势。
因此，就简单性和有效性而言，一种由两个单独驱动的心室组成的气动TAH似乎是应对不断变化的血流动力学状况的更理想选择。
