Meissner Florian, Galbas Michelle Costa, Straky Hendrik, Vestner Heiko, Schoen Manuela, Schimmel Marius, Reuter Johanna, Buechsel Martin, Dinkelaker Johannes, Cristina Schmitz Heidi, Czerny Martin, Bothe Wolfgang
Department of Cardiovascular Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
Institute for Clinical Chemistry and Laboratory Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
Bioengineering (Basel). 2024 Aug 19;11(8):848. doi: 10.3390/bioengineering11080848.
A new accessory was developed to allow implantation of left ventricular assist devices (LVADs) without requiring an anastomosis to the ascending aorta. The accessory combines the LVAD inflow and outflow into a dual-lumen device. Initial prototypes encountered reduced pump performance in vitro, but a second-generation prototype successfully addressed this issue. This feasibility study aimed to demonstrate the anatomic fit, safe implantation, and hemodynamic effectiveness of the LVAD with the accessory. The accessory was implanted in ten female pigs (104 ± 13 kg). Following sternotomy and apical coring under cardiopulmonary bypass, a balloon catheter was retrogradely inserted and exteriorized through the coring site, where it was inflated within the distal third of the outflow graft. It was utilized to pull the accessory's outflow across the aortic valve. After LVAD attachment, the catheter was removed. Echocardiography revealed no relevant valve regurgitation post-implantation. During ramp testing, pump flow increased from 3.7 ± 1.2 to 5.4 ± 1.2 L/min. Necropsy confirmed correct accessory placement in nine animals. No valve lesions or device thrombosis were observed. The accessory enabled LVAD implantation without compromising pump performance. Future work includes design refinements for implantation without cardiopulmonary bypass and long-term testing in a chronic heart failure model.
一种新的附件被开发出来，用于在无需与升主动脉吻合的情况下植入左心室辅助装置（LVAD）。该附件将LVAD的流入和流出整合到一个双腔装置中。最初的原型在体外测试中泵性能有所下降，但第二代原型成功解决了这个问题。这项可行性研究旨在证明带有该附件的LVAD在解剖学上的适配性、安全植入性和血流动力学有效性。该附件被植入十头雌性猪（体重104±13千克）体内。在体外循环下进行胸骨切开术和心尖取芯后，将球囊导管逆行插入并通过取芯部位引出，在流出道移植物的远端三分之一处充气。利用它将附件的流出端拉过主动脉瓣。在连接LVAD后，移除导管。超声心动图显示植入后无相关瓣膜反流。在递增测试期间，泵流量从3.7±1.2升/分钟增加到5.4±1.2升/分钟。尸检证实九只动物的附件放置正确。未观察到瓣膜病变或装置血栓形成。该附件使LVAD能够植入，且不影响泵的性能。未来的工作包括对无需体外循环植入的设计改进以及在慢性心力衰竭模型中的长期测试。
