Narayanaswamy Krishnaraj, Petz Jakob, Bierewirtz Tim, Loewe Christian, Kertzscher Ulrich, Zimpfer Daniel, Granegger Marcus
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Deutsches Herzzentrum der Charité, Institute of Computer-Assisted Cardiovascular Medicine, Berlin, Germany.
Artif Organs. 2025 Feb;49(2):196-206. doi: 10.1111/aor.14878. Epub 2024 Oct 3.
ShuttlePump is a novel total artificial heart (TAH) recently introduced to potentially overcome the limitations associated with the current state-of-the-art mechanical circulatory support devices intended for adults. In this study, we adapted the outflow cannulation of the previously established ShuttlePump TAH and evaluated the anatomical compatibility using the virtual implantation technique.
We retrospectively assessed the anatomical compatibility of the ShuttlePump using virtual implantation techniques within 3D-reconstructed anatomies of adult heart failure patients. Additionally, we examined the impact of outflow cannula modification on the hemocompatibility of the ShuttlePump through computational fluid dynamic simulations.
A successful virtual implantation in 9/11 patients was achieved. However, in 2 patients, pump interaction with the thoracic cage was observed and considered unsuccessful virtual implantation. A strong correlation (r <-0.78) observed between the measured anatomical parameters and the ShuttlePump volume exceeding pericardium highlights the importance of these measurements apart from body surface area. The numerical simulation revealed that the angled outflow cannulation resulted in a maximum pressure drop of 1.8 mmHg higher than that of the straight outflow cannulation. With comparable hemolysis index, the shear stress thresholds of angled outflow differ marginally (<5%) from the established pump model. Similar washout behavior between the pump models indicate that the curvature did not introduce stagnation zone.
This study demonstrates the anatomic compatibility of the ShuttlePump in patients with biventricular failure, which was achieved by optimizing the outflow cannulation without compromising hemocompatibility. Nevertheless, clinical validation is critical to ensure the clinical applicability of these findings.
穿梭泵是一种新型的全人工心脏（TAH），最近被引入，旨在潜在地克服与当前用于成人的先进机械循环支持装置相关的局限性。在本研究中，我们对先前建立的穿梭泵全人工心脏的流出道插管进行了改进，并使用虚拟植入技术评估了解剖学兼容性。
我们在成人心力衰竭患者的三维重建解剖结构中，使用虚拟植入技术回顾性评估了穿梭泵的解剖学兼容性。此外，我们通过计算流体动力学模拟研究了流出道插管改良对穿梭泵血液相容性的影响。
11例患者中有9例成功实现了虚拟植入。然而，在2例患者中，观察到泵与胸廓相互作用，被认为虚拟植入不成功。测量的解剖学参数与超过心包的穿梭泵体积之间观察到强相关性（r < -0.78），这突出了这些测量除体表面积之外的重要性。数值模拟显示，与直流出道插管相比，成角度的流出道插管导致最大压力降高出1.8 mmHg。在溶血指数相当的情况下，成角度流出道的剪切应力阈值与已建立的泵模型略有不同（<5%）。泵模型之间类似的冲洗行为表明，曲率并未引入停滞区。
本研究证明了穿梭泵在双心室衰竭患者中的解剖学兼容性，这是通过优化流出道插管实现的，且不影响血液相容性。然而，临床验证对于确保这些发现的临床适用性至关重要。
