Unger F, Olsen D B, Oster H, Kolff W J
Eur Surg Res. 1976;8(2):105-16. doi: 10.1159/000127852.
When total artificial heart (TAH) recipients live over 100 h it is possible to evaluate the thrombogenicity of design and biomaterials. In 20 consecutive TAH recipients of the Jarvik heart with Björk-Shiley valves we compared rough (Dacron fibril-coated Silastic) and smooth (Biomer and Avcothane) blood surfaces. The mean survival times with rough surfaces was 296 h, with smooth surfaces 545 h. The present designs necessitate a sharp angle junction between the diaphragm and housing, creating stagnation areas and turbulences which induce thromboembolization. The valve rings and struts are another constant source of thromboembolism. Of the 80 valves, 41% showed thrombus deposition independent of anticoagulation. The polyurethane surfaces, in contrast to the fibrilized surfaces, were very clean and free of thrombi at autopsy. The thromboembolization was not dependent on anticoagulation and platelet adhesiveness inhibitor in hearts with rough surfaces. Based on 20 experiments including 78- and 94-day TAH survivors (Avcothane and Biomer hearts), there is an indication of the need of a new ventricular design. The ultimate design should generate physiological pulse waves without turbulences or stagnation areas within the device.
当全人工心脏（TAH）接受者存活超过100小时时，就有可能评估其设计和生物材料的血栓形成倾向。在连续20例接受带有 Björk-Shiley 瓣膜的 Jarvik 心脏的TAH接受者中，我们比较了粗糙（涤纶纤维涂层硅橡胶）和光滑（Biomer 和 Avcothane）的血液接触面。粗糙表面的平均存活时间为296小时，光滑表面为545小时。目前的设计要求隔膜与外壳之间有一个锐角连接，这会产生停滞区域和湍流，从而引发血栓栓塞。瓣膜环和支柱是另一个持续的血栓栓塞来源。在80个瓣膜中，41%显示出与抗凝无关的血栓沉积。相比之下，在尸检时聚氨酯表面非常干净，没有血栓。在粗糙表面的心脏中，血栓栓塞不依赖于抗凝和血小板粘附抑制剂。基于包括78天和94天存活的TAH接受者（Avcothane和Biomer心脏）在内的20次实验，有迹象表明需要一种新的心室设计。最终设计应能产生生理脉搏波，且装置内没有湍流或停滞区域。
