Takatsugu Shimono

Development of an Implantable Centrifugal Ventricular Assist Device (CVAD)

The centrifugal ventricular assist device (CVAD) was developed for long-term circulatory support, and is capable of either intracorporeal implantation or paracorporeal placement. The pump was designed based on our antithrombogenic concepts: (1) sealless pump casing, (2) elimination of stationary parts, and (3) blood flow acceleration under the impeller. To meet conditions (1) and (2), a pivot bearing system was adopted to support the impeller. The inlet port was placed slightly off-center and inclined 60° towards the same direction as the outlet port. This port configuration not only yielded a space where an inlet cup bearing could be directly embedded but also allowed for a significant reduction of the pump height, hence, resulting in easier placement inside the body cavity. Two small secondary vanes were installed in the bottom of the impeller to satisfy condition (3). Five paracorporeal left ventricular (LV) AD studies, using calves, were performed to evaluate the antithrombogenic design of the pump. The first two cases were subjected to 2-week tests. With the activated clotting time (ACT) kept at 250 s with heparin, the initial two cases had trouble-free performances over the 2 weeks. Following these successful results, another three cases were subjected to 1-month validation studies, in which there was no device-induced thrombus formation inside the pump housing. These results confirm that the CVAD, the C1E3, meets the requirements for a 1-month paracorporeal LVAD.

Is it true that cardiac operations with cardiopulmonary bypass impair the reticuloendothelial system

Reticuloendothelial system (RES) function after cardiac operations is a controversial issue. Sequential changes in plasma fibronectin levels and RES phagocytic function were studied after a cardiac operation and a lung operation (control). In the cardiac operation group, the plasma fibronectin level decreased until the third postoperative day and increased thereafter. Reticuloendothelial system phagocytic function remained unchanged on the third postoperative day and then it increased. However, in the control group it increased significantly after operation. In the past, investigators have demonstrated a decline in plasma fibronectin levels following cardiac operation and have assumed that RES function was impaired. However, this sequential study showed that phagocytic function was not impaired, but its enhanced phase was delayed. Moreover, our previous morphologic studies demonstrated that RES function was potentially activated after cardiopulmonary bypass. It appears that the delay of the enhanced phase is caused by the overloading of substances which must be processed by the RES during cardiopulmonary bypass. Thus, we conclude that cardiac operation produces hyperactive, yet oversaturated RES function. There is no impairment of RES function after cardiac operations.

Phase 1 Ex Vivo Studies of the Baylor/NASA Axial Flow Ventricular Assist Device

The Baylor/NASA ventricular assist device (VAD) is a small, electrically driven, valveless axial flow pump that is implantable inside the chest cavity. It is intended to assist a diseased heart. In the phase 1 study of this pump development program, the 2-day pump is intended to produce an assist device for cardiopulmonary bypass (CPB) application. The main focus of this phase of the program was to develop a pump which produced minimum blood trauma. Antithrombogenic features are planned to be incorporated into the phase 2 pump. In this phase 1 study, eight pumps were implanted paracorporeally in two calves as LVADs to assess hemolysis, pump performance, efficiency, and stability, the goal for this study being a 2-day implantation. The pump running times ranged from 18 to 203 (78.1 ± 23.7; mean ± SE) h. Plasma free hemoglobin levels were below 13.7 mg/di, except for one case complicated by inflow cannula obstruction due to pannus formation. Pump speed was maintained between 10100 and 11400rpm. Pump output ranged from 3.6 to 5.11/min. The electrical power required by the system ranged from 10.5 to 12.8W. No detectable organ dysfunction was noted and postmortem evaluations demonstrated no pump-related adverse effects in any of the calves. Thrombus deposition was observed mainly at the hub area and flow straightener. For the next series of experiments (phase 2), the thrombogenic regions in these subacute experiments should be eliminated.