Assessment of Hydraulic Performance and Biocompatibility of a MagLev Centrifugal Pump System Designed for Pediatric Cardiac or Cardiopulmonary Support

Dasse, Kurt A.; Gellman, Barry; Kameneva, Marina V.; Woolley, Joshua R.; Johnson, C. Anderson; Gempp, Thomas; Marks, John D.; Kent, Stella; Koert, Andrew; Richardson, J S; Franklin, Steven O.; Snyder, Trevor A.; Wearden, Peter D.; Wagner, William R.; Borovetz, Harvey S.

doi:10.1097/mat.0b013e31815dbf66

Cited by 33 publications

(26 citation statements)

References 29 publications

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“…From comparisons of early LV assist devices64,65 to the development of a totally implantable biventricular assist system,66 large animals have served an integral role in groundbreaking advances in cardiac destination therapies. The adaptation of such devices for neonatal and pediatric use has also been possible through large animal models 67. The development of minimally invasive devices to unload pressure from the failing LV have also utilized large animal models.…”

Section: Developing New Therapeutic Targets In Hfmentioning

confidence: 99%

Large Animal Models of Heart Failure

Dixon

Spinale

2009

Circ: Heart Failure

261

125

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Abstract-Congestive heart failure (HF) is a clinical syndrome, with hallmarks of fatigue and dyspnea, that continues to be highly prevalent and morbid. Because of the growing burden of HF as the population ages, the need to develop new pharmacological treatments and therapeutic interventions is of paramount importance. Key Words: myocardial infarction Ⅲ myocardial remodeling Ⅲ overload states Ⅲ rapid pacing C ongestive heart failure (HF) is a constellation of symptoms, with hallmarks of fatigue and dyspnea, which continues to be a highly prevalent and morbid clinical syndrome. Although the etiologic underpinnings of HF can be diverse, common pathophysiologic features include changes in left ventricle (LV) structure, function, and neurohormonal activation. The impact of HF will undoubtedly become even more substantial as the population ages. Accordingly, the need to develop new pharmacological treatments and therapeutic interventions for HF is of paramount importance. The journey from discovery, to understanding, to clinical application of the biological basis of HF is one that can only be traveled with the use of large animal models that recapitulate this clinical phenotype.The current pharmacological armamentarium in the treatment of HF includes angiotensin-converting enzyme inhibitors, aldosterone antagonists, and angiotensin and ␤-adrenergic receptor blockade. 1 Although inhibition of the renin-angiotensin-aldosterone and sympathetic adrenergic systems have provided clear benefit to those suffering from HF, the disease process nonetheless continues. Therefore, further research is required to find additional pathways and mechanisms to target in the battle against HF. The Need for Large Animal Models of HFSignificant insight into the molecular and cellular basis of cardiovascular biology has come from small animal models, particularly mice. However, significant differences exist with regard to cardiac characteristics such as heart rate, oxygen consumption, adrenergic receptor ratios, and response to loss of regulatory proteins, when mice are contrasted to humans. 2,3 Moreover, contractile protein expression, critical to the excitation-contraction coupling process, seems to differ between the 2 species, as evidenced by their differing predominant myosin isoforms. 2 Finally, evidence exists of significant phenotypic differences between mouse and human stem cells. 3 Consequently, extrapolation of murine systems, particularly after induction of cardiovascular stress, becomes problematic when making interpretations of human HF pathophysiology. Therefore, large animal models of HF, which more closely approximate human physiology, function, and anatomy, are essential to develop the discoveries from murine models into clinical therapies and interventions for HF.This review aims to summarize some of the more frequently used large animal models, which recapitulate the clinical HF phenotype arising from the common clinical etiologies of myocardial ischemia/infarction, ventricular overload states, and dilated cardiomyopath...

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Section: Developing New Therapeutic Targets In Hfmentioning

confidence: 99%

Large Animal Models of Heart Failure

Dixon

Spinale

2009

Circ: Heart Failure

261

125

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“…1 Among the children born with CHD, approximately 25% of them need invasive cardiac surgery requiring the use of cardiopulmonary bypass (CPB) procedures. 3 Neurological complication after CPB procedures is a known cause of morbidity and mortality in this population. Gaseous microemboli exposure during the CPB procedure is one of many contributing factors leading to adverse neurological outcomes.…”

mentioning

confidence: 99%

Microemboli Generation, Detection and Characterization During CPB Procedures in Neonates, Infants, and Small Children

Win

Wang²,

Ündar³

2008

ASAIO Journal

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In our laboratory, we study different factors that influence the microemboli counts in the extracorporeal circuit using a simulated pediatric cardiopulmonary bypass (CPB) model identical to the one used in our operating rooms. For monitoring and classification of microemboli, we use the novel Emboli Detection and Classification (EDAC) Quantifier system which allows for real-time monitoring, localization, and size characterization of microemboli as small as 10 microm. Our results show that high flow rates, low perfusate temperature, use of vacuum assisted venous drainage (VAVD), use of roller pump, and pulsatile flow results in higher microemboli counts at postpump site. Microemboli counts at postoxygenator, and postfilter sites are significantly less. This indicates that hollow fiber membrane oxygenator was able to remove most of the microemboli, and an opened arterial filter purge line augments the removal of microemboli that were not captured by the oxygenator. Majority of the microemboli detected at all sites were <40 microm in size. Based on the results of our studies, we started using the EDAC Quantifier system in our operating rooms at Penn State Hershey Children's Hospital. More basic science studies and clinical outcome data are needed for further study in minimizing the adverse effects of pediatric CPB procedure.

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“…It was decided to use a Levitronix PediVAS device for mechanical circulatory support rather then ECMO as we were considering a possibility for long-time heart failure. In this case Levitronix could be used up to 30 days and longer [2,8]. Single ventricle (left heart bypass) support with the PediVAS device was initiated through median resternotomy by placing a 12-French Medtronic DLP ® arterial cannula to the ascending aorta and bent angle wire-reinforced 18-French Terumo® venous cannulla to the dome of the common atrium ( Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…The PediVAS (Levitronix LLC, Waltham, MA) is intended for neonates and pediatric patients with flows from 0.3 to 3.0 L/min at rotor speeds up to 5,500 rpm. The pump is capable of functioning for weeks with low hemolysis and minimal thrombus formation [2]. We report a successful application of the Levitronix PediVAS system in the small pediatric patient as a bridge to recovery after Fontan surgery in acute cardiac failure.…”

Section: Introductionmentioning

confidence: 99%

Successful experience with Levitronix PediVAS for management of acute heart failure after Fontan surgery

Bezuska

Lebetkevičius²,

Lankutis

et al. 2012

Open Medicine

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AbstractAn extracorporeal membrane oxygenation was long a golden standard in the pediatric population with acute cardiac failure for short-term mechanical circulatory support. It gives the limited availability of pediatric-sized pumps and the outcomes remain disproportionately poor. The Levitronix PediVAS system (Levitronix LLC, Waltham, MA) offers expanded options for short-term support for this population. We report our experience with the successful use of the PediVAS (left heart bypass) in the 3-year-old male patient as a bridge to recovery after Fontan surgery in acute heart failure. Short-term circulatory support with the Levitronix PediVAS has proven to be a less invasive, safe, and effective for our pediatric patient.

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Assessment of Hydraulic Performance and Biocompatibility of a MagLev Centrifugal Pump System Designed for Pediatric Cardiac or Cardiopulmonary Support

Cited by 33 publications

References 29 publications

Large Animal Models of Heart Failure

Large Animal Models of Heart Failure

Microemboli Generation, Detection and Characterization During CPB Procedures in Neonates, Infants, and Small Children

Successful experience with Levitronix PediVAS for management of acute heart failure after Fontan surgery

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