Progress in the Development of the Pulsatile CorWave LVAD

Botterbusch, C.; Barabino, N.; Cornat, F.; Jem, N.; Pruvost, R.; Marino, De; Benoit, Stefanie; Monticone, E.; Polverelli, L.; Snyder, Trevor A.; Loobuyck, Valentin; Susen, Sophie; Vincentelli, André

doi:10.1016/j.healun.2021.01.338

Cited by 7 publications

(7 citation statements)

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“…Because there is minimal perpendicular movement of the membrane relative to the neighboring surfaces, this offers a low shear means of pumping. Preliminary data shows the ability of CORWAVE to provide sufficient flow rates with minimal hemolysis and destruction of HMW vWF in mock flow loops and animal models 62 . The durability of the membrane may present a challenge though long‐term data are not available.…”

Section: Next Steps In Vad Engineeringmentioning

confidence: 99%

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Left ventricular assist devices: A historical perspective at the intersection of medicine and engineering

2022

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Over the last half‐century, left ventricular assist device (LVAD) technology has progressed from conceptual therapy for failed cardiopulmonary bypass weaning to an accepted destination therapy for advanced heart failure. The history of LVAD engineering is defined by an initial development phase, which demonstrated the feasibility of such an approach, to the more recent three major generations of commercial devices. In this review, we explore the engineering challenges of LVADs, how they were addressed over time, and the clinical outcomes that resulted from each major technological development. The first generation of commercial LVADs were pulsatile devices, which lacked the appropriate durability due to their number of moving components and hemocompatibility. The second generation of LVADs was defined by replacement of complex, pulsatile pumps with primarily axial, continuous‐flow systems with an impeller in the blood passageway. These devices experienced significant commercial success, but the presence of excessive trauma to the blood and in‐situ bearing resulted in an unacceptable burden of adverse events. Third generation centrifugal‐flow pumps use magnetically suspended rotors within the pump chamber. Superior outcomes with this newest generation of devices have been observed, particularly with respect to hemocompatibility‐related adverse events including pump thrombosis, with fully magnetically levitated devices. The future of LVAD engineering includes wireless charging foregoing percutaneous drivelines and more advanced pump control mechanisms, including synchronization of the pump flow with the native cardiac cycle, and varying pump output based on degree of physical exertion using sensor or advanced device‐level data triggers.

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Section: Next Steps In Vad Engineeringmentioning

confidence: 99%

“…Preliminary data shows the ability of CORWAVE to provide sufficient flow rates with minimal hemolysis and destruction of HMW vWF in mock flow loops and animal models. 62 The durability of the membrane may present a challenge though long-term data are not available.…”

Section: Emerging Pump Designsmentioning

confidence: 99%

Left ventricular assist devices: A historical perspective at the intersection of medicine and engineering

2022

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“…In vitro studies using circulatory models show considerable reductions in hemolysis when compared with the expected degree of hemolysis created for the amount of CO created. Further study and in-human trials are necessary to assess the safety and efficiency of both devices 72…”

Section: Future Directions Of Mcsmentioning

confidence: 99%

Mechanical circulatory support: complications, outcomes, and future directions

Cormican

Madden

Rodrigue

2022

International Anesthesiology Clinics

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“…Restoration of near-physiological levels of pulsatility is possible with the Heartmate 3 and the EVAHEART®2 via rapid changes in pump speed [49][50][51] and the CorWave Membrane LVAD with changes in the frequency of actuation of the membrane. 52 Unlike the native ventricle which can generate peak flows of 30-40 L/min, these devices are limited to peak flow rates of ~10 L/min which limits the level of pulsatility that can be restored. Therefore, pulsatility can be restored in two ways: (1) Synchronous Flow Modulation (SYN): where changes in pump speed are accomplished in synchrony with native myocardial contractions.…”

Section: Cf-vads and The Design Of The Next Generation Of Cf-vadsmentioning

confidence: 99%

“…In addition to Heartmate 3, there are two other pumps, the CorWave LVAD, which relies on a proprietary ‘wave membrane’ technology, and the EVAHEART®2 CF‐VAD, which uses a hydraulically levitated “open vane” impeller. Restoration of near‐physiological levels of pulsatility is possible with the Heartmate 3 and the EVAHEART®2 via rapid changes in pump speed 49–51 and the CorWave Membrane LVAD with changes in the frequency of actuation of the membrane 52 . Unlike the native ventricle which can generate peak flows of 30–40 L/min, these devices are limited to peak flow rates of ~10 L/min which limits the level of pulsatility that can be restored.…”

Section: Implications For Current Cf‐vads and The Design Of The Next ...mentioning

confidence: 99%

Loss of pulsatility with continuous‐flow left ventricular assist devices and the significance of the arterial endothelium in von‐Willebrand factor production and degradation

et al. 2022

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Background Patients on continuous flow ventricular assist devices (CF‐VADs) are at high risk for the development of Acquired von‐Willebrand Syndrome (AVWS) and non‐surgical bleeding. von Willebrand Factor (vWF) plays an essential role in maintaining hemostasis via platelet binding to the damaged endothelium to facilitate coagulation. In CF‐VAD patients, degradation of vWF into low MW multimers that are inefficient in facilitating coagulation occurs and has been primarily attributed to the supraphysiological shear stress associated with the CF‐VAD impeller. Methods In this review, we evaluate information from the literature regarding the unraveling behavior of surface‐immobilized vWF under pulsatile and continuous flow pertaining to: (A) the process of arterial endothelial vWF production and release into circulation, (B) the critical shear stress required to unravel surface bound versus soluble vWF which leads to degradation, and (C) the role of pulsatility in on the production and degradation of vWF. Results and Conclusion Taken together, these data suggests that the loss of pulsatility and its impact on arterial endothelial cells plays an important role in the production, release, unraveling, and proteolytic degradation of vWF into low MW multimers, contributing to the development of AVWS. Restoration of pulsatility can potentially mitigate this issue by preventing AVWS and minimizing the risk of non‐surgical bleeding.

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Progress in the Development of the Pulsatile CorWave LVAD

Cited by 7 publications

References 0 publications

Left ventricular assist devices: A historical perspective at the intersection of medicine and engineering

Left ventricular assist devices: A historical perspective at the intersection of medicine and engineering

Mechanical circulatory support: complications, outcomes, and future directions

Loss of pulsatility with continuous‐flow left ventricular assist devices and the significance of the arterial endothelium in von‐Willebrand factor production and degradation

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