The Biocompatibility Challenges in the Total Artificial Heart Evolution

Abstract

There are limited therapeutic options for final treatment of end-stage heart failure. Among them, implantation of a total artificial heart (TAH) is an acceptable strategy when suitable donors are not available. TAH development began in the 1930s, followed by a dramatic evolution of the actuation mechanisms operating the mechanical pumps. Nevertheless, the performance of TAHs has not yet been optimized, mainly because of the low biocompatibility of the blood-contacting surfaces. Low hemocompatibility, calcification, and sensitivity to infections seriously affect the success of TAHs. These unsolved issues have led to the withdrawal of many prototypes during preclinical phases of testing. This review offers a comprehensive analysis of the pathophysiological events that may occur in the materials that compose TAHs developed to date. In addition, this review illustrates bioengineering strategies to prevent these events and describes the most significant steps toward the achievement of a fully biocompatible TAH.

Preliminary hemocompatibility assessment of an innovative material for blood contacting surfaces

“…Anyway, the adoption of hemocompatible materials does not necessarily result in blood compatibility of the entire device: it also depends on structural [11] and chemical properties [12,13], biological behavior of the interfacing surfaces, flow dynamics [14], and-last but not least-the overall design. A paper discussing the hemocompatibility issue for TAHs has been recently published [15]: it presents a detailed analysis of the pathophysiological events that may arise in currently developed TAHs and illustrates bioengineering solutions to prevent them.…”

Preliminary Computational Analysis of Three Configurations for an Innovative Ventricular Chamber

“…There is at least one other fundamental aspect to consider in designing any blood-contact device, that is, its hemocompatibility [7]. It implies the absence of hemolysis and platelet activation, and the prevention of the cellular components' consumption, and activation of coagulation pathways.…”

“…During recent decades, different ventricular chambers have been designed to minimize the size and reduce the adverse reactions and complications caused by mechanical devices in permanent contact with the blood, in particular TAHs [7], such as hemorrhages and thromboembolic events [4].…”

Hybrid membranes for the production of blood contacting surfaces: physicochemical, structural and biomechanical characterization

“…Nowadays, the optimal therapeutic solution for refractory end-stage HF is represented by cardiac transplantation, which is limited by organs’ shortage [ 2 ]. The quest for alternative therapeutic treatments stimulated the development of mechanical circulatory supports (MCSs): ventricular-assist devices (VADs) successfully support one ventricle, whereas total artificial hearts (TAHs) replace both ventricles.…”

“…The quest for alternative therapeutic treatments stimulated the development of mechanical circulatory supports (MCSs): ventricular-assist devices (VADs) successfully support one ventricle, whereas total artificial hearts (TAHs) replace both ventricles. TAH implantation now represents a suitable option for patients requiring biventricular mechanical circulatory support either as bridge to transplant (BTT) or destination therapy (DT) [ 2 , 3 ].…”