Engineering and Clinical Considerations in Pulsatile Blood Pump

Abstract

The development of mechanical circulatory support systems (“MCSS”) has been in parallel to donor heart transplantation. In 1966, Michael E. DeBakey did the first successful implant of a partial artificial heart at Methodist Hospital in Houston, USA, by using a paracorporeal blood pump to assist the failing left ventricle of a female patient until her heart has recovered after 10 days [1]. A blood pump connected to the patient’s circulatory system to support the pumping function is called ventricular assist device or “VAD.” Three years later, in 1969 Denton Cooley implanted the first total artificial heart (“TAH” – a full replacement of the patient’s native heart) which was developed by Domingo Liotta into the chest of a 47-year-old patient for 64 h to bridge him for heart transplantation [2]. The first implantations with the aim of permanent life support (so-called destination therapy, “DT”) took place 13 years later in 1982 by William DeVries and his team at Utah Medical Center, USA, using the Jarvik-7 TAH developed by Willem Kolff and his team [3]. The first MCSS mimic the layout (anatomy) and function of the natural heart using pulsatile pumping mode of displacement pumps. Nowadays nonpulsatile rotary blood pumps are the first choice for long-term LVAD support. Only for pediatric use and for short- to medium-term support the pulsatile displacement pumps are being used in the clinical arena. The first implantation of an axial flow rotary blood pump was in 1998 at the German Heart Institute Berlin, Germany, performed by Roland Hetzer [4]. In 2012, Martin Strueber reported the first use of two continuous flow centrifugal blood pumps as TAH in a patient after cardioectomy at Hannover Medical School, Germany [5]. Nevertheless, the current TAH systems and those in clinical or preclinical evaluation are all pulsatile pump systems. The pulsatile TAH offers advantages like high physiologic flows in case of biventricular failure.