Pneumatic Pump Research Articles

Left Atrial Circulatory Assistance in Simulated Diastolic Heart Failure Model: First in Vitro and in Vivo

We are developing a left atrial assist device (LAAD) that is implanted at the mitral position to treat diastolic heart failure (DHF) represented by heart failure with preserved ejection fraction. The LAAD was tested at 3 pump speeds on a pulsatile mock loop with a pneumatic pump that simulated DHF conditions by adjusting the diastolic drive. The LAAD was implanted in 6 calves, and the hemodynamics were assessed. In 3 cases, DHF conditions were induced by using a balloon inserted into the left ventricle, and in 2 cases, mitral valve replacement was also performed after the second aortic cross-clamp. DHF conditions were successfully induced in the in vitro study. With LAAD support, cardiac output, aortic pressure and left atrial pressure recovered to normal values, whereas pulsatility was maintained for both in vivo and in vitro studies. Echocardiography showed no left ventricular outflow tract obstruction, and the LAAD was successfully replaced by a mechanical prosthetic valve. These initial in vitro and in vivo results support our hypothesis that use of the LAAD increases cardiac output and aortic pressure and decreases left atrial pressure, while maintaining arterial pulsatility.

Droplette: A Platform Technology to Directly Deliver Nucleic Acid Therapeutics and Other Molecules into Cells and Deep into Tissue Without Transfection Reagents.

Droplette (US 9,700,686 B2 and PCT/US2016/035695) is the first portable and contact-free transdermal technology comprising the unique combination of a piezoelectric transducer and a pneumatic diaphragm pump to deliver large biomolecules including nucleic acid therapeutics (NATs) deep into cells, and into skin and soft tissue for effective delivery over short timescales. The droplets that come out of the device are 10-50× smaller upon impact than what is created through other commercial atomizers, such as the piezoelectric transducer alone. This device has been tested extensively in vitro, in vivo and in IRB approved human studies. The Droplette device delivers metered doses using a water droplet dispersal technology already commonly used in humidifier devices, by utilizing a piezoelectric material. Three key innovations make this device technically novel and tailored specifically for both field and lab use: (1) The combination of the piezo and pump to generate sub-micron drug-loaded droplets that penetrate cells, skin, and soft tissue to effectively deliver a range of large molecules, proteins, and nucleic acids. (2) Their assembly in a modular manner which enables portability, safe sterilization, and ejection without direct device-surface contact or significant force, allowing for improved safety and ease of use in both research and clinical settings. (3) The integration of a single-use, sterile cartridge that contains a therapeutic formulation and allows easy integration of a large number of molecules. The platform has broad applications across multiple fields, such as delivery of drugs for inflammatory skin diseases, antibiotics for skin infections, and gene delivery for gene therapy and biomedical research. In this chapter, we briefly introduce the Droplette delivery technology, instructions for building your own setup (note that fully built devices are available for purchase from Droplette, Inc), and provide protocols for directly transfecting adherent cell cultures and for direct in vivo transfection using the Droplette system without the need for traditional transfection reagents or methods.

Visualization and Quantification of TGFβ/BMP/SMAD Signaling under Different Fluid Shear Stress Conditions using Proximity-Ligation-Assay.

Transforming Growth Factor β (TGFβ)/Bone Morphogenetic Protein (BMP) signaling is tightly regulated and balanced during the development and homeostasis of the vasculature system Therefore, deregulation in this signaling pathway results in severe vascular pathologies, such as pulmonary artery hypertension, hereditary hemorrhagic telangiectasia, and atherosclerosis. Endothelial cells (ECs), as the innermost layer of blood vessels, are constantly exposed to fluid shear stress (SS). Abnormal patterns of fluid SS have been shown to enhance TGFβ/BMP signaling, which, together with other stimuli, induce atherogenesis. In relation to this, atheroprone, low laminar SS was found to enhance TGFβ/BMP signaling while atheroprotective, high laminar SS, diminishes this signaling. To efficiently analyze the activation of these pathways, we designed a workflow to investigate the formation of transcription factor complexes under low laminar SS and high laminar SS conditions using a commercially available pneumatic pump system and proximity ligation assay (PLA). Active TGFβ/BMP-signaling requires the formation of trimeric SMAD complexes consisting of two regulatory SMADs (R-SMAD); SMAD2/3 and SMAD1/5/8 for TGFβ and BMP signaling, respectively) with a common mediator SMAD (co-SMAD; SMAD4). Using PLA targeting different subunits of the trimeric SMAD-complex, i.e., either R-SMAD/co-SMAD or R-SMAD/R-SMAD, the formation of active SMAD transcription factor complexes can be measured quantitatively and spatially using fluorescence microscopy. The usage of flow slides with 6 small parallel channels, that can be connected in series, allows for the investigation of the transcription factor complex formation and inclusion of necessary controls. The workflow explained here can be easily adapted for studies targeting the proximity of SMADs to other transcription factors or to transcription factor complexes other than SMADs, in different fluid SS conditions. The workflow presented here shows a quick and effective way to study the fluid SS induced TGFβ/BMP signaling in ECs, both quantitatively and spatially.

Clinical Evaluation of a Novel Wearable Compression Technology in the Treatment of Lymphedema, an Open-Label Controlled Study.

A diagnosis of lymphedema comes with a lifetime requirement for careful self-care and treatment to control skin deterioration and the consequences of excessive fluid and protein buildup leading to abnormal limb volume and an increased risk of infection. The burden of care and psychosocial aspects of physical disfiguration and loss of function are associated with compromised quality of life (QoL). The current standard therapeutic intervention is complex decongestive therapy with manual lymph drainage and frequent wearing of compression garments. With insurance limitations on therapy visits and the time and travel required, additional home treatment options are needed. Pneumatic compression pumps that mimic the manual massage pressure and pattern are sometimes prescribed, but these are bulky, difficult to apply, and require immobility during treatment. An open-label pilot study in 40 subjects was performed to evaluate the QoL and limb volume maintenance efficacy of a novel wearable compression system (Dayspring™) that is low profile, easy to use, and allows for mobility during treatment. After 28 days of use, subjects had a statistically significant 18% (p < 0.001) improvement in overall QoL as measured by the Lymphedema Quality-of-Life Questionnaire compared with baseline. Individual QoL domains, and limb volume improved with therapy. Adherence was 98% over the course of the study. Results of the clinical evaluation suggest the Dayspring wearable compression device is safe and effective and improves QoL and limb volume. The novel, low-profile device is easy to use and allows for mobility during treatment, addressing a potential barrier to adherence with pneumatic compression devices.

Feasibility study of swash plate plunger pump system in drainage gas recovery process

With the continuous development of Sulige gas field, the formation pressure has gradually dropped, problems that liquid loading and water flooding affects the normal production of gas wells have gradually appeared. Drainage gas recovery delays the decline of gas field production to some extent, but the stable production of gas wells with large water production has become a field problem. Therefore, the pneumatic swash plate plunger pump system that does not need external power equipment but has large displacement and is easy to manage is studied. It has become another weapon to prolong the blowout period of gas wells.

User-Centered Design: Developing the RELI Delivery System - a Low-Cost, Non-Electric, Pneumatic Infusion Pump.

PurposeInfusion pumps are the preferred method for intravenous delivery of drugs and fluids, and an essential tool in health facilities. Their high cost, complexity and reliance on electricity pose serious challenges to wide-spread use, availability and access in low- and middle-income countries. PATH developed the RELI Delivery System (RELI), a low cost, non-electric infusion pump to address these challenges. Input collected from fifty-nine newborn and maternal care providers and from seven national level decision makers in Uganda was used to guide product development, further informing product design requirements, and optimal design features to best serve their needs.MethodsA formative evaluation following a mixed methods approach including focus group discussions (FGDs), stakeholder interviews, and observations was used to collect data from end users.ResultsStakeholders provided critical input on the RELI prototype design features, safety criteria, and contexts of use of infusion pumps, as well as recommendations for design refinements. Infusion systems are greatly needed but not readily available and their use is limited to well-resourced higher level facilities, even though the need is high in non-tertiary care hospital where patient volume is high, resources are scarce, power is inconsistent, and facilities are understaffed and overcrowded. Users expressed a need for an affordable and simple device with an intuitive user interface, clear instructions for use, and basic safety features.ConclusionThe study provided important guidance for further design refinements based on input from respondents and confirmed the need for robust, affordable, infusion pumps that meet the requirements for use in low-resource settings.

Thermoplastic Elastomer (TPE)-Poly(Methyl Methacrylate) (PMMA) Hybrid Devices for Active Pumping PDMS-Free Organ-on-a-Chip Systems.

Polydimethylsiloxane (PDMS) has been used in microfluidic systems for years, as it can be easily structured and its flexibility makes it easy to integrate actuators including pneumatic pumps. In addition, the good optical properties of the material are well suited for analytical systems. In addition to its positive aspects, PDMS is well known to adsorb small molecules, which limits its usability when it comes to drug testing, e.g., in organ-on-a-chip (OoC) systems. Therefore, alternatives to PDMS are in high demand. In this study, we use thermoplastic elastomer (TPE) films thermally bonded to laser-cut poly(methyl methacrylate) (PMMA) sheets to build up multilayered microfluidic devices with integrated pneumatic micro-pumps. We present a low-cost manufacturing technology based on a conventional CO2 laser cutter for structuring, a spin-coating process for TPE film fabrication, and a thermal bonding process using a pneumatic hot-press. UV treatment with an Excimer lamp prior to bonding drastically improves the bonding process. Optimized bonding parameters were characterized by measuring the burst load upon applying pressure and via profilometer-based measurement of channel deformation. Next, flow and long-term stability of the chip layout were measured using microparticle Image Velocimetry (uPIV). Finally, human endothelial cells were seeded in the microchannels to check biocompatibility and flow-directed cell alignment. The presented device is compatible with a real-time live-cell analysis system.

Research and application of hydraulic fracturing borehole bag sealing technology

Aiming at the problems existing in the sealing of fracturing boreholes using the regular bag sealing device in the conventional ‘two sealing and one injection’ process, this paper investigated a practical and reliable ZBQ-30/1.0 modified pneumatic grouting pump for coal mines, optimized the ‘B’ sealing material which was applied for the sealing of fracturing boreholes designed the ‘three sealing and two injection’ hole sealing device which was applied for the sealing of hydraulic fracturing boreholes, and finally carried out in Songzao Coal Mine. The results showed that the strength of the optimized ‘B’ sealing material was 14.64~15.43MPa, which was much higher than that of the regular extraction expansion sealing material. In addition, the hydraulic fracturing could withstand more than 20MPa, and the sealability was also well. This research implied the fixed-point sealing of hydraulic fracturing drilling can be carried out to save the sealing cost.

The study of hydraulic characteristics of pneumatic lifting pump with air startup and shutdown

Pneumatic lifting pump, as one of the ideal new methods for mining and upgrading, has obvious advantages such as simple structure, safety and reliability. The research of it has important scientific value and engineering significance. Based on Fluent simulation software, using Euler model and SST k-ω turbulence model, with the help of UDF self-programming, the influence of variable air volumes-linear opening, linearly closing on the hydraulic characteristics of the air-water lifting pump is discussed. The results are shown as follows. 1) In the slow linear opening mode of the gas flow, the liquid lifting flow increases, the change trend of it is slower than that of fast linear closing mode. 2) In the slow linear closing mode of the gas flow, the liquid lifting flow reduces, the change trend of it is slower than that of fast linear closing mode. These research results will lay the theoretical foundation for the application of pneumatic lifting technology in river dredging, sewage treatment, oil extraction and other fields.

An absorption spectrophotometer compatible paper-based thin-layer cuvette with an integrated pneumatic pump.

This study presents a paper-based thin-layer optical cuvette for absorption spectroscopy with a pneumatically driven pump for the introduction of an aqueous sample. The three major components, a sample reservoir, an open-channel as an optical path and a pneumatic pump, are patterned in polypropylene paper using an electronic cutting machine. When sealed with transparent tape, the patterned paper serves as the side walls of the paper-based cuvette with an integrated pneumatic pump. Due to the reduced pressure inside the open-channel caused by the depression of the pump with a finger, aqueous samples spotted onto the reservoir are introduced into the open-channel of the paper-based cuvette. We demonstrated that the paper-based cuvettes are compatible with conventional spectrophotometers for absorption spectroscopic measurements and capable of quantifying the concentrations of various colored dyes in aqueous samples.

Development and usability of solar thermal collectors in different fields: An overview

In the present work, solar energy utilizations by different solar systems such as solar water treatment, solar water heating, stem generation for the purpose of electricity generation; solar pumps, etc. have been introduced. Out of these, a focused approach for the solar water heating, solar water distillation by utilizing different solar collectors have been extensively reviewed to identify the generalized usability in that field. The collection of different solar collectors have different capabilities towards the absorption of direct and diffused solar radiations based on its materials, geometry, design, etc. and for that a rigorous observations have been made in the present effort. As the Earth has a solar energy rich surfaces so related technology search in other fields such as mechanical devices such as in mechanical devices, pneumatic suspension cars, thermal devices, pneumatic pumps, etc. is a worthwhile approach with the help of the current study. In the present study, solar thermal collectors such as vacuum tube collectors, flat plate collectors, concentrated reflectors, trough collectors, etc. have been recognized in this study. The parabolic concentrator covers the larger area of solar energy and evacuated tubes efficiently hold the available solar energy. And, polygeneration systems presents better options for the multi-disciplinary utilizations of renewable energy resources. Depending on the targeted approach, a dignified discussion and a concise conclusion have been framed with its futuristic recommendations.

Origami Pump Actuator Based Pneumatic Quadruped Robot (OPARO)

In this study, we proposed an origami pump actuator based pneumatic quadruped robot (OPARO). The robot was constructed with a four-leg system controlled by only two motors. Specifically, the forelegs and hindlegs are pneumatically coupled to operate simultaneously with a tendon-driven system. The forelegs simultaneously performs pumping and actuating to supply air to the hindlegs, and the hindlegs are passively actuated by the air supply from the forelegs. We conducted a series of experiments to evaluate the mobility performance of OPARO. We measured the posture of each leg and analyzed the movement to determine the operating mechanism in locomotion. The motion, gait, and repeatability of OPARO were analyzed from the experimental results. Additionally, we conducted a parametric study to determine the tendencies at different gait frequencies and motor inputs. The OPARO moves at a maximum velocity of 0.11 body length per second (10.29 mm/s). Furthermore, we evaluated the gait velocity with various gait patterns according to different duty ratios and floor surfaces. Moreover, the steering performance of OPARO was demonstrated. We found that the tendon-driven pneumatic origami pump actuator system is adequate for a quadruped robot without an external air supply system.

An untethered soft robotic gripper with high payload-to-weight ratio

Most of the soft grippers with high payload cannot carry cumbersome control systems and power sources themselves, and have to be tethered to external hardware through tubes and wires. To tackle this problem, we proposed an untethered soft pneumatic gripper with a high payload by developing a soft gripping structure with a high gripping force to pressure ratio. The untethered soft gripper integrates silicone elastomer structure, pneumatic artificial muscle (PAM), air pump, battery, controller, solenoid valve, and other components, with a total weight of 1.5 kg. The entire power sources of the untethered soft gripper are supplied by a battery, allowing it to perform at least 300 opening and closing movements. The lightweight and high load capacity of the untethered soft gripper enable its payload to weight ratio to exceed 26. Further, the untethered soft gripper can be installed on an unmanned aerial vehicle to expand its workspace. Also, a tightening force model for winding PAMs is presented in this paper, which can be used to evaluate the pressing force of the untethered soft gripper on the surface of an object.

Technological framework for the reversible chemical regeneration of water wells

Groundwater is mainly used for water supply of cities, rural settlements and industries in the Republic of Belarus. About 90% of water wells operate at reduced specific production rates as a consequence of biological and chemical clogging. Due to the insufficient efficiency of existing regeneration methods, the average service life of water wells rarely exceeds 18–20 years, which is significantly shorter than the estimated life. In this regard, creation of the effective and simple regeneration methods is becoming an urgent scientific and practical problem of great importance. A reversible pulse-and-chemical regeneration assembly has been designed for water wells; it consists of a compressor, hoses and a submersible device in the form of a two-chamber pneumatic displacement pump. The advantage of this assembly is the absence of a circulation pump in its configuration and the possibility of efficient treatment of a limited filter interval. A technology for the regeneration of water wells using the reversible pulse-and-chemical regeneration assembly is proposed. The installation, hoisting and other related operations should be carried out using a truck crane with a telescopic lifting boom. The reagent can be universal acid cleansing agent Deskam TU RB 37430824.001-97. One of the advantages of water well regeneration using the proposed assembly is the reverse movement of the reagent in gravel filter. Two regeneration modes were tested on a laboratory scale: the reversible flow and one-way flow of the reagent. The analysis of the laboratory research data shows that the use of the reversible mode of the reagent movement significantly reduces the cleaning time required for the removal of colmatant from the gravel filter as compared with the one-way flow of the reagent.

Abstract 16365: A New Left Atrial Assist Device for Heart Failure With Preserved Ejection Fraction: In Vitro Test

Introduction: The effective treatment for patients with heart failure with preserved ejection fraction is not yet established. We previously reported the concept of the left atrial assist device (LAAD) that pumps blood from the left atrium to the left ventricle to treat diastolic heart failure (DHF). We have now developed the first working prototype of the LAAD that can be implanted at the mitral valve level (Fig. 1). The purpose of the study was to demonstrate that the LAAD can reduce left atrial pressure (LAP) and increase cardiac output (CO) while maintaining arterial pulsatility and normal aortic valve function in the in vitro DHF model. Methods: The LAAD was tested at three pump speeds (3,600, 4,400 and 5,200 rpm) on a pulsatile mock loop with a pneumatic pump that simulated the normal function of the native ventricle, as well as mild, moderate, and severe DHF conditions, by adjusting the diastolic drive pressure to limit diastolic filling of the ventricle. Results: Without the LAAD, CO and aortic pressure (AoP) decreased dramatically: from 3.9 L/min and 102 mm Hg at normal heart condition to 1.0 L/min and 33 mm Hg at severe DHF, respectively (Fig. 2A, 2B). With LAAD support, both CO and AoP recovered to normal heart values at 4,200 rpm and surpassed normal heart values at 5,200 rpm (Fig. 2A, 2B). With LAAD support, LAP recovered to that of the normal heart condition at 5,200 rpm (Fig. 2C). The pulsatility was maintained (Fig. 2D), as all the CO went through the aortic valve. Conclusions: These initial in vitro results support our hypothesis that use of the LAAD increases CO and AoP and decreases LAP under DHF conditions, while maintaining arterial pulsatility and full function of the aortic valve.

Modular Microphysiological System for Modeling of Biologic Barrier Function.

Microphysiological systems, also known as organs-on-chips, are microfluidic devices designed to model human physiology in vitro. Polydimethylsiloxane (PDMS) is the most widely used material for organs-on-chips due to established microfabrication methods, and properties that make it suitable for biological applications such as low cytotoxicity, optical transparency, gas permeability. However, absorption of small molecules and leaching of uncrosslinked oligomers might hinder the adoption of PDMS-based organs-on-chips for drug discovery assays. Here, we have engineered a modular, PDMS-free microphysiological system that is capable of recapitulating biologic barrier functions commonly demonstrated in PDMS-based devices. Our microphysiological system is comprised of a microfluidic chip to house cell cultures and pneumatic microfluidic pumps to drive flow with programmable pressure and shear stress. The modular architecture and programmable pumps enabled us to model multiple in vivo microenvironments. First, we demonstrate the ability to generate cyclic strain on the culture membrane and establish a model of the alveolar air-liquid interface. Next, we utilized three-dimensional finite element analysis modeling to characterize the fluid dynamics within the device and develop a model of the pressure-driven filtration that occurs at the glomerular filtration barrier. Finally, we demonstrate that our model can be used to recapitulate sphingolipid induced kidney injury. Together, our results demonstrate that a multifunctional and modular microphysiological system can be deployed without the use of PDMS. Further, the bio-inert plastic used in our microfluidic device is amenable to various established, high-throughput manufacturing techniques, such as injection molding. As a result, the development plastic organs-on-chips provides an avenue to meet the increasing demand for organ-on-chip technology.

Improvement of the design of the aeration device of the pneumatic chamber pump

The production of building materials is a complex technological process involving the processing of raw materials with various physical and mechanical properties, as well as using a variety of degrees of complexity of technological equipment and auxiliary mechanisms. High-pressure pneumatic transport has found application in construction, refractory, chemical and other industries. It is widely used for transportation of fine-grained bulk materials such as cement, alumina, soda, apatite, ash, clay, synthetic products, mineral fertilizers. The process of pneumatic transportation occurs due to the action of compressed air on the material being moved. However, at the same time, as a rule, there are through channels in the material layer, which leads to an increased consumption of compressed air, part of the unloaded material remains at the bottom of the pump chamber, which reduces productivity. Due to the fact that some fluidizing devices can form through channels in the material layer and given the large volumes of material being transported, it is necessary to solve issues to improve the efficiency of pneumatic chamber pumps and reduce the consumption of compressed air required for transporting bulk materials. This can be achieved by organizing effective fluidization of the material, that is, uniform mixing of the transported material with air.

高用量アンチトロンビン投与が血小板機能と凝固機能に及ぼす影響(The influence of a high dose antithrombin on the platelet function and blood coagulability)

要旨【目的】KyberSept trialのサブグループ解析では，アンチトロンビン高用量投与群はプラセボ群に比べて有意に死亡率が低かった。しかし，高用量アンチトロンビン投与による，凝固系への影響に関しては詳しく知られていない。今回アンチトロンビン高濃度検体の凝固特性について調査を行った。【対象】健常者10人より血液検体を採取し，アンチトロンビン製剤を添加することでアンチトロンビン濃度が異なる検体を作成した。凝固特性の調査には生体内での反応に近づけるため，全血を利用するT–TAS®およびROTEM®を使用した。【結果】血小板機能を反映するPL測定では，血栓閉塞開始時間はアンチトロンビン濃度に依存し有意差をもって延長した。AR測定でも同様に，血栓閉塞開始時間はアンチトロンビン濃度に依存し延長した。また血栓閉塞時間もアンチトロンビン濃度に依存し延長した。健常検体内では十分量存在し飽和状態と考えられていたアンチトロンビンであるが，高用量投与された場合には抗凝固作用が増強することが証明された。さらに，T–TAS®を用いたPL測定を行うことで，血小板血栓形成能にも抑制効果が認められることが証明された。【結語】アンチトロンビンは濃度依存性に抗凝固作用を発揮する。また血小板粘着能に対しても影響を及ぼしており，濃度依存性に血小板血栓形成能を抑制する。

Nanoliter-scale liquid metering and droplet generation based on a capillary array for high throughput screening

Herein, we developed a simple approach for quantitative metering of nanoliter-scale liquids in parallel based on a capillary array and applied it in high throughput screening protein crystallization conditions. The quantitative metering of liquids was achieved by using capillary force to spontaneously introduce the liquids into short capillaries with fixed length and inner diameter, and the nanoliter-scale droplets were generated by using a pneumatic pump to deliver liquids out from the capillary channels. We adopted measures of sharpening the capillary tips and performing a hydrophobic treatment on the tip surface to significantly reduce the capillary residues during the liquid aspirating and dispensing process, and thus improved the precision to 0.2%–3.5% relative standard deviations (RSD, n = 3) in metering droplets in the range of 280 pL-90 nL. We evaluated the performance of the system in metering liquids of different surface tensions and viscosity. On the basis of this approach, we built a capillary array system with 12 capillaries, by which parallel generation of 12 nL droplets of 12 samples could be achieved in 40 s with a relative standard deviation (RSD) of 1.2%. We applied the system in the screening of lysozyme crystallization conditions of 48 precipitants with 7.5 nL precipitant and 7.5 nL protein solutions in each crystallization droplet reactor, to demonstrate its potentials in large-scale high-throughput screening and analysis with different samples.

Chugging to silent machines: development of mechanical cardiac support.

The concept of a mechanical device to support failing hearts arose after the introduction of the heart lung bypass machine pioneered by Gibbon. The initial devices were the pulsatile paracorporeal and total artificial heart (TAH), driven by noisy chugging pneumatic pumps. Further development moved in three directions, namely short-term paracorporeal devices, left ventricular assist devices (LVADs), and TAH. The paracorporeal pumps moved in the direction of electrically driven continuous-flow pumps as well as catheter-mounted intracardiac pumps for short-term use. The LVAD became the silent durable electric, implantable continuous-flow pumps. The TAH remains a pneumatically driven pulsatile device with limited application, but newer technology is moving toward electrically operated TAH. The most successful pumps are the durable implantable continuous-flow pumps now taken over by the 3rd-generation pumps for the bridge to transplant and long-term use with significantly improved survival and quality of life. But bleeding including gastrointestinal bleeding, strokes, and percutaneous driveline infections exist as troublesome issues. Available data supports less adverse hemocompatibility of HeartMate 3 LVAD. Eliminations of the driveline will significantly improve the freedom from infections. Restoring physiological pulsatility to continuous-flow pumps is in the pipeline. Development of appropriate right VAD, miniaturization, and pediatric devices is awaited. Poor cost-effectiveness from the cost of LVAD needs to be resolved before mechanical cardiac support becomes universally available as a substitute for heart transplantation.