Output Of Total Artificial Heart Research Articles

The OregonHeart Total Artificial Heart: Design and Performance on a Mock Circulatory Loop.

Widespread use of heart transplantation is limited by the scarcity of donor organs. Total artificial heart (TAH) development has been pursued to address this shortage, especially to treat patients who require biventricular support. We have developed a novel TAH that utilizes a continuously spinning rotor that shuttles between two positions to provide pulsatile, alternating blood flow to the systemic and pulmonary circulations without artificial valves. Flow rates and pressures generated by the TAH are controlled by adjusting rotor speed, cycle frequency, and the proportion of each cycle spent pumping to either circulation. To validate the design, a TAH prototype was placed in a mock circulatory loop that simulates vascular resistance, pressure, and compliance in normal and pathophysiologic conditions. At a systemic blood pressure of 120/80 mm Hg, nominal TAH output was 7.4 L/min with instantaneous flows reaching 17 L/min. Pulmonary artery, and left and right atrial pressures were all maintained within normal ranges. To simulate implant into a patient with severe pulmonary hypertension, the pulmonary vascular resistance of the mock loop was increased to 7.5 Wood units. By increasing pump speed to the pulmonary circulation, cardiac output could be maintained at 7.4 L/min as mean pulmonary artery pressure increased to 56 mm Hg while systemic blood pressures remained normal. This in vitro testing of a novel, shuttling TAH demonstrated that cardiac output could be maintained across a range of pathophysiologic conditions including pulmonary hypertension. These experiments serve as a proof-of-concept for the design, which has proceeded to in vivo testing.

Home Discharge and Out-of-Hospital Follow-Up of Total Artificial Heart Patients Supported by a Portable Driver System

To enhance ambulation and facilitate hospital discharge of total artificial heart (TAH)–supported patients, we adapted a mobile ventricular assistance device (VAD) driver (Excor) for TAH use and report on the performance of Excor-driven TAH patients discharged home. Ten patients stabilized on a TAH, driven by the CSS (“Circulatory Support System”), were progressively switched over to the Excor in hospital over 14 days as a pilot, with daily hemodynamics and laboratory parameters measured. Twenty-two stable TAH patients were subsequently placed on the Excor, trained, and discharged home. Clinical and hemodynamic parameters were followed. All pilot study patients were clinically stable on the Excor, with no decrease in TAH output noted (6.3 + 0.3 L/min [day 1] vs. 5.8 + 0.2 L/min [day 14], p = 0.174), with a trend suggesting improvement of both hepatic and renal function. Twenty-two TAH patients were subsequently successfully discharged home on the portable driver and were supported out of hospital for up to 598 days (range, 2–598; mean = 179 ± 140 days), remaining ambulatory, New York Heart Association (NYHA) class I or II, and free of readmission for 88.5% of the time of support. TAH patients may be effectively and safely supported by a mobile drive system. As such, the utility of the TAH may be extended to support patients beyond the hospital, at home, with overall ambulatory freedom.

Transient response of remnant atrial heart rate to step changes in total artificial heart output

In a total artificial heart (TAH) recipient, the remnant atrial rate reflects the control signal on cardiac function from the recipient's central nervous system via both the neural and the humoral pathways. Therefore, it can provide useful information for physiologic control of a TAH. We investigated step responses in the remnant atrial rate to step changes in TAH output in a calf implanted with a pneumatic TAH and characterized the dynamic property of the open-loop native cardiac output control system. The pumping rate was changed suddenly from 90 to 60 bpm, and in the next stage from 60 to 90 bpm. This process was repeated three times. Along with the step changes in TAH pumping rate, TAH output also changed at once in a similar fashion. The atrial rate altered immediately and converged after an overshoot. These changes were regarded as second-order delay responses, and the dynamic properties were estimated. When the pumping rate was decreased from 90 to 60 bpm and when it was increased from 60 to 90 bpm, the rise times were 70 ± 1 and 132 ± 38 s, the peak times were 127 ± 15 and 179 ± 15 s, the maximum overshoots were 30 ± 4% and 12 ± 7%, and the settling times were 232 ± 11 and 245 ± 10 s, respectively. We conclude that the obtained open-loop characteristics and dynamic properties can be useful indexes for physiologic control of TAH output, which reflects the properties of the native central nervous control system.

Analysis of hemodynamic response with 1/R control on biventricular bypass goat.

A conductance and arterial pressure based method (1/R control) to determine the cardiac output (CO) of a total artificial heart (TAH) was developed to provide a central nervous system with control over the output of TAH. In order to clarify the deference in hemodynamic response between natural heart and 1/R control, biventricular bypass was introduced in the goat. After 2 pneumatically driven sac-type blood pumps were connected to the natural heart, the pulmonary artery was totally clamped to acquire 100% right heart bypass, and the ascending aorta was stenosed to acquire about 60 to 90% left heart bypass; 1/R control was performed substituting the output of the right artificial heart for the CO. The results demonstrated that stable control could be achieved. A discrepancy was often seen between the pulse rate (PR) of the artificial heart and the heart rate (HR) in absolute value. However, the relative changes of PR were quite similar to that of HR for the most part, indicating that the responses of 1/R control were the duplication of natural cardiac responses in normal daily activity.

Control of a total artificial heart using mixed venous oxygen saturation.

We developed a control of the total artificial heart (TAH) using mixed venous oxygen saturation (SvO2). With this method, the TAH output was controlled by automatically adjusting drive parameters in response to changes in measured SvO2. The feasibility and validity of this method were evaluated in a series of treadmill exercise tests using a calf implanted with a pneumatic TAH. The cardiac output (CO) and SvO2 were measured with an ultrasonic flowmeter and an oximetric catheter, respectively. The calf performed graded exercise under a fixed drive control mode (fixed mode), in which the drive parameters were unchanged throughout the treadmill test, and under the SvO2 based control mode (SvO2 mode). The calf could go to Stage 6 in both modes, but the maximal oxygen consumption in the SvO2 mode was 1.5 times as large as that of the fixed mode. Compared with the fixed mode, CO was increased effectively in the SvO2 mode, and the capacity for exercise was augmented. When considering the relationship between oxygen consumption and oxygen delivery, it was revealed that the CO in the SvO2 mode responded more adequately to the recipient's oxygen demand than that in the fixed mode. We conclude that this SvO2 based control method is feasible and physiologically effective.

Estimation of the native cardiac output from a rotary blood pump flow: in vitro study.

The rotary blood pump will be an implantable left ventricular assist device (LVAD) in the near future. However, the best control method and the interrelationship between the rotary blood pump and native heart functions are unclear. An estimation was made of the native heart cardiac output from the change of an LVAD's outflow waveform. The mock circulation loop was composed of an aortic compliance chamber, left arterial chamber, total artificial heart as a native heart, and a rotary blood pump that was placed as an LVAD with left ventricular drainage. The fast Fourier transform (FFT) technique was utilized to analyze the LVAD's outflow waveform and calculate the pulse power index (PPI) to examine a relation between the PPI and total artificial heart (TAH) output. The PPI increased with the increase of the TAH output; there was a positive correlation, and there was an inverse correlation between the PPI and the assist ratio. From this viewpoint, an estimation of the pulsatility change of the LVAD's outflow wave may indicate the native cardiac output.

Measurement of Oxygen Consumption and Arterial-Venous Oxygen Saturation following Total Artificial Heart Implantation

Current algorithms for control of the total artificial heart are directed at maintaining hemodynamic homeostasis. Future control systems will also need to modify cardiac output in response to metabolic needs. This study was undertaken to evaluate oxygen metabolism monitoring as an indicator of the adequacy of organ and tissue perfusion. Following recovery from implantation of the Utah-100 pneumatic total artificial hearts, five calves (85 to 95 kg) underwent placement of fiberoptic oximetry catheters to determine mixed venous and arterial oxygen saturations. By continuously measuring oxygen consumption with a gas analyzer, oxygen utilization and delivery were determined. In the awake calves, at-rest cardiac output was varied to produce hyperperfused and hypoperfused conditions while the adequacy of tissue perfusion was assessed with continuous mixed venous oximetry and confirmed with serum lactate (Lact) levels. Inadequate tissue perfusion (Lact > 1.0 mmol/L) was evidenced by a mixed venous oxygen saturation < 40%, oxygen delivery of < 200.0 milliliters/minute/m2), and oxygen delivery to utilization ratio of < 1.8 during the hypoperfusion conditions of the experiment. By accounting for oxygen consumption, the ratio of oxygen delivery to oxygen utilization was predictive of the adequacy of tissue perfusion. These results suggest that continuous oxygen metabolism monitoring may be useful as a physiologic control modifier to maintain total artificial heart output sufficient to meet physiologic needs, while avoiding hyperperfusion, unnecessary wear and deterioration of the implanted device due to excessive heart rates.