Novel Left Ventricular Assist System: an electrocardiogram-synchronized LVAS that avoids cardiac cannulation.
We propose a Novel Left Ventricular Assist System (Novel LVAS) as a bridge to cardiac transplantation and to functional heart recovery in advanced heart failure. This report regards the principles that led to its development. It is our hope that the design of a high-peak-output pump of smaller size will lead to improved functional capacity, when compared with currently available left ventricular assist bridges to heart recovery. Several basic considerations went into the design of this system: 1) we did not want to cannulate the heart chambers; 2) in particular, we rejected the use of a left ventricular apical cannula for myocardial recovery, because it destroys the helical anatomy of the chamber; 3) we chose an atriostomy for blood inflow to the implanted pump; and 4) we synchronized the pump to the patient's electrocardiogram, to ensure blood pump ejection in diastole. The key to success is the atriostomy, which creates an opening larger than the patient's mitral valve. The atriostomy may be performed with the heart beating. Bleeding from the left ventricular apical anastomosis is a fairly common occurrence in currently available left ventricular assist systems; subsequent transfusion can exacerbate right heart dysfunction and sensitize the immune system. These complications are avoided with our system. The new system works either in partial mode or total mode, depending on whether partial or full left ventricular unloading is required. The Novel Left Ventricular Assist System is in its initial clinical trial stage, under the supervision of the author.
Liotta
Domingo
D
Service of Cardiovascular Surgery, Dupuytren Institute-Quilmes Trinity Cardiovascular Center, Av. Belgrano 3402, Buenos Aires (C 1210 AAP), Argentina. medicina@unimoron.edu.ar
D015716:Electrocardiography, Ambulatory / Q000295:instrumentation*; D004867:Equipment Design; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000628:therapy*