title: Use of the aortoatrial continuity as means of providing left ventricular assist support without entering the ventricle: a feasibility study.
abstract: BACKGROUND
  Left ventricular assist devices (LVADs) are increasingly used to treat patients with refractory heart failure. Current-generation LVADs have major limitations, including the need for open chest surgery, limiting their widespread use. We hypothesized that the aortoatrial continuity could be used as a unique anatomic vantage point for entirely percutaneous LVAD placement.
  
  
  RESULTS
  Forty human autopsied hearts were examined to ascertain the presence and define the dimensions of the continuity between the posterior aortic wall and the left atrium. In all cases, a "septum" between the aorta and left atrium was identified. In 3 animal experiments, a custom mechanical shunt was deployed in the wall between the left atrium and noncoronary cusp. With continuous intracardiac ultrasound imaging, and at necropsy, there was no evidence of device dislodgement, pericardial effusion, or aortic or coronary artery trauma noted.
  
  
  CONCLUSIONS
  It is feasible to use the wall between the aorta and left atrium as an access route for a potentially entirely percutaneous LVAD. Such a system obviates the need for accessing the left ventricle, minimizing complications. In the future, such devices may allow widespread treatment of heart failure, malignant cardiac arrhythmia, and severe aortic and mitral valvular disease.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. friedman.paul@mayo.edu
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.forename: Sudhir S
authors.initials: SS
authors.lastname: Kushwaha
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Bruce
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
authors.forename: Dorothy J
authors.initials: DJ
authors.lastname: Ladewig
authors.forename: Susan B
authors.initials: SB
authors.lastname: Mikell
authors.forename: Susan B
authors.initials: SB
authors.lastname: Johnson
authors.forename: Scott H
authors.initials: SH
authors.lastname: Suddendorf
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Danielsen
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
mesh_terms: D000818:Animals; D001011:Aorta / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D002102:Cadaver; D004285:Dogs; D005240:Feasibility Studies; D006325:Heart Atria / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D006353:Heart-Assist Devices; D006801:Humans; D023421:Models, Animal; D019919:Prosthesis Implantation / Q000379:methods*; D014463:Ultrasonography