title: Right ventricular unloading and respiratory support with a wearable artificial pump-lung in an ovine model.
abstract: BACKGROUND
  Device availability of mechanical circulatory or respiratory support to the right heart has been limited. The purpose of this study was to investigate the effect of right heart unloading and respiratory support with a wearable integrated artificial pump-lung (APL).
  
  
  METHODS
  The APL device was placed surgically between the right atrium and pulmonary artery in 7 sheep. Anti-coagulation was performed with heparin infusion. The device's ability to unload the right ventricle (RV) was investigated by echocardiograms and right heart catheterization at different bypass flow rates. Hemodynamics and echocardiographic data were evaluated. APL flow and gas transfer rates were also measured at different device speeds.
  
  
  RESULTS
  Hemodynamics remained stable during APL support. There was no significant change in systemic blood pressure and cardiac index. Central venous pressure, RV pressure, RV end-diastolic dimension and RV ejection fraction were significantly decreased when APL device flow rate approached 2 liters/min. Linear regression showed significant correlative trends between the hemodynamic and cardiac indices and device speed. The oxygen transfer rate increased with device speed. The oxygen saturation from the APL outlet was fully saturated (>95%) during support. The impact of APL support on blood elements (plasma free hemoglobin and platelet activation) was minimal.
  
  
  CONCLUSIONS
  APL device support significantly unloaded the RV with increasing device speed. The device also provided stable hemodynamics and respiratory support in terms of blood flow and oxygen transfer. The right heart unloading performance of this wearable device needs to be evaluated further in an animal model of right heart failure with long-term support.
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA; Department of Cardiac Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Pablo G
authors.initials: PG
authors.lastname: Sanchez
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA; Department of Cardiac Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
authors.forename: Xufeng
authors.initials: X
authors.lastname: Wei
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Tieluo
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Amelia C
authors.initials: AC
authors.lastname: Watkins
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Shu-ying
authors.initials: SY
authors.lastname: Li
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Bartley P
authors.initials: BP
authors.lastname: Griffith
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA; Department of Cardiac Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China. Electronic address: zwu@smail.umaryland.edu.
authors.forename: Zhongjun J
authors.initials: ZJ
authors.lastname: Wu
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation* / Q000379:methods*; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D016014:Linear Models; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery; D012756:Sheep; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology / Q000601:surgery*
keywords: artificial pump lung; extracorporeal membrane oxygenation(ECMO); heart failure; mechanical circulatory support; respiratory support; right heart unloading
references.citation: ASAIO J. 2001 Nov-Dec;47(6):628-33
references.pmid: 11730201
references.citation: Eur J Cardiothorac Surg. 2011 Jun;39(6):939-44; discussion 944
references.pmid: 21071240
references.citation: J Heart Lung Transplant. 2007 Oct;26(10):974-9
references.pmid: 17919615
references.citation: Am J Med Sci. 2014 Jan;347(1):80-3
references.pmid: 23426085
references.citation: N Engl J Med. 2007 Aug 30;357(9):885-96
references.pmid: 17761592
references.citation: Surg Today. 2005;35(10):861-8
references.pmid: 16175468
references.citation: Circulation. 2011 Feb 8;123(5):533-43
references.pmid: 21300961
references.citation: J Heart Lung Transplant. 2008 Apr;27(4):466-8
references.pmid: 18374886
references.citation: Circulation. 2012 Aug 14;126(7):866-74
references.pmid: 22891167
references.citation: J Heart Lung Transplant. 2012 Nov;31(11):1223-9
references.pmid: 22980952
references.citation: J Thorac Cardiovasc Surg. 2011 Oct;142(4):755-61
references.pmid: 21924145
references.citation: Ann Thorac Surg. 2007 Nov;84(5):1699-703
references.pmid: 17954089
references.citation: BMJ Case Rep. 2012 Aug 02;2012:
references.pmid: 22865810
references.citation: Med Monatsschr Pharm. 2012 May;35(5):183-5
references.pmid: 22624352
references.citation: Am J Cardiol. 2012 Sep 15;110(6 Suppl):39S-48S
references.pmid: 22921031
references.citation: J Heart Lung Transplant. 2012 Aug;31(8):858-64
references.pmid: 22609185
references.citation: Circulation. 2006 Oct 24;114(17):1883-91
references.pmid: 17060398
references.citation: Interact Cardiovasc Thorac Surg. 2013 Apr;16(4):568-9
references.pmid: 23322095
references.citation: Am J Cardiol. 2010 Apr 1;105(7):1030-5
references.pmid: 20346326
references.citation: Science. 2002 Feb 8;295(5557):998-9
references.pmid: 11834809
references.citation: ASAIO J. 2010 Jul-Aug;56(4):369-76
references.pmid: 20467298
references.citation: J Thorac Cardiovasc Surg. 2005 Oct;130(4):973-8
references.pmid: 16214507
references.citation: Ann Thorac Surg. 2012 Jan;93(1):274-81
references.pmid: 22115337
references.citation: J Heart Lung Transplant. 2012 Jan;31(1):101-5
references.pmid: 22014451