title: Deairing Techniques for Double-Ended Centrifugal Total Artificial Heart Implantation.
abstract: The unique device architecture of the Cleveland Clinic continuous-flow total artificial heart (CFTAH) requires dedicated and specific air-removal techniques during device implantation in vivo. These procedures comprise special surgical techniques and intraoperative manipulations, as well as engineering design changes and optimizations to the device itself. The current study evaluated the optimal air-removal techniques during the Cleveland Clinic double-ended centrifugal CFTAH in vivo implants (n = 17). Techniques and pump design iterations consisted of developing a priming method for the device and the use of built-in deairing ports in the early cases (n = 5). In the remaining cases (n = 12), deairing ports were not used. Dedicated air-removal ports were not considered an essential design requirement, and such ports may represent an additional risk for pump thrombosis. Careful passive deairing was found to be an effective measure with a centrifugal pump of this design. In this report, the techniques and design changes that were made during this CFTAH development program to enable effective residual air removal and prevention of air embolism during in vivo device implantation are explained.
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic.
authors.forename: Jamshid H
authors.initials: JH
authors.lastname: Karimov
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic.
authors.forename: David J
authors.initials: DJ
authors.lastname: Horvath
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic.
authors.forename: Nicole
authors.initials: N
authors.lastname: Byram
authors.forename: Gengo
authors.initials: G
authors.lastname: Sunagawa
authors.affiliation: Perfusion Services, Miller Family Heart and Vascular Institute, Cleveland Clinic.
authors.forename: Patrick
authors.initials: P
authors.lastname: Grady
authors.affiliation: Perfusion Services, Miller Family Heart and Vascular Institute, Cleveland Clinic.
authors.forename: Martin
authors.initials: M
authors.lastname: Sinkewich
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic.|Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure, Cardiac Transplantation and Mechanical Circulatory Support, Miller Family Heart and Vascular Institute, Cleveland Clinic.
authors.forename: Nader
authors.initials: N
authors.lastname: Moazami
authors.affiliation: Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Shiva
authors.initials: S
authors.lastname: Sale
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic.
authors.forename: Leonard A R
authors.initials: LAR
authors.lastname: Golding
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Fukamachi
mesh_terms: D000818:Animals; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002417:Cattle; D004618:Embolism, Air / Q000209:etiology / Q000517:prevention & control; D006354:Heart, Artificial / Q000009:adverse effects; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control
keywords: -Air embolism; -Air removal; -Centrifugal blood pump; -Pump deairing; Total artificial heart