Hybrid Continuous-Flow Total Artificial Heart
Hybrid Continuous-Flow Total Artificial Heart
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DOI：
10.1111/aor.13080
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发表时间：
2018-05-01
影响因子：
2.4
通讯作者：
Throckmorton, Amy
中科院分区：
文献类型：
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作者：
Fox, Carson;Chopski, Steven;Throckmorton, Amy
使用全人工心脏(TAHS)的临床研究表明，儿童和成人患者从这种治疗形式中获得了生活质量的好处。然而，两种临床批准的Tahs和其他正在开发的泵在设计上存在挑战和限制，包括血栓栓塞事件、神经损伤、由于大尺寸和经皮传动系统而导致的感染风险，以及缺乏行走能力，仅举几例。为了解决这些局限性，我们正在开发一种混合设计、连续流动、可植入或体外磁悬浮的TAH，适用于儿童和成人心力衰竭患者。该TAH只有两个运动部件：一个用于肺循环的轴向叶轮和一个用于体循环的离心叶轮。该装置将采用最新一代的磁悬浮轴承技术。利用泵设计方程建立了初始几何形状，计算模型提供了对泵性能的洞察。这些设计是样机制造和液压测试的基础。研究结果表明，在1500~10000转/分的压力范围内，全肺循环压力升高1~92 mm Hg，体循环压力升高24~150 mm Hg，目标血流量为1~6.5RPM/m in。TAH的这一初始设计是成功的，并为其继续发展成为一种新颖、更紧凑、不会导致血栓形成和有效的治疗婴儿、儿童、青少年和成人心力衰竭的替代疗法奠定了基础。
Clinical studies using total artificial hearts (TAHs) have demonstrated that pediatric and adult patients derive quality-of-life benefits from this form of therapy. Two clinically-approved TAHs and other pumps under development, however, have design challenges and limitations, including thromboembolic events, neurologic impairment, infection risk due to large size and percutaneous drivelines, and lack of ambulation, to name a few. To address these limitations, we are developing a hybrid-design, continuous-flow, implantable or extracorporeal, magnetically-levitated TAH for pediatric and adult patients with heart failure. This TAH has only two moving parts: an axial impeller for the pulmonary circulation and a centrifugal impeller for the systemic circulation. This device will utilize the latest generation of magnetic bearing technology. Initial geometries were established using pump design equations, and computational modeling provided insight into pump performance. The designs were the basis for prototype manufacturing and hydraulic testing. The study results demonstrate that the TAH is capable of delivering target blood flow rates of 1-6.5 L/min with pressure rises of 1-92 mm Hg for the pulmonary circulation and 24-150 mm Hg for the systemic circulation at 1500-10000 rpm. This initial design of the TAH was successful and serves as the foundation to continue its development as a novel, more compact, nonthrombogenic, and effective therapeutic alternative for infants, children, adolescents, and adults with heart failure.