Evaluation and development of minimally invasive techniques to connect an artificial lung to the heart and central vessels (Connex AL)

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Patients suffering from terminal pulmonary disease are extremely fragile. Central cannulation of an artificial lung (AL) is nowadays Achilles´ heel for clinical success and surgical approaches should therefore induce minimal trauma to the patient. Following implantation, unrestricted mobility is of paramount importance to the patient on AL. It remains to investigate, which route of perfusion is at the same time efficient enough in terms of achievable flow rates, available for minimal invasive placement (and removal) and allowing maximal mobility. Although a central access in proximity to the heart seems favourable, specialised medical tools and devices are currently unavailable. The aim of the current project is the systematic categorization of all anatomically possible cannulation sites for a minimal invasive surgical or interventional AL placement. This is realised in a three step iterative approach. In each iteration, the connection of an AL mock circuit to all imaginable cardial or vascular connection sites is examined. This is followed by a surgical and technical evaluation as well as a hemodynamic characterization to gather all relevant parameters and compare them between the different approaches. The first work package will start from the currently available minimalinvasive and endoscopic techniques (I: MI surgery). The second package (II: assisted MI surgery) will complement newly developed techniques that assist the minimal invasive surgical approach from the outside. This mainly includes new endoscopic devices allowing to staple, stent or otherwise connect the circuit to the vessel. This approach is inverted in the third work package: In the mainly endovascular section (III: endovascular surgery), endoscopic surgery is only needed to assist a rather interventional, catheter-based approach. Within each package, the development is iterated through an in vitro and simulation setting, a cadaver trial and a pilot animal trial phase. The project is then finalized by the thorough characterization of all minimal invasive cannulation techniques for the connection of an AL with or without an additional blood pump. This data is then made available and linked to other projects of the focus program (SPP2014).