RESUMEN
BACKGROUND: The Cleveland Clinic CorAide left ventricular assist system is based on a small implantable continuous-flow centrifugal blood pump with a completely suspended rotating assembly designed for long-term circulatory support (5 to 10 years). METHODS: Between June 1999 and August 2000, the CorAide blood pump was implanted in 10 calves for 1 month and in 3 calves for 3 months. RESULTS: The mean pump flow and arterial pressure were 6.1 +/- 1.1 L/min and 97 +/- 5 mm Hg, respectively. The mean plasma free-hemoglobin level after postoperative day 3 was 2.0 +/- 1.8 mg/dL. Renal and hepatic function remained normal in all cases. There was no incidence of mechanical failure, hemolysis, bleeding, or systemic organ dysfunction in any of the cases. Significant findings at autopsy were limited to two cases of renal infarction, one of which was associated with an outflow graft infection. CONCLUSIONS: The CorAide blood pump is easily implanted, reliable, nonhemolytic, and nonthrombogenic, positioning it as a leading third-generation, continuous-flow left ventricular assist system with a completely suspended rotor.
Asunto(s)
Corazón Auxiliar , Hemodinámica , Animales , Velocidad del Flujo Sanguíneo , Presión Sanguínea , Bovinos , Electrocardiografía , Corazón Auxiliar/efectos adversos , Hemoglobinas/análisisRESUMEN
A numeric model consisting of a lump-parameter cardiovascular system (CVS) model and a model for the Cleveland Clinic Implantable Ventricular Assist System (IVAS), a nonpulsatile rotary pump designed to augment the failing left ventricle, are described in this paper. The purposes of this study were to 1) observe the hemodynamic interactions between CVS and IVAS under various physiologic and pathophysiologic conditions running at different speeds; and 2) allow testing and optimization of various IVAS control algorithms. An existing numeric model of CVS (24 coupled differential equations, representing all cardiac chambers and systemic and pulmonary vasculature) was modified to add the IVAS pump as an auxiliary chamber between the left ventricle and aorta with pressure-flow-speed characteristics derived from in vitro testing. Simulations were conducted for ventricles with normal and abnormal systolic and diastolic dysfunction at different exercise levels with the pump running at various speeds. Computer simulations show that 1) numeric modeling is useful for predicting hemodynamic response of CVS to IVAS in various circumstances; 2) IVAS results in normalization of cardiac output, especially in failing hearts, although with reduced pulse pressure; and 3) various control algorithms allowing adaptation of IVAS to physiologic demands of CVS could be developed based on the simulation study.