Abstract
There is an unmet need for total circulatory support in infants on the waiting list for heart transplantation. Congenital defects and pulmonary dysfunction often require right heart support in addition to systemic support. Penn State is developing a pediatric total artificial heart (TAH) based on a 12 ml pulsatile VAD currently in preclinical testing. The TAH consists of independent left and right pulsatile pumps designed for orthotopic placement. An automatic control system ensures full-to-empty operation, estimates inlet and outlet pressures, and controls right pump output to safely limit left atrial pressure. A portable pneumatic driver has been developed. The TAH has been tested in a juvenile ovine model.
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References
Kirklin JK, Pagani FD, Kormos RL, Stevenson LW, Blume ED, Myers SL, et al. Eighth annual INTERMACS report: special focus on framing the impact of adverse events. J Heart Lung Transplant. 2017;36(10):1080–6.
Copeland JG. SynCardia total artificial heart: update and future. Tex Heart Inst J. 2013;40(5):587–8.
Torregrossa G, Anyanwu A, Zucchetta F, Gerosa G. SynCardia: the total artificial heart. Ann Cardiothorac Surg. 2014;3(6):612–20.
Torregrossa G, Morshuis M, Varghese R, Hosseinian L, Vida V, Tarzia V, et al. Results with SynCardia total artificial heart beyond 1 year. ASAIO J. 2014;60(6):626–34.
Gerosa G, Scuri S, Iop L, Torregrossa G. Present and future perspectives on total artificial hearts. Ann Cardiothorac Surg. 2014;3(6):595–602.
Thanavaro KL, Tang DG, Kasirajan V, Shah KB. Clinical indications for implantation of the total artificial heart. ASAIO J. 2014;60(5):594–6.
Copeland J, Copeland H, Nolan P, Gustafson M, Slepian M, Smith R. Results with an anticoagulation protocol in 99 SynCardia total artificial heart recipients. ASAIO J. 2013;59(3):216–20.
Colvin M, Smith JM, Hadley N, Skeans MA, Carrico R, Uccellini K, et al. OPTN/SRTR 2016 annual data report: heart. Am J Transplant. 2018;18(Suppl 1):291–362.
Almond CS, Morales DL, Blackstone EH, Turrentine MW, Imamura M, Massicotte MP, et al. Berlin Heart EXCOR pediatric ventricular assist device for bridge to heart transplantation in US children. Circulation. 2013;127(16):1702–11.
Voeller RK, Epstein DJ, Guthrie TJ, Gandhi SK, Canter CE, Huddleston CB. Trends in the indications and survival in pediatric heart transplants: a 24-year single-center experience in 307 patients. Ann Thorac Surg. 2012;94(3):807–15; discussion 15–6.
Almond CS, Singh TP, Gauvreau K, Piercey GE, Fynn-Thompson F, Rycus PT, et al. Extracorporeal membrane oxygenation for bridge to heart transplantation among children in the United States: analysis of data from the Organ Procurement and Transplant Network and Extracorporeal Life Support Organization Registry. Circulation. 2011;123(25):2975–84.
Weinstein S, Bello R, Pizarro C, Fynn-Thompson F, Kirklin J, Guleserian K, et al. The use of the Berlin Heart EXCOR in patients with functional single ventricle. J Thorac Cardiovasc Surg. 2014;147(2):697–704; discussion -5.
Kirklin JK, Pearce FB, Dabal RJ, Carlo W Jr, McGiffin DC. Cardiac transplantation and mechanical support for functional single ventricle. World J Pediatr Congenit Heart Surg. 2012;3(2):183–93.
Ideen C, Albers E, Warner P, Permut L, Kemna M. Effect of initial surgical palliation on allosensitization and post-transplant outcomes in infants with hypoplastic left heart syndrome. J Heart Lung Transplant. 2014;33(11):1178–80.
Auerbach SR, Smith JK, Gralla J, Mitchell MB, Campbell DN, Jaggers J, et al. Graft survival is better without prior surgery in cardiac transplantation for functionally univentricular hearts. J Heart Lung Transplant. 2012;31(9):987–95.
Kirklin JK, Naftel DC, Kirklin JW, Blackstone EH, White-Williams C, Bourge RC. Pulmonary vascular resistance and the risk of heart transplantation. J Heart Transplant. 1988;7(5):331–6.
Zafar F, Jefferies JL, Tjossem CJ, Bryant R 3rd, Jaquiss RD, Wearden PD, et al. Biventricular Berlin Heart EXCOR pediatric use across the United States. Ann Thorac Surg. 2015;99(4):1328–34.
Cooper BT, Roszelle BN, Long TC, Deutsch S, Manning KB, Cooper BT, et al. The 12 cc Penn State pulsatile pediatric ventricular assist device: fluid dynamics associated with valve selection. J Biomech Eng. 2008;130(4):041019.
Snyder A, Pae WE, Boehmer J, Rosenberg G, Weiss W, Pierce W, et al. First clinical trials of a totally implantable destination therapy ventricular assist system. J Congest Heart Fail Circ Support. 2001;1(4):185–92.
Mehta SM, Pae WE Jr, Rosenberg G, Snyder AJ, Weiss WJ, Lewis JP, et al. The LionHeart LVD-2000: a completely implanted left ventricular assist device for chronic circulatory support. Ann Thorac Surg. 2001;71(3 Suppl):S156–61; discussion S83–4.
Pierce WS, Rosenberg G, Donachy JH, Landis DL, Weiss W, Hensley F, et al. Postoperative cardiac support with a pulsatile assist pump: techniques and results. Artif Organs. 1987;11(3):247–51.
Pierce WS, Snyder AJ, Rosenberg G, Weiss WJ, Pae WE, Waldhausen JA. A long-term ventricular assist system. J Thorac Cardiovasc Surg. 1993;105(3):520–4.
Rosenberg G, Snyder A, Weiss W, Landis DL, Geselowitz DB, Pierce WS. A cam-type electric motor-driven left ventricular assist device. J Biomech Eng. 1982;104(3):214–20.
Rosenberg G, Snyder AJ, Weiss WJ, Kusagawa H, Rawhouser MA, Prophet GA, et al. Dynamic in vitro and in vivo performance of a permanent total artificial heart. Artif Organs. 1998;22(1):87–94.
Lukic B, Clark JB, Izer JM, Cooper TK, Finicle HA, Cysyk J, et al. Chronic ovine studies demonstrate low thromboembolic risk in the Penn State infant VAD. ASAIO J. 2019;65(4):371–9.
Connell JM, Khalapyan T, Myers JL, Rosenberg G, Weiss WJ. Anatomic fit assessment for the Penn State pediatric ventricular assist device. ASAIO J. 2007;53(6):687–91.
Kao PC, Chiang WC, Yang CW, Chen SJ, Liu YP, Lee CC, et al. What is the correct depth of chest compression for infants and children? A radiological study. Pediatrics. 2009;124(1):49–55.
Park SS, Sanders DB, Smith BP, Ryan J, Plasencia J, Osborn MB, et al. Total artificial heart in the pediatric patient with biventricular heart failure. Perfusion. 2014;29(1):82–8.
Brickman AD, Landis DL, O’Bannon W, Mortimer VD Jr, Nisley E, Pierce WE. Control system implementation in the air-driven artificial heart. Trans Am Soc Artif Intern Organs. 1974;20(B):680–4.
Landis DL, Pierce WS, Rosenberg G, Donachy JH, Brighton JA. Long-term in vivo automatic electronic control of the artificial heart. Trans Am Soc Artif Intern Organs. 1977;23:519–25.
Pierce WS, Landis D, O’Bannon W, Donachy JH, White W, Phillips W, et al. Automatic control of the artificial heart. Trans Am Soc Artif Intern Organs. 1976;22:347–56.
Weiss WJ, Rosenberg G, Snyder AJ, Pierce WS, Pae WE, Kuroda H, et al. Steady state hemodynamic and energetic characterization of the Penn State/3M Health Care Total Artificial Heart. ASAIO J. 1999;45(3):189–93.
Weiss WJ, Rosenberg G, Snyder AJ, Donachy J Sr, Reibson J, Kawaguchi O, et al. A completely implanted left ventricular assist device. Chronic in vivo testing. ASAIO J. 1993;39(3):M427–32.
Weiss WJ. Pulsatile pediatric ventricular assist devices. ASAIO J. 2005;5(15):540–5.
Weiss WJ, Carney EL, Clark JB, Peterson R, Cooper TK, Nifong TP, et al. Chronic in vivo testing of the Penn State infant ventricular assist device. ASAIO J. 2012;58(1):65–72.
Acknowledgments
Thanks to Patrick Leibich, Kirby Bletcher, Bradley Doxtater, and Eric Yeager for their outstanding fabrication skills; Gerson Rosenberg, PhD, for design input; Heidi Finicle, Dr. John L. Myers, and Dr. William S. Pierce for their assistance in surgical planning and animal surgery; perfusionists Robert Wise, Karl Woitas, and Gary Irwin; John Reibson and Branka Lukic for instrumentation support; Choon-Sik Jhun, PhD, and Chris Scheib for valve analysis; and surgical technologists Dolly Schepps and Nate Shanaman.
Funding Source
This research is supported by NIH grant R01HL131921.
OPTN/SRTR 2016 Annual Data Report is not copyrighted. Readers are free to duplicate and use all or part of the information contained in this publication. Data are not copyrighted and may be used without permission if appropriate citation information is provided.
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Weiss, W.J., Newswanger, R., Clark, J.B., Izer, J.M. (2020). The Penn State Pediatric Total Artificial Heart. In: Karimov, J., Fukamachi, K., Starling, R. (eds) Mechanical Support for Heart Failure . Springer, Cham. https://doi.org/10.1007/978-3-030-47809-4_36
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DOI: https://doi.org/10.1007/978-3-030-47809-4_36
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