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Left Ventricular Assist Devices: Challenges Toward Sustaining Long-Term Patient Care

Abstract

Over the last few decades, the left ventricular assist device (LVAD) technology has been tremendously improved transitioning from large and noisy paracorporeal volume displacement pumps to small implantable turbodynamic devices with only a single transcutaneous element, the driveline. Nevertheless, there remains a great demand for further improvements to meet the challenge of having a robust and safe device for long-term therapy. Here, we review the state of the art and highlight four key areas of needed improvement targeting long-term, sustainable LVAD function: (1) LVADs available today still have a high risk of thromboembolic and bleeding events that could be addressed by the rational fabrication of novel surface structures and endothelialization approaches aiming at improving the device hemocompatibility. (2) Novel, fluid dynamically optimized pump designs will further reduce blood damage. (3) Infection due to the paracorporeal driveline can be avoided with a transcutaneous energy transmission system that additionally allows for increased freedom of movement. (4) Finally, the lack of pump flow adaptation needs to be encountered with physiological control systems, working collaboratively with biocompatible sensor devices, targeting the adaptation of the LVAD flow to the perfusion requirements of the patient. The interdisciplinary Zurich Heart project investigates these technology gaps paving the way toward LVADs for long-term, sustainable therapy.

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Abbreviations

LVAD:

Left ventricular assist device

vdLVAD:

Volume displacement LVAD

tLVAD:

Turbodynamic LVAD

BTT:

Bridge to transplant

DT:

Destination therapy

CF:

Continuous flow

LV:

Left ventricular, left ventricle

AV:

Aortic valve

TETS:

Transcutaneous energy transmission system

DHZB:

German Heart Center Berlin

INTERMACS:

Interagency registry for mechanically assisted circulatory support

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Acknowledgments

The authors thankfully acknowledge the financial support by the Baugarten Foundation, the Georg und Bertha Schwyzer-Winiker Foundation, the IMG Foundation, the Mäxi Foundation, the Propter Homines Foundation, the Stavros Niarchos Foundation, and the Uniscientia Foundation as well as the ETH Zurich Foundation and the UZH Foundation. This work is part of the Zurich Heart project under the umbrella of University Medicine Zurich. Graphic design of Figs. 1 and 2 by mnemosyne Basel, Switzerland.

Conflict of interest

Aldo Ferrari and Dimos Poulikakos participate in a Spin-off, aiming at the commercialization of biomedical materials and devices for soft tissue repair.

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Correspondence to Marianne Schmid Daners.

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Associate Editor Andreas Anayiotos oversaw the review of this article.

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Schmid Daners, M., Kaufmann, F., Amacher, R. et al. Left Ventricular Assist Devices: Challenges Toward Sustaining Long-Term Patient Care. Ann Biomed Eng 45, 1836–1851 (2017). https://doi.org/10.1007/s10439-017-1858-9

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Keywords

  • Adverse events
  • Heart failure
  • Cardiac surgery
  • Surface structure
  • Hemocompatibility
  • Fluid dynamics
  • Implantability
  • Physiological control