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Left atrial assist device to treat patients with heart failure with preserved ejection fraction: Initial in vitro
Kiyotaka Fukamachi1, David J Horvath2, Jamshid H Karimov1
1Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
Objectives:
Many patients with heart failure have preserved ejection fraction but also diastolic dysfunction, with no effective therapy. We are developing a new pump (left atrial assist device, LAAD) for implantation at the mitral position to pump blood from the left atrium to sufficiently fill the left ventricle. The purpose of the initial in vitro study was to demonstrate that the LAAD can reduce left atrial pressure (LAP) and increase cardiac output (CO) while maintaining arterial pulsatility and normal aortic valve function using a proof-of-concept device.
Methods:
The LAAD concept was tested at 3 pump speeds on a pulsatile mock loop with a pneumatic pump that simulated the normal function of the native ventricle as well as 3 levels of diastolic heart failure (DHF 1, 2, and 3) by adjusting the diastolic drive pressure to limit diastolic filling of the ventricle.
Results:
Without the LAAD, CO and aortic pressure (AoP) decreased dramatically from 3.8 L/min and 100 mm Hg at normal heart condition to 1.2 L/min and 35 mm Hg at DHF 3, respectively. With LAAD support, both CO and AoP recovered to normal heart values at 3200 rpm and surpassed normal heart values at 3800 rpm. Furthermore, with LAAD support, LAP recovered to almost that of the normal heart condition at 3800 rpm.
Conclusions:
These initial in vitro results support our hypothesis that use of the LAAD increases CO and AoP and decreases LAP under DHF conditions while maintaining arterial pulsatility and full function of the aortic valve.
