Atrial and Ventricular Cannulation for Biventricular Circulatory Support With Double-Ended Centrifugal Pump: In Vitro...

In patients with biventricular heart failure, a biventricular assist device (BVAD) may be necessary for hemodynamic support. BVAD inflows can be established through cannulation of the atrial (AC) and/or ventricular (VC) chambers, but no consensus exists on optimal cannulation techniques. This study aimed to characterize BVAD performance related to cannulation types (AC and VC) using a continuous-flow total artificial heart (CFTAH) as the BVAD.

Both methods of cannulation (AC and VC) were tested on a mock loop using dual pulsatile ventricles with valves (AB5000; Abiomed) paired as the native ventricles and a double-ended centrifugal pump with two volutes, CFTAH, as a BVAD. Pressures were collected at the inlet and outlets of the AB5000 (LAP, RAP, AoP, and PAP) and the CFTAH (Lin, Rin, Lout, and Rout). The left and right flows exiting the CFTAH (LPF and RPF) and total flow (TF), exiting systemic resistance, were monitored. Several heart failure conditions were simulated with adjustment of the pneumatic pressures (AB5000).

Trends between the AC and VC are similar where RAP, Lin, and Lout decreased, and AoP, PAP, TF, LPF, and RPF increased with increased support. The trends differ in LAP with an increase during AC as opposed to a decrease during VC. As a result, with this setup, left-right balance is more easily achieved during VC. TF is higher with AC, even though LPF and RPF are lower. This signifies the flow going through the aortic valve (TF-LPF) and pulmonary valve (TF-RPF) is higher with AC.

The increased TF and valvular flow favored AC for introducing a CFTAH as BVAD to the native heart in these conditions.