Device-Induced Blood Damage in Pump-Assisted Circulation: A Comparative Study of HeartMate III and BrioVAD Pumps

Mechanical circulatory support (MCS) has emerged as a life-saving intervention and may be a potential alternative to organ transplant for patients with end-stage heart failure. The Heartmate III (HM3) left ventricular assist device (LVAD) is a magnetically levitated centrifugal pump and the most advanced LVAD on the current MCS market. The BrioVAD is a newly developed LVAD featuring a fully magnetically suspended blood pump and has recently been approved by the FDA for the INNOVATE trial in the US. However, device-related complications, which are highly related to blood damage by the pump, remain a major concern for patients with MCS. This study aimed to compare device-induced blood damage by the HM3 and BrioVAD pumps in vitro in a circulatory loop.

The device-assisted circulatory loop was filled with fresh, healthy human blood. Both pumps were operated under the same clinically relevant condition, i.e., a blood flow rate of 4.5 L/min and an afterload pressure head of 75 mmHg, for 4 h. Hourly blood samples were collected to assess device-induced damage to blood components, including red blood cells, platelets, neutrophils, and von Willebrand factor (VWF).

Both pumps had comparable impacts on blood components, with no statistically significant difference between them in all the measured parameters (except one neutrophil activation marker). After the four hours of device-assisted circulation, both pumps caused minimal hemolysis and moderate platelet damage but had significant impacts on VWF and neutrophils.

This study provides a comprehensive comparative in vitro analysis of blood damage caused by the HM3 and BrioVAD pumps under a clinically relevant condition. The results provide valuable insight into the potential implications for clinical use of the two devices and guidance for the design of new LVADs.