Early in vivo experience with the pediatric continuous-flow total artificial heart

BACKGROUND: Heart transplantation in infants and children is an accepted therapy for end-stage heart failure, but donor organ availability is low and always uncertain. Mechanical circulatory support is another standard option, but there is a lack of intracorporeal devices due to size and functional range. The purpose of this study was to evaluate the in vivo performance of our initial prototype of a pediatric continuous-flow total artificial heart (P-CFTAH), comprising a dual pump with one motor and one rotating assembly, supported by a hydrodynamic bearing. METHODS: In acute studies, the P-CFTAH was implanted in 4 lambs (average weight: 28.7 +/- 2.3 kg) via a median sternotomy under cardiopulmonary bypass. Pulmonary and systemic pump performance parameters were recorded. RESULTS: The experiments showed good anatomical fit and easy implantation, with an average aortic cross-clamp time of 98 18 minutes. Baseline hemodynamics were stable in all 4 animals (pump speed: 3.4 +/- 0.2 krpm; pump flow: 2.1 +/- 0.9 liters/min; power: 3.0 +/- 0.8 W; arterial pressure: 68 +/- 10 mm Hg; left and right atrial pressures: 6 +/- 1 mm Hg, for both). Any differences between left and right atrial pressures were maintained within the intended limit of 5 mm Hg over a wide range of ratios of systemic-to-pulmonary vascular resistance (0.7 to 12), with and without pump-speed modulation. Pump-speed modulation was successfully performed to create arterial pulsation. CONCLUSION: This initial P-CFTAH prototype met the proposed requirements for self-regulation, performance, and pulse modulation. (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.