Axial and centrifugal continuous-flow rotary pumps: A translation from pump mechanics to clinical practice Nader Moazami, MD, Kiyotaka Fukamachi, MD,

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Axial and centrifugal continuous-flow rotary pumps: A translation from pump mechanics to clinical practice Nader Moazami, MD, Kiyotaka Fukamachi, MD, PhD, Mariko Kobayashi, MD, Nicholas G. Smedira, MD, Katherine J. Hoercher, RN, Alex Massiello, MEBME, Sangjin Lee, MD, MS, David J. Horvath, MSME, Randall C. Starling, MD, MPH The Journal of Heart and Lung Transplantation Volume 32, Issue 1, Pages 1-11 (January 2013) DOI: 10.1016/j.healun.2012.10.001 Copyright © 2013 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 1 Rotary pump bearing types. (A) Mechanical pivot bearing: a drawing of a generic axial-flow pump illustrates how the rotating element (rotor) is suspended by pivot bearings on either end as it spins. These bearings, which are usually made from very hard jewel or ceramic materials, are in mechanical contact while the rotor is spinning. (B) Electromagnetic bearing: Illustration shows electromagnetic levitation of the INCOR (Berlin Heart GmbH) axial continuous-flow pump rotor. Levitating electromagnets act on opposing permanent magnets (black) on both ends of the rotating element to suspend the rotor axially, while the permanent follower magnets in the rotating element and electromagnetic forces induced in the motor stator suspend the rotating element radially. The arrows show the directions of magnetic forces. (C) Hydrodynamic radial bearing: Diagram shows a cross-section through a generic rotating cylinder (white disc in cross-section) within a stationary cylinder that is suspended by thin fluid film pressures (fluid is grey in the diagram). This bearing has no mechanical contact because the hydrodynamic forces keeping the rotating element away from the stationary element increase as the distance between them decreases. The magnitude and direction of these fluid forces is represented by the height and direction of the arrows. (D) Hydrodynamic thrust bearing: Diagram shows the cross-section of a generic thrust bearing, consisting of 2 plates, where thin fluid film pressure acts to separate a rotating surface (2) moving to the right in this figure relative to a stationary surface (3). These forces are created by the fluid wedge created between geometry of the moving plate relative to the stationary plate and again are represented by the direction and height of the arrow in the diagram. An example of this bearing type is shown in Panel E. (E) Hydrodynamic thrust and permanent magnet bearing combination: Assembled component view of the HeartWare HVAD centrifugal continuous flow LVAD on the right and cross-section on the left. Permanent magnets (1-1) align and separate the rotating disc impeller (2) from the conical stationary center shaft of the pump housing to form a permanent magnet bearing. This bearing is combined with thin film fluid pressures generated at the tapered hydrodynamic thrust bearing surface of the rotating disc impeller (2) that creates the fluid wedge needed to create sufficient hydrodynamic forces to lift the impeller off the stationary housing bearing surface (3). The red line between the rotor (2) and housing (3) is the blood fluid film. The Journal of Heart and Lung Transplantation 2013 32, 1-11DOI: (10.1016/j.healun.2012.10.001) Copyright © 2013 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 2 (A) Representation of the systemic arterial pressure (AoP) and left ventricular pressure (LVP) relationship is shown during rotary LVAD support in a failing ventricle. Comparison of (B) centrifugal-flow and (C) axial rotary pump performance characteristics are shown as pressure differential across pump inlet and outlet in mm Hg and pump flow in liters/min. (D) Representative centrifugal and axial rotary pump flow waveforms during rotary LVAD support in a failing ventricle are compared. Reprinted with permission from Pagani FD. Continuous-flow rotary left ventricular assist devices with “3rd generation” design. Semin Thorac Cardiovasc Surg 2008;20:255–263. © 2008 Elsevier, Inc. The Journal of Heart and Lung Transplantation 2013 32, 1-11DOI: (10.1016/j.healun.2012.10.001) Copyright © 2013 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 3 Comparison of head curves for axial vs centrifugal continuous flow (CF) pumps is shown for the (A) HeartMate II axial CF, the (B) HeartWare HVAD* centrifugal CF,3 and the (C) Terumo DuraHeart centrifugal CF. Reprinted with permission from Frazier OH et al. Optimization of axial-pump pressure sensitivity for a continuous flow total artificial heart. J Heart Lung Transplant 2010;29:687–91. © 2010 Elsevier Inc. and Alex Medvedev, Terumo Heart, Inc.*The HeartWare HVAD is an investigational device limited by Federal Law to investigational use. The Journal of Heart and Lung Transplantation 2013 32, 1-11DOI: (10.1016/j.healun.2012.10.001) Copyright © 2013 International Society for Heart and Lung Transplantation Terms and Conditions