James E. Lowe, G. Chad Hughes, Shankha S. Biswas

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Presentation transcript:

Non–Blood-Contacting Biventricular Support: Direct Mechanical Ventricular Actuation James E. Lowe, G. Chad Hughes, Shankha S. Biswas Operative Techniques in Thoracic and Cardiovascular Surgery Volume 4, Issue 4, Pages 345-351 (November 1999) DOI: 10.1016/S1522-2942(07)70128-9 Copyright © 1999 Elsevier Inc. Terms and Conditions

Fig I Schematic diagram of DMVA drive system and cup. The cup is shown actuating both ventricles into systolic (right) and diastolic configurations (left). (Reprinted with permission.5) Operative Techniques in Thoracic and Cardiovascular Surgery 1999 4, 345-351DOI: (10.1016/S1522-2942(07)70128-9) Copyright © 1999 Elsevier Inc. Terms and Conditions

Fig II The components of a DMVA heart cup. The wrap-around design contains a flexible diaphragm bonded circumferentially at the base and apex of a semi-rigid housing. The apical port communicates with the space occupied by the ventricles. The side arm communicates with the space between the outer housing and inner diaphragm. (Reprinted with permission.5) Operative Techniques in Thoracic and Cardiovascular Surgery 1999 4, 345-351DOI: (10.1016/S1522-2942(07)70128-9) Copyright © 1999 Elsevier Inc. Terms and Conditions

Fig III Volume-controlled driveline system control panel display. Note the ability to adjust assist rate, systolic duration volume and pressure. the diastolic pressure, as well as the continuous apical suction. Operative Techniques in Thoracic and Cardiovascular Surgery 1999 4, 345-351DOI: (10.1016/S1522-2942(07)70128-9) Copyright © 1999 Elsevier Inc. Terms and Conditions

Fig IV Before cardiac transplantation, cardiopulmonary bypass was instituted using standard cannulation techniques through a virgin sternotomy (left). Device removal was performed by cutting the sterile drivelines within the chest and removing the cup through the sternotomy (right). (Reprinted with permission from the Society of Thoracic Surgeons.9) Operative Techniques in Thoracic and Cardiovascular Surgery 1999 4, 345-351DOI: (10.1016/S1522-2942(07)70128-9) Copyright © 1999 Elsevier Inc. Terms and Conditions

Fig V Systemic arterial and venous pressures before and during 45 hours of support in a DMVA recipient. Use of an intra-aortic balloon pump and all inotropic agents was discontinued immediately after DMVA application. (Reprinted with permission from the Society of Thoracic Surgeons.9) Operative Techniques in Thoracic and Cardiovascular Surgery 1999 4, 345-351DOI: (10.1016/S1522-2942(07)70128-9) Copyright © 1999 Elsevier Inc. Terms and Conditions

1 After placement of an arterial line and pulmonary artery pressure catheter, the patient is positioned supine with the left hemithorax elevated by padding to approximately 30°. DMVA cup application is made by exposing the heart via a left anterior thoracotomy through the sixth intercostal space. The pericardium is opened anterior to the phrenic nerve and the cup positioned over the ventricular apex, which results in self-attachment via the apical vacuum line (left). After assuring an adequate cup fit, the apical suction and drivelines are brought through separate stab incisions. A single chest tube is placed, and the chest is closed in a routine fashion (right). (Reprinted with permission from the Society of Thoracic Surgeons.9) Operative Techniques in Thoracic and Cardiovascular Surgery 1999 4, 345-351DOI: (10.1016/S1522-2942(07)70128-9) Copyright © 1999 Elsevier Inc. Terms and Conditions