Transcript Centrifugal or Axial LVAD? : Denis Papin versus Archimedes

Centrifugal or Axial LVAD? :
Denis Papin versus Archimedes
H. Edward Garrett, Jr., MD
February 27, 2016
Intracorporeal
Implantable Ventricular
Assist Devices
Pulsatile
Continuous Flow
Axial Flow
Centrifugal
Flow
Disclosures
• HeartMate II Principal Investigator (Study
Completed)
• XVE Registry Principal Investigator (Study
Completed)
HeartMate® XVE LVAS
• Pneumatic driven piston
pump
• First approved device for
bridge to transplant and
destination therapy
• Pulsatility is advantageous
• Disadvantages in size and
durability
First generation pulsatile left ventricular assist device HeartMate XVE... - Scientific
Figure on ResearchGate. Available from:
https://www.researchgate.net/figure/51552937_fig1_First-generation-pulsatile-leftventricular-assist-device-HeartMate-XVE-a-and-Thoratec [accessed Feb 15, 2016]
HeartMate II®
• Axial flow pump
• Approved for bridge to
transplant and
destination therapy
HeartMate II left ventricular assist device and cross-sectional... - Scientific Figure on
ResearchGate. Available from:
https://www.researchgate.net/figure/51552937_fig2_HeartMate-II-left-ventricularassist-device-and-cross-sectional-internal-view [accessed Feb 15, 2016]
Axial Flow Pump
• Differ from radial flow in that the fluid enters
and exits along the same direction parallel to
the rotating shaft.
• The fluid is not accelerated but instead “lifted”
by the action of the impeller.
• The pump may be likened to a propeller
spinning in a length of tube.
HeartWare hVAD® System
• Centrifugal flow pump
• Approved for bridge to transplant
• Current study in progress for destination therapy
External (a) and internal (b) view of third-generation continuous-flow... - Scientific Figure on ResearchGate. Available from:
https://www.researchgate.net/figure/51552937_fig3_External-a-and-internal-b-view-of-third-generation-continuous-flow-rotary-left
[accessed Feb 15, 2016]
Centrifugal Pump
• A rotodynamic pump that uses a rotating impeller
to increase the pressure and flow rate of fluid.
• Most common pump used to move liquids
through a piping system.
• Fluid enters the pump impeller along or near the
rotating axis and is accelerated by the impeller,
flowing radially outward or axially into a diffuser
or volute chamber, then exits into the
downstream piping system.
• Axial flow pump attributed to Archimedes
although he may have improved upon a
design used to irrigate the Hanging Gardens of
Babylon
=
http://www.bing.com/images/search?q=hanging+gardens+of+babylon&qs=AS&sk=
&FORM=QBIRMH&pq=hanging&sc=8-7&sp=1&qs=AS&sk
Archimedes
• Born 287 B.C. in
Syracuse, Sicily
• Killed by a Roman
soldier 212 B.C. After 2
years siege at Syracuse
in the Second Punic
War
http://www.bing.com/images/search?q=archimedes%20&qs=n&form=
QBIR&pq=archimedes%20&sc=8-11&sp=-1&sk=
Contributions
• Archimedes principle for determining the
volume of an object with irregular shape
• Value of π
• Defensive war machines like Claw and
Archimedes Ray
•
•
http://www.bing.com/images/search?q=Archimedes+Solar-Ray&FORM=IRIBEP
http://www.bing.com/images/search?q=archimedes+mirror+weapon&qs=AS&sk=&FORM=QBIR&pq=archimedes%20mirro&sc=616&sp=1&qs=AS&sk=
Archimedes screw (water pump) used
in largest ship built in antiquity
http://www.bing.com/images/search?q=archimedes%20screw&qs=IM&form=QBIRMH&pq=archimedes%20screw&sc=816&sp=1&sk=
Denis Papin
• Born in Blois, France 1647
• Died a pauper in London
1712
http://www.bing.com/images/search?q=Denis%20Papin%20&qs=n
&form=QBIRMH&pq=denis%20papin%20&sc=0-0&sp=-1&sk=
Contributions
• Centrifugal pump
• Pressure cooker
• Steam driven paddle
wheel boat
•
http://www.bing.com/search?q=denis+papin&form=PRUSEN&mkt=enus&refig=3f9aa7e072704afebf6f0a8dca2b3e45&filters=ufn%3A%22denis+papin%22
+sid%3A%22d5bb562c-0f83-48b7-9332-c88a84bfe364%22&qs=MB&pq=denis&sc=85&sp=1&cvid=3f9aa7e072704afebf6f0a8dca2b3e45
Heart Mate II®
Heartware hVAD®
Mechanism
Continuous Flow, Axial
Continuous Flow, Centrifugal
Operating Range
(Typical range)
6,000 - 15,000 rpm
(8,000 - 11,000 rpm)
2,400 - 3,200 rpm
(2,400 - 2,800 rpm)
Inflow Sintering
Complete
Partial (ring)
Placement
Subdiaphragmatic
Intrapericardial
Anti-Thrombotic Rx
Asa/Coumadin
Asa/Coumadin
BTT Approval?
Yes, 2008
Yes, 2012
DT Approval
Yes, 2010
No
Implants Worldwide
>21,000
>9,000
Goldstein DJ, Continuous Flow Left Ventricular Assist Devices: Dare to Compare, The Journal of Thoracic and Cardiovascular Surgery (2015), doi: 10.
1016/j.jtcvs.2015.09.104
Comparison of Axial vs Centrifugal
Pumps
Moazami N, Fukamachi K, Kobayashi M, et al: Axial and centrifugal continuous-flow rotary pumps: A translation from pump mechanics to clinical practice.
J Heart Lung Transplant 32:1-11,2013
LOS
CVA @ 2 years
Activated coagulation
and immune system
Pump
Thrombosis
Heartmate II®
20 days
12%
Higher
Higher
Heartware®
16 days
28%
Lower
Lower
• Both Heartmate II® and Heartware hVAD ®
pumps have been proven fairly equally
successful with similar one year survival rates
85 – 90%
• Both achieve similar flow rates up to 10 L/M
• Similar rates of GI Bleeding occurrences
Moazami N, Fukamachi K, Kobayashi M, et al: Axial and centrifugal continuous-flow rotary pumps: A translation from pump mechanics to clinical
practice. J Heart Lung Transplant 32:1-11,2013
Heartmate 3™
• Now in clinical trials
MOMENTUM 3 IDE
• Centrifugal pump with
many similarities to
Heartware hVAD®
Bourque K, Gernes, D, Loree H, et al: HeartMate III: Pump Design
for a Centrifugal LVAD with a Magnetically Levitated Rotor ASAIO J
401-405, 2001
Questions?