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In Vitro Evaluation of an External Compression Device for F ontan Mechanical Assistance
Author(s) -
Valdovinos John,
Shkolyar Eugene,
Carman Gregory P.,
Levi Daniel S.
Publication year - 2014
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12152
Subject(s) - pulsatile flow , cuff , medicine , hemodynamics , cardiology , ventricle , fontan procedure , compression (physics) , pulse pressure , biomedical engineering , central venous pressure , materials science , blood pressure , surgery , heart rate , composite material
While F ontan palliation in the form of the total cavopulmonary connection has improved the management of congenital single ventricle physiology, long‐term outcomes for patients with this disease are suboptimal due to the lack of two functional ventricles. Researchers have shown that ventricular assist devices ( VAD s) can normalize F ontan hemodynamics. To minimize blood contacting surfaces of the VAD , we evaluated the use of an external compression device ( C ‐ P ulse H eart A ssist S ystem, S unshine H eart I nc.) as a F ontan assist device. A mock circulation was developed to mimic the hemodynamics of a hypertensive F ontan circulation in a pediatric patient. The S unshine C ‐ P ulse compression cuff was coupled with polymeric valves and a compressible tube to provide nonblood‐contacting pulsatile flow through the F ontan circulation. The effect of the number, one or two, and placement of valves, before or after the compression cuff, on inferior vena cava pressure ( IVCP ) was studied. In addition, the effect of device inflation volume and compression rate on maintaining low IVCP was investigated. With one valve located before the cuff, the device was unable to maintain an IVCP below 15.5 mm Hg . With two valves, the C ‐ P ulse was able to maintain IVCP as low as 8.5 mm Hg . The C ‐ P ulse provided pulsatile flow and pressure through the pulmonary branch of the mock circulation with a pulse pressure of 16 mm Hg and 180 mL /min additional flow above unassisted flow. C ‐ P ulse compression reduced IVCP below 12 mm Hg with 13 cc inflation volume and compression rates above 105 bpm. This application of an external compression device combined with two valves has potential for use as an artificial right ventricle by maintaining low IVCP and providing pulsatile flow through the lungs.