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DOI: 10.1055/s-0034-1367152
Development of a retrograde flow inhibition device in continues flow VAD for emergency rescue
Objectives: Implantation of continues flow VAD is a widely used option to handle end-stage heart failure. In case of device dysfunction (thrombus, electrical or mechanical disorder) severe hemodynamic instability occur, due to an aortic insufficiency across the device. Despite remained cardiac function the additional retrograde flow can cause fulminant pulmonary oedema and death. ECMO implantation is not an alternative, due to increasing retrograde flow and cardiopulmonary deterioration.
Methods: We developed a small implantable electrical engine, which clamps the outflow prostheses of continues flow VAD triggered by retrograde flow or an external command system. A mock circulation including an introduced HeartWare HVAD was established. By simulating a HVAD dysfunction retrograde flow and aortic pressure were investigated with (n = 10) and without (n = 10) the retrograde flow inhibition device (RFID).
Results: Retrograde flow or external command triggered stimulation lead immediately to occlusion of the prostheses. In the RFID group no retrograde flow occurred and mean aortic pressure was 69 ± 8 mmHg. Simulating HVAD dysfunction without RFID lead to mean retrograde flow of 1,9 ± 0,5 L/min and a mean aortic pressure of 57 ± 6 mmHg.
Conclusion: The retrograde flow inhibition device can prevent a severe aortic insufficiency and stabilize cardiopulmonary situation. A simultaneous use with an ECMO can lead to farther stability and facilitate operative intervention e.g. for a system exchange, due to VAD thrombus.