In Vitro Benchmarking Study of Ventricular Assist Devices in Current Clinical Use

Gemma Radley, Ina Laura Pieper, Christian R. Robinson, Sabrina Ali, Mostafa Beshr, Owen Bodger, Catherine A Thornton

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BACKGROUND: Left ventricular assist devices (LVADs) offer live-saving therapy to transplant-ineligible heart failure patients. A major limitation of the technology includes pump thrombosis, bleeding, and recurrent infection that prove difficult to predict from in vivo animal testing. Shear stress introduced by the LVAD affects more than just haemolysis since platelets, leukocytes, and plasma proteins all contribute to the propensity for complications. It is important to assess overall damage by a new device against a base line as early as possible in the development process so that design iterations can be made if required.

METHODS: Explanted VADs currently in clinical use (HeartMate 2 and HVAD) were carefully cleaned, inspected, and run at 5 L/min and pressure at 100 mmHg in a standard 500 mL mock circulatory loop using bovine blood. The CentriMag was used as a control pump due to its low blood damage profile. Samples were collected at regular intervals and the following analysed: complete cell counts; haemolysis; platelet activation; leukocyte-derived microparticles (LMPs); and von Willebrand factor (vWF) degradation.

RESULTS: The HeartMate 2 had the highest levels of haemolysis and platelet activation after 6 hours compared to the HVAD and CentriMag. A decreased granulocyte count, high numbers of LMPs and CD11bBrightHLADR- LMPs, and decreased vWF collagen binding activity was most evident in the HVAD.

CONCLUSIONS: The results indicate that it is possible to observe differences between different pump designs during in vitro testing that might translate to clinical performance. This study demonstrates the importance of developing standard in vitro total blood damage methods against which device developers could use to modify design to reduce complication risk long before implantation.

Original languageEnglish
JournalJournal of Cardiac Failure
Early online date5 Oct 2019
Publication statusE-pub ahead of print - 5 Oct 2019


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