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 • Heart. Mate II Principal Investigator (Study Completed) • XVE Registry Principal Investigator (Study Completed)

Heart. Mate® 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 Heart. Mate XVE. . . - Scientific Figure on Research. Gate. Available from: https: //www. researchgate. net/figure/51552937_fig 1_First-generation-pulsatile-leftventricular-assist-device-Heart. Mate-XVE-a-and-Thoratec [accessed Feb 15, 2016]

Heart. Mate II® • Axial flow pump • Approved for bridge to transplant and destination therapy Heart. Mate II left ventricular assist device and cross-sectional. . . - Scientific Figure on Research. Gate. Available from: https: //www. researchgate. net/figure/51552937_fig 2_Heart. Mate-II-left-ventricular-assist -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.

Heart. Ware h. VAD® 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 Research. Gate. Available from: https: //www. researchgate. net/figure/51552937_fig 3_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%20 mirro&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%20 screw&qs=IM&form=QBIRMH&pq=archimedes%20 screw&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%20 Papin%20&qs=n &form=QBIRMH&pq=denis%20 papin%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=3 f 9 aa 7 e 072704 afebf 6 f 0 a 8 dca 2 b 3 e 45&filters=ufn%3 A%22 denis+papin%22 +sid%3 A%22 d 5 bb 562 c-0 f 83 -48 b 7 -9332 -c 88 a 84 bfe 364%22&qs=MB&pq=denis&sc=85&sp=1&cvid=3 f 9 aa 7 e 072704 afebf 6 f 0 a 8 dca 2 b 3 e 45

Heart Mate II® Heartware h. VAD® 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 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 Heartware® 16 days 28% Lower

• Both Heartmate II® and Heartware h. VAD ® 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 h. VAD® Bourque K, Gernes, D, Loree H, et al: Heart. Mate III: Pump Design for a Centrifugal LVAD with a Magnetically Levitated Rotor ASAIO J 401 -405, 2001

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