Development of a Low Cost Ex Vivo Perfusion System for the Elucidation of Flow Modulation Induced Vascular Remodeling

Overview

Heart Failure (HF) is the progressive weakening of the heart’s ability to pump blood and a small subset of HF patients have Advanced Heart Failure (AHF), a form that does not respond to traditional treatment options such as optimal medical management and lifestyle changes. Heart transplantation remains the gold standard for AHF treatment, but the limited organ supply has led to the development of mechanical circulatory support devices, most notably the Left Ventricular Assist Device (LVAD), which is attached to the apex of the Left Ventricle (LV) and assists the LV in pumping. Over time, LVAD design has shifted from pulsatile flow (PVAD) to continuous flow (CVAD) due to improved device efficiency and enhanced patient quality of living. However, this decrease in pulsatility has coincided with an increased occurrence of certain symptoms, notably gastrointestinal bleeding and aortic insufficiency. Flow modulation patterns have been devised to mimic pulsatility within CVADs and simultaneously minimize the occurrence of these symptoms. In this study, an Ex Vivo Perfusion System (EXVP) was assembled and optimized to recreate various LVAD flow modulation conditions. All six flow modulation conditions were successfully achieved with four running simultaneously in an incubator. Two-way ANOVA found no significant difference in the pulsatility indices (p=0.1773) and surplus hemodynamic energies (p=0.3574) generated from the flow modulation conditions between the EXVP and a live bovine model. These results validate the EXVP as a viable small scale model for the replication of the proposed flow modulation conditions. In the future, vessels will be implanted within an EXVP and subjected to the various flow modulation conditions in order to better understand how the vasculature changes in response.

Competition history

• AJAS 2018 Category not listed

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