TY - JOUR
T1 - Use of the aortoatrial continuity as means of providing left ventricular assist support without entering the ventricle
T2 - A feasibility study
AU - Friedman, Paul A.
AU - Kushwaha, Sudhir S.
AU - Bruce, Charles J.
AU - Park, Soon J.
AU - Ladewig, Dorothy J.
AU - Mikell, Susan B.
AU - Johnson, Susan B.
AU - Suddendorf, Scott H.
AU - Danielsen, Andrew J.
AU - Asirvatham, Samuel J.
N1 - Funding Information:
Funding: Supported by the Mayo Clinic Innovation Loan Program .
Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2011/6
Y1 - 2011/6
N2 - Background: Left ventricular assist devices (LVADs) are increasingly used to treat patients with refractory heart failure. Current-generation LVADs have major limitations, including the need for open chest surgery, limiting their widespread use. We hypothesized that the aortoatrial continuity could be used as a unique anatomic vantage point for entirely percutaneous LVAD placement. Methods and Results: Forty human autopsied hearts were examined to ascertain the presence and define the dimensions of the continuity between the posterior aortic wall and the left atrium. In all cases, a "septum" between the aorta and left atrium was identified. In 3 animal experiments, a custom mechanical shunt was deployed in the wall between the left atrium and noncoronary cusp. With continuous intracardiac ultrasound imaging, and at necropsy, there was no evidence of device dislodgement, pericardial effusion, or aortic or coronary artery trauma noted. Conclusions: It is feasible to use the wall between the aorta and left atrium as an access route for a potentially entirely percutaneous LVAD. Such a system obviates the need for accessing the left ventricle, minimizing complications. In the future, such devices may allow widespread treatment of heart failure, malignant cardiac arrhythmia, and severe aortic and mitral valvular disease.
AB - Background: Left ventricular assist devices (LVADs) are increasingly used to treat patients with refractory heart failure. Current-generation LVADs have major limitations, including the need for open chest surgery, limiting their widespread use. We hypothesized that the aortoatrial continuity could be used as a unique anatomic vantage point for entirely percutaneous LVAD placement. Methods and Results: Forty human autopsied hearts were examined to ascertain the presence and define the dimensions of the continuity between the posterior aortic wall and the left atrium. In all cases, a "septum" between the aorta and left atrium was identified. In 3 animal experiments, a custom mechanical shunt was deployed in the wall between the left atrium and noncoronary cusp. With continuous intracardiac ultrasound imaging, and at necropsy, there was no evidence of device dislodgement, pericardial effusion, or aortic or coronary artery trauma noted. Conclusions: It is feasible to use the wall between the aorta and left atrium as an access route for a potentially entirely percutaneous LVAD. Such a system obviates the need for accessing the left ventricle, minimizing complications. In the future, such devices may allow widespread treatment of heart failure, malignant cardiac arrhythmia, and severe aortic and mitral valvular disease.
KW - Left ventricular assist device
KW - heart failure
KW - left ventricle
KW - ventricular fibrillation
UR - http://www.scopus.com/inward/record.url?scp=79957821844&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79957821844&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2011.01.014
DO - 10.1016/j.cardfail.2011.01.014
M3 - Article
C2 - 21624740
AN - SCOPUS:79957821844
SN - 1071-9164
VL - 17
SP - 511
EP - 518
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 6
ER -