Use of the aortoatrial continuity as means of providing left ventricular assist support without entering the ventricle: A feasibility study

Paul A. Friedman, Sudhir S. Kushwaha, Charles J. Bruce, Soon J. Park, Dorothy J. Ladewig, Susan B. Mikell, Susan B. Johnson, Scott H. Suddendorf, Andrew J. Danielsen, Samuel J. Asirvatham

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)511-518
Number of pages8
JournalJournal of Cardiac Failure
Volume17
Issue number6
DOIs
StatePublished - Jun 1 2011

Keywords

  • Left ventricular assist device
  • heart failure
  • left ventricle
  • ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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