Pulsatile Systems
 Pulsatile systems emulate the heart’s natural pulsatile blood flow with periods of rest (filling) and work (emptying). Many ingenious methods have been developed to provide pulsatile flow from a mechanical pump. Pulsatile systems have valves or one-way doors, which provide unidirectional flow. The work of squeezing a flexible blood sac is accomplished either with compressed air or mechanically with an electromechanical motor.

ABIOMED BVS 5000 and AB5000

(ABIOMED, Inc. Danvers, Massachusetts)


The BVS 5000 and AB5000 are FDA approved as a recovery device. They allow quick surgical insertion and easy operation. The BVS5000 requires the patient to be bed bound. Patients are frequently transferred to UPMC on the BVS5000. After the surgeon evaluations the patient, the BVS500 can be easily replaced with AB5000 using the same cannula (tubes from the heart) if necessary. The AB5000 allows patients to become mobile.

Arrow Intra Aortic Balloon Pump (IABP)

(Arrow International, Inc., Reading, PA)

Commonly the first line of defense in the battle against cardiac dysfunction, IABPs are used widely, often to transport critically ill patient to UPMC. IABPs are most frequently used to prevent cardiac ischemia by reducing the workload on the heart and increasing coronary perfusion. IABPs provide a limited amount of blood flow and are frequently inserted before other ventricular assist devices that may provide complete circulatory support. Arrow IABP catheters are available as 8 Fr with 30cc and 40cc balloons as well as 9 Fr with a 40cc balloon or 10 Fr with a 50cc balloon.
The Artificial Heart Program utilizes the Arrow with great efficiency, handling transport from other centers to UPMC hospitals as well as in-hospital supervision of IABP operation. The AHP staff provides on-site coverage 24 hours a day, 365days a year.

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Heartmate

(Thoratec Corp, Pleasanton, CA)

The Heartmate LVAS is an implanted, electrically driven, left ventricular assist system with unique textured blood contacting surfaces. This is the only circulatory assist device to employ special surfaces, which do not require anticoagulation. The textured surfaces develop a pseudo-intimal lining reducing the need to anticoagulate as well as reducing the risk of thromboembolism. Like other systems it can take over the workload completely from the left ventricle. The external components are very light; two batteries fit into shoulder harnesses and connect to a small controller that then connects percutaneously to the implanted pump. This setup makes it very portable and even concealable under a jacket or coat. Another unique feature of the Heartmate is the ability to hand pump or connect to a pneumatic driver if a mechanical failure was to occur.

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Thoratec VAD System

(Thoratec Corp, Pleasanton, CA)

The Heartmate LVAS is an implanted, electrically driven, left ventricular assist system with unique textured blood contacting surfaces. This is the only circulatory assist device to employ special surfaces, which do not require anticoagulation. The textured surfaces develop a pseudo-intimal lining reducing the need to anticoagulate as well as reducing the risk of thromboembolism. Like other systems it can take over the workload completely from the left ventricle. The external components are very light; two batteries fit into shoulder harnesses and connect to a small controller that then connects percutaneously to the implanted pump. This setup makes it very portable and even concealable under a jacket or coat. Another unique feature of the Heartmate is the ability to hand pump or connect to a pneumatic driver if a mechanical failure was to occur.

The FDA has approved the use of the Thoratec system for both bridge-to-transplant and recovery from open-heart surgery. It is the only device with both approvals.

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Thoratec IVAD System

(Thoratec Corp, Pleasanton, CA)

Thoratec's newest system, currently in clinical trials, is an implanted version of the external system (SEE ABOVE). This is the only implantable biventricular assist device, which does not require removal of the native heart. Very similar to the external system with exception of a titanium outer housing (allowing a smaller external dimension), and a transducer which measures pump emptying. The blood contacting components have not changed from the successful external version. This version may improve a patient's quality of life, especially when discharged from the hospital, by reducing the external components a patient must deal with.

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WorldHeart - Novacor LVAS

(WorldHeart Corp., Ottawa, Canada)

The three external components, weighing just over 7 lbs (3.3 kg) together, may be carried on a belt or in a shoulder bag. The controller electronics are worn outside the body, powered by primary and reserve battery packs. A single percutaneous lead connects the controller to the implanted pump. This design allows patients with the Novacor LVAS a high degree of mobility. Many even return to work full-time.

The Novacor LVAS, made by World Heart Corporation, is commercially available for bridge to cardiac transplantation in the US, Europe, Canada and parts of Asia. A clinical trial is currently underway in the US and Canada to evaluate the long-term use of the Novacor LVAS as an alternative to medical therapy in non-transplant-eligible patients who are inotrope dependent. In Europe, the device is already available without restriction for use by heart failure patients.

To demonstrate its high level of confidence in the durability and reliability of Novacor LVAS, WorldHeart has announced a three-year warranty for all implanted components. Over 100 recipients have been supported by the Novacor LVAS for more than one year, with some recipients supported for more than four years.

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