Left Atrial Appendage Cannulation for Less Invasive LVAD Support
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Solution Overview
Problem
Existing left ventricular assist devices (LVADs) require sternotomy and cardiopulmonary bypass, causing damage to the already weak left ventricle and complicating replacement procedures.
Innovation Solution
A cannula is introduced through the left atrial appendage and mitral valve to suction blood from the left atrium and ventricle, connecting to a mechanical circulatory support device without damaging the left ventricle, allowing easy replacement of devices like LVAD or ECMO.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If a cannula is introduced through the left ventricle apex using conventional LVAD methodology, then mechanical circulatory support can be achieved, but sternotomy and cardiopulmonary bypass are required causing damage to the already weak left ventricle
Solution Approach 1:
The patent uses the left atrial appendage as an intermediary access point to introduce the inflow cannula into the left ventricle, avoiding direct apical access through the ventricle wall. This intermediary approach allows cannula insertion through the mitral valve opening rather than requiring sternotomy and cardiopulmonary bypass, thereby reducing harmful damage to the already weak left ventricle while still achieving reliable mechanical circulatory support
2Ease of operation
If a hole is made in the left ventricle apex for cannula insertion, then inflow cannula can be positioned, but the left ventricle is already very weak and cannot withstand additional damage
Solution Approach 1:
The patent employs the left atrial appendage and mitral valve as intermediary structures to facilitate cannula positioning without directly perforating the left ventricle apex. The inflow cannula is introduced through the mitral valve opening into the left ventricle, avoiding the need to create a hole in the already fragile ventricular wall, thus preserving left ventricle strength while enabling easy cannula positioning
3Reliability
If conventional LVAD implantation is performed through sternotomy, then mechanical circulatory support is established, but the procedure is complex and time-consuming
Solution Approach 1:
The patent uses the left atrial appendage as an intermediary access point that simplifies the surgical procedure. Instead of requiring complex sternotomy and cardiopulmonary bypass, the inflow cannula can be introduced through the left atrial appendage and mitral valve opening, significantly reducing procedural complexity and time while still establishing reliable mechanical circulatory support
4Ease of operation
If the left ventricle is damaged during LVAD implantation, then cannula can be positioned, but replacement of the device becomes difficult
Solution Approach 1:
The patent employs the left atrial appendage as a reusable intermediary access point that allows for easy device replacement. Since the cannula is introduced through the mitral valve opening rather than requiring apical perforation, the same access point can be used for removing and reinserting cannulas or replacing the entire LVAD device, making future interventions simple and straightforward without requiring additional surgical complexity
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
Facilitates cardiac circulation without cardiopulmonary bypass or sternotomy, enabling easy device replacement and reducing operative risk, while maintaining cardiac function.
Implementation Method 1
The inflow cannula is designed to allow suction of blood along various portions of its length that are intended to be positioned within the heart
Implementation Method 2
The blood that is suctioned by the inflow cannula flows into a mechanical circulatory support device, such as left ventricular assist device (LVAD), to be pumped therefrom, via an outflow cannula and into the aorta
Data Source
AI summary
The present disclosure provides a solution for assisting cardiac circulation of a subject. In one aspect of the present disclosure, the new solution replaces the common practice of implementing a cannula of left ventricular assist device (LVAD) to the left ventricle (LV) through a large opening made in the apex of the LV, which has some disadvantages such as requirement of sternotomy, making a hole in an already very weak left ventricle, requirement of cardiopulmonary bypass, etc.The solution of the present disclosure suggests introducing the inflow cannula, namely the cannula/tube that suctions blood from the heart, through an opening made in the left atrium appendage (LAA) and guiding it through the left atrium (LA) and the mitral valve (MV) into the LV to be positioned therein. The inflow cannula is designed to allow suction of blood along various portions of its length that are intended to be positioned within the heart, namely along portions that are positioned in the LV, LA and optionally the LAA.The blood that is suctioned by the inflow cannula flows into a mechanical circulatory support device to be pumped therefrom, via an outflow cannula and into the aorta, thereby allowing supply of oxygenated blood to the entire body. Optionally, the outflow cannula can be coupled to the descending aorta and not to the ascending aorta as commonly done in the cases of LVAD implementations.A second aspect of the present disclosure provides a new solution for overcoming right ventricle failure by withdrawing blood from a first portion of the pulmonary artery and streaming blood to a second portion of the pulmonary artery, the second portion is downstream the first portion, namely more proximal to the lungs. The two solutions may be carried out by a similar surgical procedure, such as left thoracotomy. If the two solutions of the present disclosure are used together, they form a total artificial heart solution.