Pulsatile ventricular assist devices
View Patent ↗An implantable LVAD system includes an implantable LVAD including an outflow cannula, which is couplable in fluid communication with a circulatory system of the patient at a first site; and an inflow cannula, which is couplable in fluid communication with the circulatory system at a second site upstream of the first site. The LVAD further includes a continuous-flow pump includes a first inlet in fluid communication with the inflow cannula, and a first outlet. The LVAD still further includes a pulsatile-flow pump includes a second inlet in fluid communication with the first outlet of the continuous-flow pump, and a second outlet in fluid communication with the outflow cannula. Control circuitry is configured to activate the continuous-flow pump to provide flow without synchronization with cardiac cycles of a heart of the patient, and activate the pulsatile-flow pump to provide pulsatile flow synchronized with the cardiac cycles. Other embodiments are also described.
1. A left ventricular assist device (LVAD) system for treating a patient, the LVAD system comprising:
(i) an implantable LVAD for implantation in the patient, the LVAD comprising:
(a) an outflow cannula, which is couplable in fluid communication with a circulatory system of the patient at a first site;
(b) an inflow cannula, which is couplable in fluid communication with the circulatory system at a second site upstream of the first site;
(c) a continuous-flow pump, which comprises (1) a first inlet in fluid communication with the inflow cannula, and (2) a first outlet; and
(d) a pulsatile-flow pump, which comprises (1) a second inlet in fluid communication with the first outlet of the continuous-flow pump, and (2) a second outlet in fluid communication with the outflow cannula; and
(ii) control circuitry, which is configured to:
activate the continuous-flow pump to provide flow without synchronization with cardiac cycles of a heart of the patient, and
activate the pulsatile-flow pump to provide pulsatile flow synchronized with the cardiac cycles.
2. The LVAD system according to claim 1 , further comprising a cardiac sensor, which is configured to sense one or more features of the cardiac cycles, wherein the control circuitry is coupled to the cardiac sensor.
3. The LVAD system according to claim 1 , wherein the second site is an apex of a left ventricle of the heart.
4. The LVAD system according to claim 1 , further comprising a stationary one-way outflow valve, which is arranged to allow downstream blood flow from the second outlet of the pulsatile-flow pump to the outflow cannula, and to inhibit upstream blood flow from the outflow cannula to the second outlet.
5. The LVAD system according to claim 1 , further comprising a tube which couples the second inlet of the pulsatile-flow pump in the fluid communication with the first outlet of the continuous-flow pump.
6. The LVAD system according to claim 1 , wherein the pulsatile-flow pump:
is shaped so as to define a pump chamber having (a) an upstream inflow end in fluid communication with the second inlet, and (b) a downstream outflow end in fluid communication with the second outlet, and
comprises a tubular linear motor, which comprises (a) a magnetic piston, which comprises a reciprocating one-way valve configured to allow downstream blood flow and inhibit upstream blood flow; and (b) a stator, which is configured to magnetically drive the magnetic piston with reciprocating motion, so as to pump blood downstream during downstream motion of the magnetic piston while the reciprocating one-way valve is closed.
7. The LVAD system according to claim 6 , wherein the control circuitry is configured to activate the tubular linear motor to provide the pulsatile flow synchronized with the cardiac cycles by, during each of the cardiac cycles:
activating the stator of the tubular linear motor to move the magnetic piston downstream during a portion of systole of the cardiac cycle, and
activating the stator of the tubular linear motor to move the magnetic piston upstream during at least a portion of diastole of the cardiac cycle.
8. The LVAD system according to claim 6 , further comprising a stationary one-way outflow valve, which is arranged to allow downstream blood flow from the second outlet of the pulsatile-flow pump to the outflow cannula, and to inhibit upstream blood flow from the outflow cannula to the second outlet.
9. The LVAD system according to claim 6 , further comprising a stationary one-way inflow valve, which is arranged to allow downstream blood flow into the pump chamber of the pulsatile-flow pump, and to inhibit upstream blood flow from the pump chamber.
10. The LVAD system according to claim 1 , wherein the continuous-flow pump comprises a magnetically-levitated centrifugal pump.
11. The LVAD system according to claim 1 , wherein the control circuitry is configured to activate the pulsatile-flow pump to provide pulsatile flow synchronized with the cardiac cycles by, during each of the cardiac cycles, activating the pulsatile-flow pump to pump blood downstream during a portion of systole of the cardiac cycle.
12. The LVAD system according to claim 11 , wherein the control circuitry is configured to activate the pulsatile-flow pump to pump blood downstream during the portion of systole of the cardiac cycle, and not to pump blood downstream during any portion of diastole of the cardiac cycle.
13. The LVAD system according to claim 11 , wherein the control circuitry is configured, during each of the cardiac cycles, to activate the pulsatile-flow pump to begin the portion of systole at a delay after the beginning of systole.
14. The LVAD system according to claim 13 , wherein a duration of the delay is 200-400 milliseconds.
15. The LVAD system according to claim 13 ,
further comprising a cardiac sensor, which is configured to sense one or more features of the cardiac cycles,
wherein the control circuitry is coupled to the cardiac sensor, and
wherein the control circuitry is configured to set a duration of the delay equal to 20%-40% of a total duration of the cardiac cycle.
16. The LVAD system according to claim 13 , wherein the control circuitry is configured to activate the pulsatile-flow pump to begin the portion of systole upon detection by the control circuitry of a beginning of a decline in pressure after a rise in pressure during systole.
17. The LVAD system according to claim 16 ,
wherein the pulsatile-flow pump:
is shaped so as to define a pump chamber having (a) an upstream inflow end in fluid communication with the second inlet, and (b) a downstream outflow end in fluid communication with the second outlet, and
comprises a tubular linear motor, which comprises (a) a magnetic piston, which comprises a reciprocating one-way valve configured to allow downstream blood flow and inhibit upstream blood flow; and (b) a stator, which is configured to magnetically drive the magnetic piston with reciprocating motion, so as to pump blood downstream during downstream motion of the magnetic piston while the reciprocating one-way valve is closed,
wherein the LVAD system further comprises an upstream pressure sensor, which is disposed and configured to measure blood pressure of blood upstream of the magnetic piston of the pulsatile-flow pump, and
wherein the control circuitry is configured to detect the beginning of the decline in the pressure after the rise in the pressure during systole, using the upstream pressure sensor.
18. The LVAD system according to claim 17 , wherein the upstream pressure sensor is disposed and configured to measure the blood pressure of blood entering the upstream inflow end of the pump chamber of the pulsatile-flow pump.
19. The LVAD system according to claim 17 , wherein the upstream pressure sensor is disposed upstream of the continuous-flow pump, and configured to measure left-ventricular pressure (LVP).
20. A method for treating a patient comprising:
implanting a left ventricular assist device (LVAD) of an LVAD system in the patient, by:
coupling an outflow cannula of the LVAD in fluid communication with a circulatory system of the patient at a first site; and
coupling an inflow cannula of the LVAD in fluid communication with the circulatory system at a second site upstream of the first site,
wherein the LVAD includes (a) a continuous-flow pump, which includes (1) a first inlet in fluid communication with the inflow cannula, and (2) a first outlet, and (b) a pulsatile-flow pump, which includes (1) a second inlet in fluid communication with the first outlet of the continuous-flow pump, and (2) a second outlet in fluid communication with the outflow cannula; and
activating control circuitry of the LVAD system to:
activate the continuous-flow pump to provide flow without synchronization with cardiac cycles of a heart of the patient, and
activate the pulsatile-flow pump to provide pulsatile flow synchronized with the cardiac cycles.