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Biomedical subjects

W J Kolff

Publications and source records attributed to W J Kolff.

At least 19 recordsLinked to original sources
PubMed1997

Simultaneous separate assessment of the cardiac and LVAD output.

The electroimpedance indicators' dilution (EIID) technique was used to study the possibility of a simultaneous separate assessment of the biological heart and LVAD performance in the position of LVB. The experimental part of the research was performed on 5 dogs; an artificial ventricle of the pulsing type (USA) with cusps was used as a pump. The clinical part of the work was conducted on 5 patients after open-heart surgery who had the clinical picture of postcardiotomy cardiogenic shock; a centrifugal pump "Biopump" (Medtronic, USA) was used. The authors have shown a principally important possibility of applying the EIID, technique for studying the performance curves which are the integral derivatives of the work of a specific hybrid system--"the biological heart-assist device". From the practical viewpoint the EIID technique permits in the read time mode to control continuously the part of the pumping function which is assumed by the patient's own heart. This information can serve as the basis for making the prognosis and determining the further tactics of treatment; the restoration of the heart performance or its replacement by transplantation.

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PubMed1996

A computer controlled pulsatile pump: preliminary study.

A Stepper Motor Driven Reciprocating Pump (SDRP) can replace roller pumps and rotary pumps for cardio pulmonary bypass, hemodialysis and regional perfusion. The blood pumping ventricles are basically the same as ventricles used for air driven artificial hearts and ventricular assist devices. The electric stepper motor uses a flexible linkage belt to produce a reciprocating movement, which pushes a hard sphere into the diaphragm of the blood ventricles. The SDRP generates pulsatile flow and has a small priming volume. The preset power level of the motor driver limits the maximum potential outflow pressure, so the driver acts as a safety device. A double pump can be made by connecting two fluid pumping chambers to opposing sides of the motor base. Each pump generates pulsatile flow. Pressure and flow studies with water were undertaken. Preliminary blood studies showed low hemolysis, even when circulating a small amount of blood up to 16 hours.

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PubMed1994

Muscle- and pneumatic-powered counterpulsating LVADs: a pilot study.

There is a worldwide interest in supporting the failing heart with a skeletal muscle by either wrapping it around the natural heart (dynamic cardiomyoplasty) or by constructing a skeletal muscle ventricle (SMV) used for counterpulsation. Conventional cardiomyoplasty in many clinics carries an operative mortality rate of 15-20% partly because it requires 6 weeks to train the muscle to contract continually. A flexible, pear-shaped blood pump with an inflatable air chamber was designed and made around which a muscle can be wrapped. The advantage of our design is that it can also be driven by pneumatic power, immediately supporting the circulation of a seriously ill patient while that patient is still on the operating table. After a period of time to allow for revascularization and the subsequent training of the muscle, the external pneumatic power can be gradually discontinued. Then the assisted patient becomes tether-free. If, at any time, the muscle power fails, the pneumatic-powered mechanism can be reactivated. In the preferred approach, the blood pump is connected to the aorta for diastolic counterpulsation. A muscle can either be wrapped around the blood pump directly, or around one of two separate muscle pouches connected to the blood pump. To facilitate surgery, a large pouch is inserted under the musculus latissimus dorsi, which is connected to a blood pump. When stimulated, the muscle will contract over the pouch compressing it and providing power to the blood pump. If it is found that the pressure generated in the pouch cannot meet the aortic blood pressure, it can be augmented by using a pressure amplifier.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1992

Evaluation of an extraaortic counterpulsation device in severe cardiac failure.

A valveless, single-orifice polyurethane ventricle with a maximum stroke volume of 60 mL was implanted on the brachiocephalic artery just above the aortic arch in sheep (n = 14) to act as an extraaortic counterpulsation device. In parallel, an intraaortic balloon was placed in the descending thoracic aorta. Both devices were pneumatically driven with an intraaortic balloon pump console that was gated by the electrocardiogram to provide aortic diastolic augmentation at a stroke volume of 40 mL. To compare the efficacy of counterpulsation for each device during severe cardiac failure, biventricular block was induced by continuous infusion of esmolol (100 to 600 micrograms.kg-1.min-1), titrated to reduce aortic flow and pressure to less than 75% of baseline. Pulsatile coronary and aortic flows were recorded with ultrasonic flow probes placed around their respective vessels. Aortic root and left ventricular pressures were recorded using micromanometers. The enhancement of hemodynamic variables for both devices were compared for optimal timing conditions, which were defined as inflation set just before the dicrotic notch and deflation bordering on isovolumetric systole. The extraaortic counterpulsation device was able to significantly augment aortic and coronary flows while simultaneously decreasing left ventricular tension time index and aortic end-diastolic pressure (p less than 0.02). The intraarotic balloon pump was able to significantly reduce only tension time index (p less than 0.002) to a lesser extent that the extraaortic counterpulsation device. All analysis was performed with the paired-samples t test. The extraaortic counterpulsation device greatly improves the myocardial oxygen supply-consumption ratio of the left ventricle by increasing diastolic coronary flow and reducing left ventricular wall tension during systole.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1992

Electrohydraulic-clamshell heart with energy converter inside the compliance reservoir.

Two new ideas on the electrohydraulic actuation of blood pumps have been combined. The first idea was to put the energy converters that propel the hydraulic fluid inside the compliance reservoir instead of having them separate. Compactness of the device and better cooling of the energy converter by the surrounding fluid are two major advantages of this approach. Secondly, we put the pumping membrane inside a clamshell that fits over a soft ventricle (1). The ventricle can be implanted first, after which the shell is slid over it. These two ideas have resulted in devices described in this paper. Preliminary in vitro and in vivo data are presented.

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PubMed1992

Small soft left ventricular assist device powered by intraaortic balloon pump console for infants: a less expensive option.

We have developed a pneumatically driven 20 cc soft ventricle for temporary right, left, or biventricular assist. The ventricle consists of a vacuum-formed soft housing, diaphragm, tricuspid outflow valve, and biflap inflow valve. All components including inflow and outflow valves were made with Pellethane. The advantages of this blood pump are as follows: it eliminates use of the quick connect system and therefore is less thrombogenic; the biflap inflow valve provides low inflow resistance; the soft ventricle is easy to implant; the polyurethane valves eliminate blood damage and thromboembolism and are low in cost compared with mechanical valves; and the vacuum-forming technique is reliable, fast, capable of mass production, and therefore inexpensive. We have already demonstrated in both in vitro and in vivo experiments that this ventricle has excellent hemodynamic performance with less blood damage and thrombogenesis. In this study, we evaluated the possible application of a well-defined and widely distributed intraaortic balloon pump (IABP) console to the 20 cc left ventricular assist device (LVAD) driver. The pump was tested in 6 mongrel dogs (6 to 10 kg) using an IABP console. The pump was connected between the left atrium and the ascending aorta, placed paracorporeally on the chest wall, and driven at a synchronous or fixed rate mode without using vacuum. The 20 cc ventricle could maintain the same output as the control output of the natural heart at filling pressures of 5 to 10 mm Hg during the entire observation time of 5 h. Thus, this 20 cc soft ventricle has the potential to be widely used for the treatment of severe heart failure in infants because of its excellent hemodynamic performance, simplicity, and low cost.

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PubMed1991

Concept of a soft, compressible artificial ventricle under evaluation.

This study was designed to compare the relative merits of soft and rigid artificial ventricles. A cascade mock circulation was used to measure cardiac output under different circumstances. The data show that these soft air driven ventricles show a Starling's-like response over a wider range of filling pressures than identical, but rigid, ventricles. Compression of soft ventricles by high intrathoracic pressures was simulated in vitro. Air pressures up to +20 mm Hg did not seriously affect soft ventricles. Cardiac tamponade was simulated by compressing the ventricle in a closed fluid compartment. Tamponade became severe when volume reduction of the ventricle rose to 60 ml. Hemolysis caused by soft and rigid ventricles was tested in a blood bag set-up and was 48-82% higher in the rigid ventricle, depending on the driving conditions. Possibly, this could be explained by the authors' finding that rigid ventricles showed a 20% higher intraventricular dP/dtmax value than soft ventricles. Soft ventricles were implanted in three calves as a total artificial heart (TAH). Implantation without quick connectors was easy because the surgeon could easily fold and compress the ventricles. No physiological complications of softness were observed. Blood damage in the animals was low (less than 5 mg/dl). The authors conclude that soft ventricles show distinct surgical and functional advantages over rigid ventricles.

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