ABSTRACT
AIMS: A common feature of various forms of pulmonary hypertension (PH) is progressive decline of pulmonary arterial compliance (CPA), which correlates with reduced survival. In this acute study, we evaluated feasibility, safety and haemodynamic performance of the Aria pulmonary endovascular device in patients with PH associated with left heart disease (PH-LHD) and chronic lung disease (PH-CLD). METHODS AND RESULTS: Eight patients with PH-LHD and 10 patients with PH-CLD were included in this study. The device was placed in the main pulmonary artery via the right femoral vein and was connected by a catheter to a gas-filled reservoir outside the body. During systole, gas shifts from the balloon to the reservoir, leading to deflation of the balloon. In diastole, the gas returns from the reservoir to the balloon, leading to balloon inflation and enhancing diastolic blood flow to the distal pulmonary capillary bed. Haemodynamics were assessed at baseline, and again with device off, device on and device off. The primary safety endpoint was the incidence of serious adverse events through 30 days after the procedure. No complications or investigational device-related serious adverse events occurred. Device activation in PH-LHD and PH-CLD patients decreased pulmonary arterial pulse pressure by 5.6 ± 4.2 mmHg (-12%; p = 0.003) and 4.2 ± 2.2 mmHg (-11%; p < 0.001), increased CPA by 0.4 ± 0.2 ml/mmHg (+23%; p = 0.004) and 0.4 ± 0.3 ml/mmHg (+25%; p = 0.001), and increased right ventricular-to-pulmonary vascular (RV-PV) coupling by 0.24 ± 0.18 (+40%; p = 0.012) and 0.11 ± 0.07 (+21%; p = 0.001), respectively. CONCLUSIONS: Temporary implantation of the Aria endovascular device was feasible and safe. Device activation resulted in acute improvement of CPA and RV-PV coupling.
Subject(s)
Hypertension, Pulmonary , Humans , Male , Female , Hypertension, Pulmonary/physiopathology , Middle Aged , Aged , Treatment Outcome , Hemodynamics/physiology , Feasibility Studies , Pulmonary Artery/physiopathology , Endovascular Procedures/methods , Equipment DesignSubject(s)
Endovascular Procedures/instrumentation , Pulmonary Arterial Hypertension/diagnosis , Pulmonary Arterial Hypertension/surgery , Vascular Access Devices , Vascular Resistance/physiology , Adult , Aged , Female , Humans , Male , Middle Aged , Pulmonary Arterial Hypertension/physiopathology , Young AdultABSTRACT
This paper investigates fundamental design, modeling and control issues related to untethered biomedical microrobots guided inside the human body through external magnetic fields. Immediate application areas for these microrobots include cardiovascular, intraocular and inner-ear diagnosis and surgery. A prototype microrobot and steering system are introduced. Experimental results on fluid drag and magnetization properties of the robots are presented along with an analysis of required magnetic fields for application inside blood vessels and vitreous humor.
