By: Antonio Fiasconaro
Bioengineering is moving giant steps forward. Thanks to the international partnership between the University of Pittsburgh Medical Center and the Istituto Mediterraneo per i Trapianti of Palermo, the Italian hospital facilities will be the first, after the center in Pennsylvania, to dispose of the artificial mini-heart for infants. Children – most of whom are newborns affected by severe cardiac malformations and genetic pathologies – can now hope to live a normal life while awaiting a transplant, thanks to this tiny artificial heart, so far the smallest ever in the world.
It’s as small as a 2-euro coin, and it’s basically a pediatric ventricular assistance device (PVAD). It consists of a miniaturized centrifuge pump using electromagnetic technology, to be implanted into children weighing between 2.5 and 15 kilograms. “The pediatric artificial ventricle can be used up to six months,” American researchers explained, “as a bridge solution for children listed for a heart transplant.” UPMC was granted 4.5 million dollars by the National Heart, Lung and Blood Institute to start the experimentation at the McGowan Institute. It will be possible to implant the artificial ventricle completely, with a small external tube connected to an external power supply. The baby patients will be able to move freely. The first experimental trial will be carried out within 5 years. This ventricular device was designed by a group of researchers of the School of Biomedical Engineering of the University of Pittsburgh and of the McGowan Institute for Regenerative Medicine.
Robert Kormos, director of the University of Pittsburgh and of the McGowan Institute’s cardiosurgery program, said, “A multidisciplinary team consisting of physicians, surgeons, bioengineers, and other researchers will be working on this project. An interdisciplinary approach will be the key of the research trial; a form of collaboration among different sectors that has been active for several years at our university.”
More than 275 artificial ventricles have been implanted in Pittsburgh since 1985, including 13 implants performed on children between 7 and 17 years of age. Ten of these young patients successfully underwent a heart transplant; in two cases, transplantation became unnecessary; and one patient is still waiting for a compatible organ.
Bradley Keller, pediatrician at UPMC, underlined, “The pediatric ventricular assistance device will be a sort of upgrade of the artificial device used to treat adults, as it needs to satisfy special medical needs mostly related to newborns’ circulatory assistance.” “We have a strong need of devices for newborns. To date, the only available means of support is the ECMO (Extra corporeal membrane oxygenation), a very complex device that forces children to remain completely immobile and that can be used only for a few weeks,” explained Harvey Borovetz, director of the University of Pittsburgh’s Bioengineering Department and head of the research trial, “not to mention that it also registers extremely high complication and mortality rates.” The ECMO has been used for approximately 30 years on pediatric patients of all ages, but the mortality rate is very high: less than half of the children subject to this type of treatment have survived.