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Review
. 2020 Aug;66(8):847-854.
doi: 10.1097/MAT.0000000000001139.

Toward a Long-Term Artificial Lung

Jutta Arens  1   2 , Oliver Grottke  3 , Axel Haverich  4 , Lars S Maier  5 , Thomas Schmitz-Rode  6 , Ulrich Steinseifer  2 , H P Wendel  7 , Rolf Rossaint  3
Affiliations
Review

Toward a Long-Term Artificial Lung

Jutta Arens et al. ASAIO J. 2020 Aug.

Abstract

Only a very small portion of end-stage organ failures can be treated by transplantation because of the shortage of donor organs. Although artificial long-term organ support such as ventricular assist devices provide therapeutic options serving as a bridge-to-transplantation or destination therapy for end-stage heart failure, suitable long-term artificial lung systems are still at an early stage of development. Although a short-term use of an extracorporeal lung support is feasible today, the currently available technical solutions do not permit the long-term use of lung replacement systems in terms of an implantable artificial lung. This is currently limited by a variety of factors: biocompatibility problems lead to clot formation within the system, especially in areas with unphysiological flow conditions. In addition, proteins, cells, and fibrin are deposited on the membranes, decreasing gas exchange performance and thus, limiting long-term use. Coordinated basic and translational scientific research to solve these problems is therefore necessary to enable the long-term use and implantation of an artificial lung. Strategies for improving the biocompatibility of foreign surfaces, for new anticoagulation regimes, for optimization of gas and blood flow, and for miniaturization of these systems must be found. These strategies must be validated by in vitro and in vivo tests, which remain to be developed. In addition, the influence of long-term support on the pathophysiology must be considered. These challenges require well-connected interdisciplinary teams from the natural and material sciences, engineering, and medicine, which take the necessary steps toward the development of an artificial implantable lung.

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Conflict of interest statement

Disclosure: The authors have no conflicts of interest to report.

Figures

Figure 1.
Figure 1.
Research fields toward an implantable lung.
Figure 2.
Figure 2.
Miniaturized, pumpless extracorporeal lung support for premature neonates (research device, priming volume of complete circuit: ≤20 ml) tested in a lamb model with cannulation of the umbilical cord vessels.
Figure 3.
Figure 3.
In silico and in vitro analysis of blood flow and gas exchange.
See this image and copyright information in PMC

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