The Past, Present, and Promising Future of Direct Cardiac Compression Devices

Abstract

Direct cardiac compression (DCC) devices, under development as a new modality for mechanical cardiac support (MCS), offer several advantages over presently available forms of MCS. DCC devices avoid the blood contact obligatory with other implantable MCS devices, the complications associated with blood contact and hematologic incompatibility, such as thrombosis, stroke, and the need for anticoagulation are avoided, and DCC does not require vascular access eliminating challenges such as bleeding and extremity ischemia. Arterial pressure pulsatility is also maintained with DCC. Significant and underappreciated advancements in DCC technology have occurred over the last decades with notable dramatic improvements in cardiac performance and minimal tissue damage. One device has entered clinical trials with a second device anticipated to follow. DCC is poorly understood by most cardiologists and cardiac surgeons. This review summarizes DCC development and advances so that upcoming human clinical trials can be properly assessed.

Keywords: biventricular support; direct cardiac compression; heart failure; mechanical circulatory assist; ventricular assist devices.

Graphical abstract

Figure 1

Schematics of Early DCC Devices (A) Schematic of the Anstadt Cup. Reprinted from Anstadt et al with permission from Elsevier. (B) Schematic of the Heart Booster. Reprinted from Kung et al with permission from Elsevier. (C) Schematic of the updated Anstadt Cup now featuring defibrillation electrodes. Reprinted from Anstadt et al with permission from Elsevier. AV = atrioventricular.

Figure 2

CardioSupport (A) Schematic of CardioSupport. Reprinted from Williams et al with permission from Elsevier. Effect of direct cardiac compression (DCC) on the relationship between end-diastolic volume and stroke volume at normal (B) and low (C) afterload arterial resistances from a representative heart. DCC shifts the end-diastolic volume–stroke volume relationship upward. Reprinted from Artrip et al with permission from Elsevier.

Figure 3

HeartPatch (A) Illustration of the direct cardiac compression (DCC) device on the heart demonstrating biventricular and left ventricle (LV) support. (B) Comparison of parameters at baseline, heart failure (HF), HF + DCC biventricular (BiV) support, LV support, and right ventricle (RV) support. Reprinted from Gallagher et al with permission from John Wiley and Sons. ∗P < 0.05 compared to baseline values; ∗∗ P < 0.05 compared to BiV DCC assist. n = 10 in each group. MVO2 = myocardial oxygen consumption; SW = stroke work.

Figure 4

CorInnova (A) Illustration of device on cardiac model. (B) Illustration of device design demonstrating structure of layers. Reprinted from Letsou et al with permission from Elsevier. (C to E) Deployment of device illustrated with real-time imaging. Pressure tracings of left ventricle (F), aorta (G), and pulmonary artery (H) in heart failure (HF) state. Reprinted from Hord et al (CC BY 4.0, https://creativecommons.org/Licenses/by/4.0/).

Figure 5

AdjuCor reBEAT (A) Illustration of device setup. (B-C) Deflated and inflated device cushions visualized in an axial view CT scan of the heart 16 days after implant. Dotted circles indicate the epicardial electrodes. (D) Increases in left ventricular (LV) cardiac output, stroke work, and stroke volume in an acute heart failure model as well as (E) effects on right-sided parameters. Reprinted from Schueler et al with permission from Elsevier. RV = right ventricle.

Figure 6

Direct Cardiac Compression Device (A and B) Schematic of device with inflatable bands in frontal and axial view. (C) Aortic flow rate compared in baseline, heart failure (HF), and variable device support. ∗∗∗P < 0.05. Reprinted from Payne et al with permission from Mary Ann Liebert, Inc.

Central Illustration

Direct Cardiac Compression Device Development Novel implantable direct cardiac compression devices include the CorInnova and AdjuCor reBeat devices that are entering human clinical trials. Hemodynamic effects of the CorInnova device in a HF animal model are illustrated on the right.