New Technologies:

The CentriMag VAD

(Levitronix)

I was asked by one of our surgeons about this device.  Having not seen it personally, I wanted to solicit opinions of individuals that have had the opportunity to either trial it- or have seen a demonstration of this device.  Any and all comments would be appreciated, please leave them in the comments section (click here to leave comments

So here is what I have found out so far …

“The CentriMag VAS (not sure what the ‘S’ stands for) was developed for support of patients with cardiac dysfunction and failure-to-wean from cardiopulmonary bypass. The device is specifically indicated to treat patients who are hemodynamically unstable and unable to be moved from the operating room without mechanical circulatory support. The device is used for up to 30 days to support one or both sides of the heart as a bridge to decision, when it is unclear whether the patient’s heart will recover or whether the patient will need alternative, longer-term therapy or transplantation.”  (Levitronix literature)

Less Hemolysis …

“The Levitronix pump causes very little damage to the blood because it does not contain any bearings or seals—components that are known to cause hemolysis and promote thrombus formation. In addition, the pump does not contain any flexing sacs, diaphragms, or valves, minimizing the risk of component failure and device-related adverse effects.”  (Texas Heart Institute)

Below is a promotional video by the manufacturer.  Good graphics and design views.  Click on it to play …

Magnetic Bearings …

“The CentriMag and PediMag Blood Pumps use magnetic forces to levitate and rotate the pump impeller. Figure 1 shows a cross section of a magnetically levitated centrifugal blood pump. With a magnetically levitated blood pump the impeller is held in place by a magnetic field. The magnetic field is not static as in a conventional pump. For the Levitronix Systems, the magnetic field is varied moment by moment as the load on the pump changes. This feedback process reacts constantly to keep the impeller in a precise position.”  (Levitronix literature)

Clinical trials …

“In the United States, the Levitronix CentriMag LVAS is still under investigation for use as a short-term device that would provide circulatory support of up to 14 days for patients with postcardiotomy cardiogenic shock (those who have developed heart failure as a result of heart  surgery).”  (Texas Heart Institute)

The Texas Heart Institute is one of four centers enrolling patients for this study.

Click to read more about the Texas Heart Institute and the CentriMag

Approvals :

Click to enlarge ...

Ok.  So that’s what I have gathered so far.

This discussion becomes “great” if I can get what I am really after …  the analysis and recommendations from my peers regarding this device.

Now that would represent some seriously solid input.   Far more substantial than the end results of a google search.

Thanks guys 🙂

Frank

20 thoughts on “New Technologies:

  1. Hi everyone

    We just took delivery of these and used one in a VAD configuration a few weeks ago. They are very, very good but very, very expensive, for us anyway. But these things are relative.

    There are a few things to watch out for. The 1/4″ flow probes, which are essentially Transonic kit, are only calibrated with 3/32″ wall thickness tubing and don’t work on anything else.

    The drive units have been updated and no longer look and feel like an ACT machine. They work as standalone units, or with a remote mount screen. The battery life is 4-6 hours under normal use and seem to work well for transport if that is an issue.

    The flow readings show in increments of 50 mls which we don’t think is quite enough for neonates especially on weaning. But you can manage ok.

    The disposables come in really useful cases, which cause some interesting discussions as to who gets to take them home 🙂 Who would have thought!

    Overall though we are impressed, and are looking forward getting some more hours with them.

    Hope that helps

    Cheers

    Hayden

  2. Iatrogenic Double-Chambered Left Atrium
    Created during Left Ventricular Assist Device Implantation

    A 45-year-old man with a thoracoabdominal aneurysm was admitted to our hospital for aortic root replacement, graft replacement of the ascending aorta and transverse aortic hemiarch, and placement of a graft to the left main coronary artery. Postoperatively, the patient could not be successfully weaned from cardiopulmonary bypass
    Iatrogenic Double-Chambered Left Atrium
    Created during Left Ventricular Assist Device Implantation

    (CPB), and an extracorporeal Levitronix® CentriMag left ventricular assist device (LVAD) (Levitronix, LLC; Waltham, Mass) was implanted for temporary support. On the 7th postoperative day, after numerous unsuccessful attempts at weaning the patient from the device, he was taken to surgery for removal of the Levitronix pump and implantation of a HeartMate II® LVAD (Thoratec Corporation; Pleasanton, Calif) for long-term left ventricular support.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014143/

  3. Frank,

    Just wanted you to know we trialed and both the Centrimag and the Rotoflow and decided on the Rotoflow. They are very similar in technology but there is a significant cost difference in the Rotoflow being a lot cheaper. I asked a lot of people about the differences and were told to just get the Rotoflow and use the Quadrox oxygenator if needed. We bought both a right and left side and am ready for whatever comes down the pipe. We replaced our Abiomed with this device.
    Kelly

  4. Many consider rotoflow/centrimag the only 2 centrifugal pumps 4 ECMO. Revolution mayB an alternative. Interesting research Certainly cheaper

  5. CentriMag v. Rotoflow Comparison

    http://prf.sagepub.com/content/25/2/71.abstract

    Abstract

    Introduction: Centrifugal blood pumps have been widely adopted in conventional adult cardiopulmonary bypass and circulatory assist procedures. Different brands of centrifugal blood pumps incorporate distinct designs which affect pump performance. In this adult extracorporeal life support (ECLS) model, the performances of two brands of centrifugal blood pump (RotaFlow blood pump and CentriMag blood pump) were compared.

    Methods: The simulated adult ECLS circuit used in this study included a centrifugal blood pump, Quadrox D membrane oxygenator and Sorin adult ECLS tubing package. A Sorin Cardiovascular® VVR® 4000i venous reservoir (Sorin S.p.A., Milan, Italy) with a Hoffman clamp served as a pseudo-patient. The circuit was primed with 900ml heparinized human packed red blood cells and 300ml lactated Ringer’s solution (total volume 1200 ml, corrected hematocrit 40%). Trials were conducted at normothermia (36°C). Performance, including circuit pressure and flow rate, was measured for every setting analyzed.

    Results: The shut-off pressure of the RotaFlow was higher than the CentriMag at all measurement points given the same rotation speed (p < 0.0001). The shut-off pressure differential between the two centrifugal blood pumps was significant and increased given higher rotation speeds (p < 0.0001). The RotaFlow blood pump has higher maximal flow rate (9.08 ± 0.01L/min) compared with the CentriMag blood pump (8.37 ± 0.02L/min) (p < 0.0001). The blood flow rate differential between the two pumps when measured at the same revolutions per minute (RPM) ranged from 1.64L/min to 1.73L/min.

    Conclusions: The results obtained in this experiment demonstrate that the RotaFlow has a higher shut-off pressure (less retrograde flow) and maximal blood flow rate than the CentriMag blood pump. Findings support the conclusion that the RotaFlow disposable pump head has a better mechanical performance than the CentriMag. In addition, the RotaFlow disposable pump is 20-30 times less expensive than the CentriMag.

  6. The CMAG is not worth it unless you offset the cost w/ elimination of bedside monitoring by ECMO Specialists.

  7. Friends,
    We are attempting to upgrade our ancillary (VAD, ECMO, CPS, Emerg. bypass) centrifugal pumps. The Centrimag and Rotaflow seem to be the best choices out there. Both the consoles and the pump heads are great systems, however, the Centrimag is much more expensive. I can’t seem to find a compelling reason to buy the (much, much) more expensive system and disposable. Am I missing something? Any insight would be appreciated.
    Thank you,

  8. The Rotoflow is a fine device. Has been used for ECMO by several centers for quite some
    time. Very few things are FDA approved for long term use. Most ECMO
    programs use off label products. Even the old silicone oxygenators were
    often used off label as only 4 of the 6 sizes were FDA approved for long
    term use and they were only approved for 4 days at that.

    In my opinion there are 3 centrifugal systems well suited for ECMO. The
    Jostra Rotoflow, Sorin Revolution, and Levitronix Centrimag. All 3 are
    being utilized in the US for ECMO support. There are still a handfull of
    centers using the Medtronic Biomedicus. It’s not one that I recommend.

  9. We use the CentriMag at our facility and like that it is small, portable, light weight and the availability of the flow alarms but our biggest concern is that we have had 2 console disable on us in the past 6 months so we don’t go anywhere without a back up.

    A question I would like to ask the group is what cannula do you use with your LVAD and RVAD. We have been using the AbioMed, 10mm out flow cannula and 32 Fr. infllow cannula, nice cannula to use but we have been informed by AbioMed that we can no longer purchase just the cannula, you now have to purchase the pump with the cannula, so we are now in search of a vendor who can provide a 10mm graft/cannula.
    Thank you
    Greg

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