The objective of this proposal is to complete development of a long-term, universal Apical Access System (AAS) to improve clinical outcomes and expand the role of left ventricular assist device (LVAD) therapy. The treatment of end stage heart failure (HF) is the greatest challenge, both clinically and economically to the U.S. health care system today. With >800,000 people suffering with end stage HF and only 2,300 heart transplants and 4,600 LVADs implanted annually there is large a population underserved. LVAD implantation requires a major operative procedure with significant peri- and post-operative bleeding complications, mortality, and treatment costs. APK Advanced Medical Technologies, Inc. AAS System will allow current LVADs and future "Mini-VADs" to be implanted suture-less through a minimally invasive incision without placing the patient on cardiopulmonary bypass (CPB). By eliminating CPB, reducing access time and reducing bleeding, a significant and measurable impact on patient health and procedural cost will be achieved. The different components of the AAS System have been tested previously on the bench, in FEA computational models, and through acute and chronic (up to 12 weeks) animal experiments with positive results. The specific aims of the current proposal are: Phase I-Aim 1: Complete fabrication of the integrated components for the re-designed AAS System and demonstrate feasibility for LVAD therapy in acute bovine model (n=2) and human cadaver (n=2). Phase II-Aim 1: Complete the engineering development and design freeze of the LVAD AAS in compliance with Good Manufacturing Practices (GMP) specifications for a human implant quality system. Aim 2: Demonstrate safety and efficacy of the AAS System by completing risk analysis driven validation and verification testing. Testing to include: 600 Millio cycle fatigue, leakage/burst testing in pressurized hearts, Finite element analysis of anchoring components, sterilization validation and biocompatibility, anatomical fit and surgical procedure study (human cadaver, n=8), and in vivo acute (n=6), 14-day (n=6), and 30-day (n=6) in a chronic bovine model with HM II (Thoratec) and HVAD (HeartWare) devices. Successful outcomes will be quantified by metrics to include; incision size, ease of use, implantation time, blood loss, durability (fatigue on clinical-grade components), need for CPB, conformance to biocompatibility and sterilization ISO standards, and secure connection without air entrainment or leakage. Aim 3: Demonstrate long-term safety and reliability of the LVAD AAS in 30-day pre-GLP (n=2) and GLP (n=4) chronic bovine model study to support an IDE application for a clinical trial in patients with advanced heart failure receiving LVAD implantation only. The successful execution of this SBIR project will lead to development of a new clinical paradigm in the treatment of HF. Specifically the AAS will reduce surgical complexity and make LVAD therapy affordable leading to improved patient outcomes and quality of life. Ultimately, clinical acceptance to treat earlier stage HF patients and expansion into global markets can be achieved.
Public Health Relevance Statement: APK Advanced Medical Technologies, Inc. Apical Access System (AAS") with universal connector enables a suture-less surgical implantation of left ventricular assist device (LVAD) on the beating heart via a minimally invasive approach, which represents a new clinical paradigm in the treatment of heart failure (HF) with LVAD therapy. The AAS approach will reduce blood loss, procedure time, patient morbidity and mortality, and cost of care that will lead to clinical acceptance in earlier stage HF patients and widespread use in global markets.
Project Terms: Adoption; Air; Animals; bioengineering; Biomedical Engineering; Blood Reticuloendothelial System; Blood; Blood donor; Cadaver; heart bypass; Heart-Lung Bypass; Cardiopulmonary Bypass; circulatory system; Heart Vascular; Cardiovascular system (all sites); Cardiovascular Organ System; Cardiovascular Body System; Cardiovascular; Cardiovascular system; cow; bovine; bovid; Bovine Species; Cattle; Cells; Mainland China; China; Clinical Engineering; clinical investigation; Clinical Trials; virtual simulation; in silico; computerized simulation; computerized modeling; computer based models; computational simulation; computational models; computational modeling; Mathematical Models and Simulations; Mathematical Model Simulation; Computerized Models; Computer based Simulation; Computer Models; Computer Simulation; disease/disorder; Disorder; Disease; Engineering; Spillage; Leakage; Extravasation; Lack of Energy; Fatigue; Freezing; Future; Goals; Government Agencies; Health; Health Care Systems; Healthcare Systems; Heart; cardiac failure; Heart failure; heart transplant; cardiac graft; Heart Grafting; Cardiac Transplantation; Heart Transplantation; blood loss; Bleeding; Hemorrhage; Hemostatics; Hemostatic Agents; Hospitals; Modern Man; Man (Taxonomy); Human; India; Institutes; heavy metal lead; heavy metal Pb; Pb element; Lead; Marketing; Study models; Morbidity; Morbidity - disease rate; Mortality; Mortality Vital Statistics; heart muscle; cardiac muscle; Myocardium; Patents; Legal patent; Patients; Postoperative; Post-Operative; Postoperative Period; Prognosis; outcome forecast; QOL; Quality of life; Researchers; Investigators; Research Personnel; Research Resources; Resources; Risk; social role; Role; Safety; seal; Spatial Distribution; Suture Technics; Suture Techniques; Sutures; Surgical sutures; Technology; Medical Technology; Testing; Time; Translating; health care; Healthcare; Treatment Cost; Caring; improved; Procedures; incision; Otomy; Surgical incisions; Left; Apical; Acute; Chronic; Clinical; Phase; Medical; Animal Experiments; Left Ventricles; Left ventricular structure; Recovery; Exposure to; Staging; tool; Techniques; LOINC Axis 4 System; System; Cannulas; surgery; Surgical Procedure; Surgical Interventions; Surgical; Operative Procedures; Operative Surgical Procedures; meetings; biocompatibility; biomaterial compatibility; Finite Element Analyses; Finite Element Analysis; Metric; Devices; Modeling; miniaturize; Adverse Experience; Adverse event; interventional strategy; Intervention Strategies; Intervention; preventing; prevent; ventricular assist device; Animal Testing; Measurable; Retrieval; in vivo; Small Business Innovation Research; SBIRS (R43/44); SBIR; Small Business Innovation Research Grant; Validation; followed up; follow up; Active Follow-up; follow-up; developmental; Development; preclinical; pre-clinical; cost; underserved people; under served population; Underserved Population; designing; design; Outcome; Coupling; innovative; innovate; innovation; Implant; implantation; prototype; commercialization; public health relevance; minimally invasive; product development; clinical practice; good laboratory practice; verification and validation; Sterilization; Secure
