Recent Advances in Cardiothoracic Assist Devices

A special issue of Bioengineering (ISSN 2306-5354). This special issue belongs to the section "Regenerative Engineering".

Deadline for manuscript submissions: 31 January 2026 | Viewed by 597

Special Issue Editors


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Guest Editor
1. Faculty of Medicine, University of Southampton, Southampton, UK
2. Division of Cardiac Surgery, University Hospital Southampton, Southampton, UK
Interests: cardiac scaffolds; new materials; bioengineered conduits; tissue engineering; tissue architecture

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Guest Editor
BioMIT, Department of Electronic Engineering, Polytechnic University of Valencia, 46022 Valencia, Spain
Interests: bioimpedance; cardiac ablation; computer modeling; cardiac electrophysiology
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Special Issue Information

Dear Colleagues,

Cardiothoracic Assist Devices (CADs) have undergone transformative advancements in recent years, revolutionizing the management of advanced heart failure. This Special Issue highlights cutting-edge innovations in cardiopulmonary and mechanical circulatory support (MCS), including ventricular assist devices (VADs), total artificial hearts (TAHs), an Organ Care system (OCS), Lung bioengineering (LBE), EVLP (Ex vivo lung perfusion), bonded circuits and minimally invasive systems, with a focus on improving durability, interface biocompatibility, and patient outcomes.

Key themes explored in this Special are as follows:

  • Next-Generation VADs: The shift toward fully magnetically levitated (maglev) pumps (e.g., HeartMate 3) has significantly reduced complications like thrombosis and hemolysis, while enhancing long-term survival.
  • Minimally Invasive and Pediatric Solutions: Devices such as Impella 5.5® and miniaturized pediatric VADs are expanding treatment options for diverse patient populations.
  • Wireless Power and Smart Systems: Advances in transcutaneous energy transfer (TET) and AI-driven adaptive control are minimizing infections and optimizing hemodynamic performance.
  • Bioprosthetic and Total Artificial Hearts: Innovations like the Carmat TAH and SynCardia’s portable drivers are improving outcomes in biventricular failure.
  • An OCS, LBE and EVLP for cardiac and pulmonary support and evaluation for transport of harvested hearts and lungs are discussed.
  • Biocompatibility and Hemocompatibility: Novel coatings (e.g., heparin, endothelial cell-seeded surfaces) aim to reduce anticoagulation needs.

This collection of research underscores the rapid evolution of CADs toward smaller, smarter, and more physiological systems, offering new hope for heart failure patients through better organ preservation during transport, organ evaluation to increase transplant success rates, destination therapy, bridge-to-transplant, or recovery. Future directions, including bioengineered solutions and fully implantable systems, are also discussed, paving the way for the next era of cardiac support.

We invite readers to explore the breakthroughs that are reshaping the landscape of advanced heart failure therapy.

Dr. Suvitesh Luthra
Prof. Dr. Enrique Berjano
Guest Editors

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Keywords

  • mechanical circulatory support
  • VAD
  • OCS
  • LBE and EVLP
  • total artificial heart
  • heart failure
  • maglev and axial flow pumps
  • minimally invasive
  • wireless power
  • biocompatibility
  • AI in cardiac devices

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Published Papers (1 paper)

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Research

18 pages, 2313 KB  
Article
In Silico and In Vitro Comparison of Seven Closed and Semi-Closed Leaflet Designs for Transcatheter Heart Valve Replacements
by Alexander Breitenstein-Attach, Marvin Steitz, Jordi Modolell, Sugat Ratna Tuladhar, Boris Warnack, Peter Kramer, Frank Edelmann, Felix Berger and Boris Schmitt
Bioengineering 2025, 12(10), 1044; https://doi.org/10.3390/bioengineering12101044 - 28 Sep 2025
Viewed by 483
Abstract
Purpose: Transcatheter heart valve replacements (TVR) are typically designed in a closed shape with initial leaflet coaptation. However, recent studies suggest a semi-closed geometry without a predefined coaptation zone, relying on diastolic pressure and clinical oversizing of 10–20 % for closure. This approach [...] Read more.
Purpose: Transcatheter heart valve replacements (TVR) are typically designed in a closed shape with initial leaflet coaptation. However, recent studies suggest a semi-closed geometry without a predefined coaptation zone, relying on diastolic pressure and clinical oversizing of 10–20 % for closure. This approach may minimize pinwheeling, a phenomenon linked to early valve degeneration. Method: Seven valve geometries were assessed: one closed design (G0) and six semi-closed variations (G1–G6). The semi-closed designs differed in free edge shape (linear, concave, convex) and opening degree, defined as the relative distance from the leaflet to the valve center in the unloaded state. The opening degree was systematically increased across G1–G6, with G6 exhibiting the highest value. 30 mm valves were fabricated using porcine pericardium and self-expanding nitinol stents. Performance was assessed in a pulse duplicator system, evaluating transvalvular pressure gradient (TPG), effective orifice area (EOA), regurgitation fraction (RF) and a novel pinwheeling index (PI) which was validated by finite element simulations. Results: Finite element simulations demonstrated that semi-closed geometries achieve valve closure at a diameter reduction of >5%. In vitro tests confirmed these findings with more homogeneous coaptation and reduced pinwheeling. With increased opening degree the RF reduced significantly (RFG0 = 18.54 ± 8.05%; RFG6 = 8.22 ± 1.27%; p < 0.0001), while valve opening remained comparable (p = 0.4519). Conclusions: A semi-closed leaflet geometry enhances valve closure, reducing regurgitation and pinwheeling while preserving effective opening. With clinical oversizing, a higher opening degree improves coaptation and may enhance durability by mitigating structural deterioration, ultimately improving the long-term performance and lifespan of transcatheter valve replacements. Full article
(This article belongs to the Special Issue Recent Advances in Cardiothoracic Assist Devices)
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