The Reitan Catheter Pump is intended to give circulatory support throughout periods of compromised left or right ventricular function. The rotation of the propeller results in an afterload reduction for the ventricle thereby facilitating its ejection capability, but also increases peripheral perfusion pressure distal to the pump. Although the propeller runs continuously, heart rhythm is maintained and the effect of the pump is simply adjusted according to the hemodynamic requirements with an rpm between 1000 and 15000. No synchronization with the heart is necessary.
REITAN CATHETER PUMP
This product is not commercially available
The Reitan Catheter Pump (RCP) is a versatile, minimally invasive cardiac assist system.
Its unique, patented foldable impeller allows for percutaneous insertion.
The unique design features of the RCP mean that maximum efficiency can be achieved while minimizing trauma at the entry site of the femoral artery.
With the concept of continuous rotation of the impeller without the need for heart synchronization, the option of temporary cardiac assist with the RCP is expanded and is not limited by the state of the aortic valve, native or prosthetic.
The RCP is a percutaneous system, designed to be inserted through an introducer in the femoral artery. Once in place the protective cage is opened and the impeller unfolded. The pump head is placed in the upper part of the descending aorta where rotation of the deployed impeller reduces the pressure in the ascending aorta and increases pressure below the pump.
As the RCP works in series with the heart with no negative effect on the native heart's performance, it is able to add hemodynamic energy to the circulation as well as reduce the ventricular afterload which, in turn, reduces myocardial oxygen consumption. It is not influenced by the heart rhythm and because the device pumps downstream it is able to increase perfusion to the peripheral vasculature.
• Increased cardiac output
• Increased systemic blood pressure
• Reduced ventricular afterload
• Increased peripheral perfusion, including the renal arteries
• Reduced myocardial oxygen consumption
A patient in cardiogenic shock following acute myocardial infarction treated with the RCP. The graph shows the cardiac output, in lit./min., prior to and the immediate response after initiation of the pump.
The effect on the arterial pressure in the same patient. After initiation of the pump, a drop in the mean pressure in the radial artery is seen and represents an afterload reduction (after 15 minutes, red line, in mm Hg). Behind the pump an increased pressure in the femoral artery was observed, indicating a higher perfusion pressure for the internal organs (grey line, in mm Hg).
A study performed in calves (n=5) with induced low arterial pressure (55 ± 5mm Hg). After initiation of the RCP an increased blood flow in the left kidney with increasing rpm was observed. At 14000 rpm the flow increased by 40% compared with baseline (p=0.003, flow in ml/min).
The RCP is intended to give circulatory support throughout periods of compromised left ventricular function. The rotation of the impeller results in an afterload reduction for the left ventricle thereby facilitating the ejection of the left ventricle, but also in an increased peripheral perfusion pressure for the internal organs. A right ventricular RCP is under development.
Although the impeller runs continuously, the pulse is maintained and the effect of the pump can be adjusted according to hemodynamic requirements with speed changes between 1000 and 15000 rpm. Synchronization with the heart is not necessary.
POTENTIAL SURGICAL USE
• Heart failure before and after open-heart surgery
• Mitral valve insufficiency due to myocardial infarction
• VSD (Ventricular Septal Defect) in connection with myocardial infarction
POTENTIAL USE IN CARDIOLOGY
• Cardiogenic shock following heart infarction
• Heart failure due to aortic and mitral valve insufficiency
• Pulmonary oedema
• Failed inotropic drug treatment
• Pre and post use in interventional cardiology
• Low blood pressure with hypo perfusion of internal organs
Increased cardiac output
A condition with left ventricular failure is often treated with vasodilation to reduce afterload for the left ventricle. Even a small reduction in arterial pressure normally causes a significant increase in cardiac output. For the heart, the RCP resembles the effect of vasodilating drugs.
Reduction in ventricular afterload
The RCP divides the arterial system in two different pressure zones. The pressure behind the pump increases with increasing rpm and causes an increased perfusion pressure for the internal organs while the pressure in front of the pump is reduced reliving the afterload pressure on the ventricle.
The RCP system consists of three main components, the catheter, the console and the drive unit.
The heart of the system is the catheter itself, which consists of a double lumen catheter with the pump at one end and the drive at the other. The unique 14 Fr pump head incorporates a folding impeller, surrounded by an expandable protective cage.
The pump is driven by means of an external drive unit that couples with the catheter manifold. The catheter is lubricated with a glucose solution delivered to the catheter from the purge pump on the console.
The primary role of the console is to control the speed of the pump in accordance with the physician’s requirements. At the side of the console is a small peristaltic pump used for lubricating the catheter. On the front of the console is a touch screen which allows all controls and monitoring parameters for the system to be carried out. The console runs on normal AC power, but can also run on battery for limited periods.
The console´s monitoring capabilities include:
• Monitoring and displaying pump speed
• Displaying purge pump status
Control and monitoring
of the purge system and pumps
The console´s control capabilities include:
• Controlling the speed of the pump
• Controlling the pressure and flow of the purge pump
• Controlling the level of the purge fluid
THE DRIVE UNIT
This unit is designed to sit over or along side the patient’s leg and has a magnetic coupling for connection to the catheter at one end and a cable which goes to the console at the other.