Cuore artificiale
Il cuore artificiale più piccolo del mondo

Il dispositivo è il più piccolo al mondo e pesa 11 grammi. L’operazione di impianto è stata eseguita su un piccolo di 16 mesi all’ospedale pediatrico Bambino Gesù di Roma.

Jarvik 2000, il cuore artificiale più piccolo al mondo
Jarvik 2000, il cuore artificiale più piccolo al mondo

Si tratta di un dispositivo messo a punto nel 2012, in grado di  sostenere un flusso che giunge fino a 1,5 litri al minuto. E’  una pompa al titanio di soli 11 grammi che ha salvato un bambino affetto da una miocardiopatia dilatativa, aggravata da un’infezione del dispositivo di assistenza ventricolare impiantato precedentemente. L’intervento, unico nel suo genere e durato 8 ore, si è reso indispensabile a causa della gravità delle condizioni di salute del piccolo che non gli avrebbero consentito di sopravvivere in attesa del trapianto di cuore e che, per le condizioni generali non erano compatibili con soluzioni temporanee di circolazione extracorporea.
L’apparecchio, giunto dagli USA, per il suo primo impiego ha avuto bisogno di un permesso speciale da parte della FDA (Food and Drug Administration) e del ministero della salute.
Considerando che più il paziente è piccolo, tanto più è difficile trovare un donatore adeguato, l’organo artificiale assume una notevole importanza poiché spesso rappresenta la sola possibilità di sopravvivenza, sia che si tratti di una soluzione temporanea – come nei casi di trapianti di cuori artificiali – sia che costituisca una soluzione definitiva.

Modello del dispositivo
Modello del dispositivo

Come funziona questo dispositivo?
Il suo nome è Jarvik 2000 ed è una cosiddetta “axial rotatory blood pump”  che tra i supporti circolatori meccanici sono quelli più adatti alla miniaturizzazione e all’impianto endovascolare.

Questo dispositivo alimentato elettricamente, fornisce un continuo flusso assiale dal ventricolo sinistro all’aorta toracica discendente. A causa della sua piccola dimensione, può essere collocato all’interno del ventricolo sinistro senza che sia necessaria alcuna cannula di aspirazione. Il flusso di sangue continuo elimina la necessità di valvole, di una camera di compliance interna, o di uno sfiato esteriorizzato.

Il sistema è costituito da una pompa di sangue, un cavo di alimentazione che passa per via percutanea, un regolatore di velocità della pompa e alimentazione in corrente continua. La pompa è semplice nel design, essendo la sua unica parte mobile una girante situata nel centro del compartimento in titanio. La girante a sua volta è costituita da un magnete al neodimio-ferro-boro sospesa da 2 cuscinetti ceramici e viene ruotata dalla forza elettromagnetica generata da un apposito motore. Sulla superficie esterna della ventola vi sono 2 lame in titanio idrodinamiche. Tutte le superfici a contatto con il sangue all’interno della pompa sono realizzate in titanio liscio, in modo che sia minimizzato l’effetto dell’attrito sul flusso.

La storia del cuore artificiale

Il cuore artificiale è senza ombra di dubbio il successo più importante ottenuto dalla bioingegneria.
Nasce nel 1982, con il modello Jarvik 7 – dal nome di uno dei suoi inventori – un dispositivo che sostituisce la pompa cardiaca ma che viene alimentato da un generatore delle dimensioni di una lavatrice. Fu impiantato per la prima volta a Barney Clark, un dentista di Seattle, che dopo l’intervento chirurgico riuscì a sopravvivere per 112 giorni, senza però poter mai lasciare l’ospedale dov’era ricoverato.

Più recentemente, nel 2001, un’industria statunitense ha progettato l’AbioCor, un cuore artificiale di piccole dimensioni, in plastica e titanio, capace di funzionare senza bisogno di essere collegato a ingombranti batterie esterne. Il record di sopravvivenza tramite l’utilizzo di questo dispositivo è stato di un anno e mezzo. Si è trattato però sempre di interventi sperimentali: le autorità infatti non hanno ancora autorizzato l’immissione in commercio di questo dispositivo.

Negli ultimi anni ci si è concentrati prevalentemente sui modelli  VADs o Ventricular Assist Device, organi che non sostituiscono per intero il cuore originale, che quindi non viene rimosso, ma lo aiutano nella sua funzione venendo in soccorso soprattutto al ventricolo sinistro, che è la parte del cuore che svolge il lavoro di entità maggiore – in quanto deve pompare il sangue verso tutti i distretti della grande circolazione – e che rimane più spesso danneggiata nelle malattie cardiache.

Il VAD può essere impiantato in attesa che si renda disponibile un cuore per un trapianto, ma a volte può rappresentare anche una soluzione definitiva.

Fonti | http://www.jarvikheart.com/news.asp?id=23

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