Toward a Long-Term Artificial Lung

ASAIO Journal, vol. 66, pp. 847–854

Abstract

Only a very small portion of end-stage organ failures can be treated by transplantation because of the shortage of donor organs. Although artificial long-term organ support such as ventricular assist devices provide therapeutic options serving as a bridge-to-transplantation or destination therapy for end-stage heart failure, suitable long-term artificial lung systems are still at an early stage of development. Although a short-term use of an extracorporeal lung support is feasible today, the currently available technical solutions do not permit the long-term use of lung replacement systems in terms of an implantable artificial lung. This is currently limited by a variety of factors: biocompatibility problems lead to clot formation within the system, especially in areas with unphysiological flow conditions. In addition, proteins, cells, and fibrin are deposited on the membranes, decreasing gas exchange performance and thus, limiting long-term use. Coordinated basic and translational scientific research to solve these problems is therefore necessary to enable the long-term use and implantation of an artificial lung. Strategies for improving the biocompatibility of foreign surfaces, for new anticoagulation regimes, for optimization of gas and blood flow, and for miniaturization of these systems must be found. These strategies must be validated by in vitro and in vivo tests, which remain to be developed. In addition, the influence of long-term support on the pathophysiology must be considered. These challenges require well-connected interdisciplinary teams from the natural and material sciences, engineering, and medicine, which take the necessary steps toward the development of an artificial implantable lung.

Authors 8

1. Jutta Arens corresponding

   University of Twente

   Affiliation as printed

   Chair in Engineering Organ Support Technologies, Department of Biomechanical Engineering, Faculty of Engineering Technologies, University of Twente, Enschede, The Netherlands

   Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty

2. Oliver Grottke Aachen Department of Anesthesiology, Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany

3. Axel Haverich

   Medizinische Hochschule Hannover

   Affiliation as printed

   Thoracic, Cardiac and Vascular Surgery, Medizinische Hochschule Hannover, Hannover, Germany

4. Lars Siegfried Maier

   University Hospital Regensburg

   Affiliation as printed

   Internal Medicine II, Universitätsklinikum Regensburg, Regensburg, Germany

5. Thomas Schmitz‐Rode Aachen Institute of Applied Medical Engineering Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany

6. Ulrich Steinseifer
   Affiliation as printed

   Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty

7. Hans Peter Wendel

   Universitätsklinikum Tübingen · University of Tübingen

   Affiliation as printed

   Thoracic, Cardiac and Vascular Surgery, Universitätsklinikum Tübingen, Tübingen, Germany

8. Rolf Rossaint Aachen Department of Anesthesiology, Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany