# The Road to Destination Therapy: Optimizing Long-Term Mechanical Cardiopulmonary Support for Pulmonary Hypertension

> **NIH NIH R01** · VANDERBILT UNIVERSITY MEDICAL CENTER · 2020 · $672,859

## Abstract

Project Abstract:
The goal of this proposal is to develop long-term cardiopulmonary support for patients with chronic, severe
pulmonary arterial hypertension (PAH) and associated RV failure. Patients with severe PAH will die of RV
failure without lung transplant. Unfortunately many of these patients experience long waiting times, are
unstable, and become transplant ineligible, due to poor cardiac output and end-organ dysfunction. To prevent
this, our team has used innovative modes of venoarterial (VA) ECMO as a temporary bridge to recovery (BTR)
or transplantation (BTT) to support the RV, facilitate ambulation, and ensure uniform perfusion of the whole
body. Our approach has led to excellent survival rates, but it would be better to intervene prior to RV failure, to
support patients for longer periods, and to offer support to non-transplant eligible patients. The goal of this
proposal is to extend and improve our successful approach for temporary ECMO support for PAH patients
toward permanent, destination therapy support. To accomplish this, we need more compact portable ECMO
systems for enhanced mobility, with oxygenators that have slower clot formation, greater durability, and limited
blood damage to eliminate the need for transfusions. We plan to test a new pulmonary assist device (PAD)
being developed by our group in a sheep pulmonary hypertension (PH)/RV failure model. The PAD consists of
two parallel, highly biocompatible gas exchanger modules that can be driven by conventional magnetically
levitated pumps for BTR or BTT or a small, VAD-quality pump for destination therapy. The fluid mechanical
design and surface treatments of the device slow clot formation and reduce shear stress damage of blood
cells, allowing for longer-term support with minimal systemic anticoagulation, no transfusions, and minimized
end-organ dysfunction. Patients could potentially be supported initially in the hospital, transitioned to home,
and return for gas exchanger replacements every 2-3 months. For Aim 1, we will determine the mode of ECMO
attachment that provides optimal RV support in a sheep model of chronic PH/RV failure. Attachment modes
include: 1) pumped right atrium (RA) to pulmonary artery (PA), 2) pumped RA to left atrium (LA), 3) pumpless
PA to LA, 4) pumped RA – innominate artery, and 5) pumped venovenous (negative control). In each case, the
support will be maintained for 4 hours while examining the effect of PAD flow rate on hemodynamics, RV
function, and PAD function. These results will inform which mode(s) could be most beneficial to PAH patients.
For Aim 2, we will examine changes in RV function and durability of the PAD system over a month of support.
Either the PAD system or a Maquet Cardiohelp (MC) system will be attached in sheep with chronic PH/RV
failure for one month. The PAD will be attached in the optimal configuration determined from Aim 1, while the
MC system will use the optimal pumped configuration, since its high resistance preclude...

## Key facts

- **NIH application ID:** 9962477
- **Project number:** 5R01HL140231-03
- **Recipient organization:** VANDERBILT UNIVERSITY MEDICAL CENTER
- **Principal Investigator:** Matthew Dominic Bacchetta
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $672,859
- **Award type:** 5
- **Project period:** 2018-08-15 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9962477

## Citation

> US National Institutes of Health, RePORTER application 9962477, The Road to Destination Therapy: Optimizing Long-Term Mechanical Cardiopulmonary Support for Pulmonary Hypertension (5R01HL140231-03). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9962477. Licensed CC0.

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