Artificial Organs

24(6):401404, Blackwell Science, Inc.

2000 International Society for Artificial Organs

Presidential Address

The History of Continuous-Flow Blood Pumps

Don B. Olsen
Utah Artificial Heart Research Institute, Salt Lake City, Utah, U.S.A.

Continuous-flow blood pumps were developed

very early by the pioneers of the heartlung machines used for cardiopulmonary bypass. Some of
the pioneers names included DeBakey, Gibbons,
and Kantrowitz. Dr. Wesolowski published on the
role of the pulse in the maintenance of normal physiology in the systemic circulation during heartlung
bypass in 1955 (1). Some of these early experiments
clearly demonstrated that pulsatile flow was not
critical to the maintenance of the integrity of either
the pulmonary or systemic circulation. The earliest
article describing continuous-flow blood pumps was
entitled An ideal heart pump with hydrodynamic
characteristics analogous to the mammalian heart,
by Saxton and Andrews in 1960 (2). The authors
delineated several potential advantages of the centrifugal blood pump over the positive displacement
pulsatile devices then under development. They
pointed out that it was smaller in size, required much
less power with a minimum of moving parts, and
required no valves or flexing plastic chambers. Furthermore, they observed that the flows were sensitive to inflow and outflow pressures, suggesting some
level of autocontrol. Of the listed advantages, this
latter item is the only one that has not yet been
proven to be factual.
Furthermore, they identified two primary disadvantages. One was the unknown shear stresses
within the pumping chamber that could result in
blood cell damage. The second disadvantage was
that continuous flow requires higher output volumes
than pulsatile flow in animals. Excessive blood cell
injury caused by high shear stress could result in

hemolysis. Several questions that could be asked include how much plasma-free hemoglobin is too
much, and what is the toxicity of a high plasma-free
hemoglobin within the organism.
The results of various levels of intravascular hemoglobin had been a subject of study for many years.
As early as 1938, Ottenberg reported that the renal
threshold in man for hemoglobin was above 150
mg%. This means that when the plasma-free hemoglobin exceeds 150 mg%, it is excreted into the
urine. His studies also demonstrated that up to 8 g of
hemoglobin was cleared in 20 h. In 1949, Maluf reported that in patients with dehydration or shock,
the consequences of high plasma-free hemoglobin
could cause renal failure at otherwise benign levels.
Latham reported that plasma-free hemoglobin at
levels up to 150 mg% was conjugated in the liver to
haptoglobin, which was cleared through the reticuloendothelial system.
Bernstein et al. in 1964 quantitated and reported
on the canine continuous infusion tolerance. They
showed that, in the dog, a continuous dose of 0.1
mg/kg/min of hemoglobin was tolerated without elevation of the blood urea nitrogen or the evidence of
hemoglobinuria (plasma-free hemoglobin within the
urine). This continuous dose of hemoglobin resulted
in plasma levels of approximately 30 mg%. The authors further reported that in dogs with sepsis, this
continuous dose often reached between 310 to as
high as 755 mg%. They concluded that hemoglobin
infusions, per se, were not lethal to the dog. They
proposed a limit of chronic intravascular hemolysis
of 0.1 mg/kg/day, or up to 10 g, of free hemoglobin
burden per day in the healthy dog without resultant
pathology. These results established the baseline of
maximum plasma-free hemoglobin that could be
generated or tolerated in the dog, and perhaps other
animals.
Rafferty et al. (3) in 1968 developed a centrifugaltype, continuous-flow blood pump that they referred

Received March 2000.

Presented in part at the 7th Congress of the International Society for Rotary Blood Pumps, held August 2627, 1999, in Tokyo,
Japan.
Address correspondence and reprint requests to Dr. Don B.
Olsen, President, Utah Artificial Heart Research Institute, Suite
180, 803 North 300 West, Salt Lake City, UT 841031414, U.S.A.

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D.B. OLSEN

to as a forced vortex principle. This pump had extremely low hemolysis rates and ultimately became
known as the BioPump, which was commercialized in 1976. Dorman and colleagues in 1969 (4) reported on the development of the velocity head
pump with an index of hemolysis less than 0.01 and
efficiency of 17 to 37% and presented the results in
animals being perfused for 13 h.
In 1974, Bernstein et al. (5) published the results
of a series of experiments described as a nonthoracotomy prolonged ventricular bypass after successfully running a continuous-flow pump in the calf for
24 h. Plasma-free hemoglobin did not exceed 21
mg%. However, there was a decrease in platelets
and there was normal clotting of the blood, with only
minor renal emboli. With the Biomedicus-type
pump, seal failure was often associated with an increase of plasma-free hemoglobin in excess of 300
mg%. Seal failure today in the Biomedicus pump
results in a rapid rise in plasma-free hemoglobin.
In 1979, Golding et al. (6) reported some initial
clinical experiences with the Medtronic pump and
reported good hemodynamic support of the patients
with plasma-free hemoglobins of 39 mg% at 24 h.
After that, the plasma-free hemoglobins dropped to
25.5 mg% for the remaining perfusion time.
Based upon favorable clinical results of temporary
ventricular support with a centrifugal pump (6), Golding et al. in 1980 (8) started a series of calf experiments in which a centrifugal pump was attached to
both the right and left ventricles, which were subsequently fibrillated, and these early experiments had
calves surviving up to 34 days on a totally nonpulsatile perfusion. Reports in the literature of the successful use of centrifugal pumps encouraged investigators to develop a variety of continuous-flow blood
pumps. A series of articles published from 1981
through 1985 by Bramm and Olsen et al. (7,9,10)
described a magnetically suspended impeller blood
pump where there were no contact bearings on the
free-floating impeller.
Wampler et al. in 1988 (11) described a miniaturized axial pump mounted on the tip of the catheter
that could be passed from the femoral artery into the
left ventricular chamber as an assist device. The impeller on this pump rotated between 25,000 and
35,000 rpm, to yield a 3.5 L output per minute. Surprisingly, the red cell destruction was very low. Dr.
Wampler calculated that if the Hemopump were to
produce 10 g of free hemoglobin per day at 3 L/min
of flow, it would have to lyse one blood cell for every
56,000 red blood cells that passed through the Hemopump.
Drs. Monties and Mesana developed a rotary
Artif Organs, Vol. 24, No. 6, 2000

FIG. 1. A cutaway of the MicroMed DeBakey VAD. The blood

flow is from left to right, passing first through the flow straightener
blades that serve to mount the inflow mechanical bearing. The
flow next traverses a two-stage rotating impeller, then through the
flow diffuser that also supports the outflow mechanical bearing.
The flow tube is three inches long and has a one-half inch inside
diameter. The casing holding the motor stator has an outside
diameter of about one inch.

pump using the Wankle engine principle (12). Dr.

Akamatsu and his team in 1990 reported on the magnetic suspended impeller pump that was later acquired by the Terumo Corporation (13). This pump
has been very successful as a left ventricular assist
device, maintaining sheep alive in excess of 2 years.
The Houston group, with Dr. Nose as the leader,
developed the Baylor Gyro pump, which underwent
a series of modifications and is presently commercially available for use as a cardiopulmonary bypass
pump (14).
Drs. DeBakey and Noon worked with a group of
engineers from NASA to develop a very small axial
pump to be used as a left ventricular assist device
(Fig. 1). This is a very well engineered pump that has
powerful magnets set in the tips of the inducer impeller vanes that minimize the air gap between the
rotor and the stator of the driving brushless-DC motor. As of this writing, the pump has been implanted
in 25 patients in Europe and has undergone extensive testing and evaluation on the bench as well as in
animals in preparation for an application to the Food
and Drug Administration (FDA) for approval for
clinical use as a bridge to transplant within the
United States (15). The bearings of this pump have
proven extremely reliable in bench tests exceeding 2
years. The Nimbus Corporation also developed a
miniaturized axial flow pump similar in size and configuration to the DeBakey VAD (16). Nimbus was
recently acquired by ThermoCardio Systems, Inc.
and their device, known as the HeartMate II, is presently being tested to gather data for an application to
the FDA. A third and similar axial flow pump was
developed by Jarvik and is referred to as the Jarvik
2000 (17). Studies are being conducted to acquire

PRESIDENTIAL ADDRESS
FDA approval to test this pump clinically in the
United States.
A magnetically suspended centrifugal pump is under development in the Utah Artificial Heart Institute, in combination with MedQuest Products, Inc.
and the University of Virginia. This pump has been
ex vivo tested in one animal study and after extensive bench evaluations (1820). Dr. Antaki and the
Pittsburgh group developed the Streamliner axial
flow pump with the impeller suspended in magnetic
bearings. As of this writing, the pump has been
tested ex vivo in 1 animal.
The 1960 publication by Saxton and Andrews (2)
pointed out that the flow through the centrifugal
pump was sensitive to inflow and outflow pressures,
suggesting some level of autocontrol. At that point,
the physiological controller for rotary blood pumps
had not been well developed. The goal of that controller would be to automatically make quick
changes in the pumps performance (that is, speed)
in response to one or more precisely monitored, derived, or determined cardiovascular parameters.
The only mechanism to control the continuous
flow of rotary blood pumps is to increase or decrease
the speed of rotation. These modifications in speed
must be keyed to some physiological parameter.
With the unavailability of highly reliable external
sensors, engineers have developed algorithms utilizing the available parameters such as motor rpm and
motor current. A great deal of progress has been
made in this arena, but there is much to be done if
these pumps are to be implanted in patients as a
permanent left ventricular or right ventricular assist
device. The DeBakey ventricular assist device has
been used in patients in Europe utilizing a flow
probe on the outflow tract as an indicator to the
attendees to increase or decrease pump rpm. This
has worked very satisfactorily as a temporary bridge
to cardiac transplantation, but a closed loop automatic system would be far more desirable in the permanent application of these devices.
A large variety of blood pumps designed to be
used as total artificial hearts or cardiac replacement
devices, as well as a variety of ventricular assist devices, are presently either on the market or are being
developed and soon will be on the marketplace. I
strongly suggest that we develop and adopt a classification system for these blood pumps. I propose the
following classifications.
First generation pumps would be used as positive
displacement or pulsatile pumps. Examples of these
first generation pumps are the CardioWest total artificial heart, the Thoratec biventricular assist devices, the TCI HeartMate I VAD, the Novacor

403

VAD, the HeartSaver by Worldheart, and the Pierce

Lion Heart. Other pulsatile devices are also under
development.
Second generation blood pumps would include the
rotary pumps with contact bearings and/or seals. The
second generation pumps would have contact bearings, either within the bloodstream or protected
from the bloodstream by seals. Examples of this
group of blood pumps would include the MicroMed
DeBakey VAD, the Jarvik 2000 VAD, and the Nimbus-TCI HeartMate II VAD. It is acknowledged that
other pumps of this type are also under development.
I recently described the third generation pump as
rotary pumps with only magnetic bearings. This criteria for classification is far too restrictive and should
be expanded to be rotary pumps without mechanical
or touching bearings. This group would contain
those pumps with magnetic bearings and those with
hydrodynamic bearings. Examples would include the
Terumo VAD, the MedQuest Heartquest VAD, the
University of Pittsburgh Streamliner VAD, and the
centrifugal pump being developed at the Cleveland
Clinic by Dr. Leonard Golding, the VentraAssist,
hydrodynamically suspended centrifugal pump by
Dr. Woodward and associates, and the Cora Heart
by Dr. Monties.
I suggest that classification of these three types of
pumps would include all of the possible pumping
mechanisms (21). There is one additional classification that may require the expanded fourth generation referred to as the magneto-hydrodynamic drive
system. This includes the concept of electromagnetic
force fields to move liquids. This system is presently
available in diffusion vacuum pumps and liquid
metal pumps. I explored this concept in previous
years. Although my consultants in physics informed
me that the ion concentrations in blood are inadequate to be pumped directly, U.S. patent number
5,685,698 was issued on November 11, 1997 utilizing
this magneto-hydrodynamic concept to pump blood.
If this patent is ever reduced to practice, then perhaps a fourth generation pump classification should
be considered.
REFERENCES
1. Wesolowski SA. The role of the pulse in maintenance of the
systemic circulation during heartlung bypass. Trans Am Soc
Artif Organs 1956;1:846.
2. Saxton, GA, Andrews CB. An ideal pump with hydrodynamic
characteristics analogous to the mammalian heart. Trans Am
Soc Artif Organs 1960;6:2889.
3. Rafferty EH, Kletschka HD, Wynyard M, Lackin JT, Smith
LV, Cheathem B. Artificial heart IIApplication of nonpulsatile radially increasing pressure gradient pumping principle.
Minn Med 1968;52:191.
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D.B. OLSEN

4. Dorman F, Bernstein EF, Blackshear PL, Sovilj R, Scott DR.

Progress in the design of a centrifugal cardiac assist pump with
transcutaneous energy transmission by magnetic coupling.
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