{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T08:17:53Z","timestamp":1788337073707,"version":"build-2803163510"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Freiburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Transapical off-pump implantation of left ventricular assist devices (LVADs) requires a separate inflow cannula and outflow graft. This study represents the first exploratory proof-of-concept evaluation of a dual-lumen stent graft designed to redirect blood from the left ventricle across the aortic valve into the ascending aorta while enabling LVAD support. The stent graft was tested in a mock circulatory loop, during wet-lab experiments on explanted porcine hearts, and in an exploratory acute large-animal study. In vitro testing showed no relevant impairment of pump performance. Wet-lab experiments confirmed that transapical positioning is feasible while revealing incomplete device expansion and myocardial tearing during balloon-assisted apical displacement. In vivo, a reinforced prototype could be positioned across the aortic valve, but myocardial compression impaired inflow expansion and LV unloading, while insufficient apical sealing resulted in bleeding and air embolism. Postmortem analysis confirmed correct device positioning without macroscopic valvular injury but identified myocardial tearing. These failure modes highlight the need for alternative design strategies for transapical off-pump LVAD implantation.<\/jats:p>","DOI":"10.1038\/s41598-026-68876-x","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T07:06:07Z","timestamp":1788332767000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploratory proof-of-concept study and failure mode analysis of a dual-lumen stent graft for transapical off-pump LVAD implantation"],"prefix":"10.1038","volume":"16","author":[{"given":"Florian","family":"Meissner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"Sch\u00f6n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle Costa","family":"Galbas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Straky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Dinkelaker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Czerny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Bothe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"68876_CR1","doi-asserted-by":"publisher","first-page":"1412","DOI":"10.1016\/j.cardfail.2023.07.006","volume":"29","author":"B Bozkurt","year":"2023","unstructured":"Bozkurt, B. et al. Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America. J. Card Fail. 29, 1412\u20131451 (2023).","journal-title":"J. Card Fail."},{"key":"68876_CR2","doi-asserted-by":"publisher","first-page":"1505","DOI":"10.1002\/ejhf.1236","volume":"20","author":"MG Crespo-Leiro","year":"2018","unstructured":"Crespo-Leiro, M. G. et al. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology: Advanced heart failure: HFA position statement. Eur. J. Heart Fail. 20, 1505\u20131535 (2018).","journal-title":"Eur. J. Heart Fail."},{"key":"68876_CR3","unstructured":"Medtronic to Stop Distribution and Sale of HVAD\u2122 System. Medtronic News https:\/\/news.medtronic.com\/2021-06-03-Medtronic-to-Stop-Distribution-and-Sale-of-HVAD-TM-System"},{"key":"68876_CR4","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.healun.2019.02.002","volume":"38","author":"E McGee","year":"2019","unstructured":"McGee, E. et al. Evaluation of a lateral thoracotomy implant approach for a centrifugal-flow left ventricular assist device: The LATERAL clinical trial. J. Heart Lung Transpl. 38, 344\u2013351 (2019).","journal-title":"J. Heart Lung Transpl."},{"key":"68876_CR5","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1097\/MAT.0000000000000038","volume":"60","author":"D Tamez","year":"2014","unstructured":"Tamez, D. et al. Early Feasibility Testing and Engineering Development of the Transapical Approach for the HeartWare MVAD Ventricular Assist System. ASAIO J. 60, 170\u2013177 (2014).","journal-title":"ASAIO J."},{"key":"68876_CR6","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1016\/j.jtcvs.2011.01.011","volume":"142","author":"MS Slaughter","year":"2011","unstructured":"Slaughter, M. S. et al. Transapical miniaturized ventricular assist device: Design and initial testing. J. Thorac. Cardiovasc. Surg. 142, 668\u2013674 (2011).","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"68876_CR7","unstructured":"Barandon, L., Nubret, K., Haddadi, M. & Garrigue, S. In-vivo Assessment Of A Novel Ventricular Systole-synchronized, Intraventricular Propelling, Left Ventricular Assist Device For Advanced Heart Failure. Presented at: 66th Annual ASAIO Conference; Washington, DC (2021). https:\/\/asaio.org\/conference\/program\/2021\/top1.cgi"},{"key":"68876_CR8","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1111\/aor.12730","volume":"40","author":"M Granegger","year":"2016","unstructured":"Granegger, M. et al. Interaction of a Transapical Miniaturized Ventricular Assist Device With the Left Ventricle: Hemodynamic Evaluation and Visualization in an Isolated Heart Setup. Artif. Organs. 40, 1113\u20131120 (2016).","journal-title":"Artif. Organs"},{"key":"68876_CR9","doi-asserted-by":"publisher","first-page":"S357","DOI":"10.1016\/j.hlc.2025.06.416","volume":"34","author":"S Dutta","year":"2025","unstructured":"Dutta, S., So, Q., Jansz, P. & Hayward, C. Use of 3D Segmentation to Quantify Post-Implantation Left Ventricular Assist Device (LVAD) Outflow Graft Characteristics. Heart Lung Circ. 34, S357\u2013S358 (2025).","journal-title":"Heart Lung Circ."},{"key":"68876_CR10","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1111\/aor.14728","volume":"48","author":"F Meissner","year":"2024","unstructured":"Meissner, F. et al. Longitudinal cardiac dimensions in patients undergoing LVAD implantation. Artif. Organs. 48, 550\u2013558 (2024).","journal-title":"Artif. Organs"},{"key":"68876_CR11","doi-asserted-by":"publisher","first-page":"e69","DOI":"10.1016\/j.jtcvs.2014.12.066","volume":"149","author":"JS Hanke","year":"2015","unstructured":"Hanke, J. S., Rojas, S. V., Martens, A. & Schmitto, J. D. Minimally invasive left ventricular assist device implantation with outflow graft anastomosis to the innominate artery. J. Thorac. Cardiovasc. Surg. 149, e69\u2013e70 (2015).","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"68876_CR12","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1097\/MAT.0000000000000559","volume":"63","author":"K May-Newman","year":"2017","unstructured":"May-Newman, K. et al. The Effect of Inflow Cannula Length on the Intraventricular Flow Field: An In Vitro Flow Visualization Study Using the Evaheart Left Ventricular Assist Device. ASAIO J. 63, 592\u2013603 (2017).","journal-title":"ASAIO J."},{"key":"68876_CR13","doi-asserted-by":"publisher","first-page":"486","DOI":"10.3390\/bioengineering10040486","volume":"10","author":"F Meissner","year":"2023","unstructured":"Meissner, F. et al. Impact of an Accessory for Left Ventricular Assist Devices on Device Flow and Pressure Head In Vitro. Bioengineering 10, 486 (2023).","journal-title":"Bioengineering"},{"issue":"Pt 1","key":"68876_CR14","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1046\/j.1469-7580.1998.19310105.x","volume":"193","author":"SJ Crick","year":"1998","unstructured":"Crick, S. J., Sheppard, M. N., Ho, S. Y., Gebstein, L. & Anderson, R. H. Anatomy of the pig heart: comparisons with normal human cardiac structure. J. Anat. 193 (Pt 1), 105\u2013119 (1998).","journal-title":"J. Anat."},{"key":"68876_CR15","doi-asserted-by":"publisher","first-page":"e3000410","DOI":"10.1371\/journal.pbio.3000410","volume":"18","author":"Percie du Sert","year":"2020","unstructured":"Percie du Sert. The ARRIVE guidelines 2.0: Updated guidelines for reporting animal research. PLOS Biol. 18, e3000410 (2020).","journal-title":"PLOS Biol."},{"key":"68876_CR16","doi-asserted-by":"publisher","first-page":"e3000411","DOI":"10.1371\/journal.pbio.3000411","volume":"18","author":"Percie du Sert","year":"2020","unstructured":"Percie du Sert. Reporting animal research: Explanation and elaboration for the ARRIVE guidelines 2.0. PLOS Biol. 18, e3000411 (2020).","journal-title":"PLOS Biol."},{"key":"68876_CR18","doi-asserted-by":"publisher","first-page":"e1777","DOI":"10.1002\/hsr2.1777","volume":"7","author":"MC Galbas","year":"2024","unstructured":"Galbas, M. C. et al. A systematic methodology for epicardial and epiaortic echocardiography in swine research models. Health Sci. Rep. 7, e1777 (2024).","journal-title":"Health Sci. Rep."},{"key":"68876_CR19","unstructured":"Wickham, H. et al. ggplot2: Create Elegant Data Visualisations Using the Grammar of Graphics. Version 3.5.1 (2024). https:\/\/cran.r-project.org\/web\/packages\/ggplot2\/index.html"},{"key":"68876_CR20","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1067\/mva.2003.58","volume":"37","author":"TS Jacobs","year":"2003","unstructured":"Jacobs, T. S. et al. Mechanical failure of prosthetic human implants: a 10-year experience with aortic stent graft devices. J. Vasc Surg. 37, 16\u201326 (2003).","journal-title":"J. Vasc Surg."},{"key":"68876_CR21","first-page":"848","volume":"11","author":"F Meissner","year":"2024","unstructured":"Meissner, F. et al. In Vivo Testing of a Second-Generation Prototype Accessory for Single Transapical Left Ventricular Assist Device Implantation. Bioeng. Basel Switz. 11, 848 (2024).","journal-title":"Bioeng. Basel Switz."},{"key":"68876_CR22","unstructured":"Netuka, I. A. Fully Implantable Intraventricular LVAD. Presented at: 8th EACTS MCS Summit; Prague (2024)."},{"key":"68876_CR23","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1097\/MAT.0000000000002157","volume":"70","author":"J Cappelli","year":"2024","unstructured":"Cappelli, J., Emling, J., Edwards, A. & Babu, A. Direct Apical Cannulation With Protek Duo Rapid Deployment Cannula via Mini Thoracotomy for Ambulatory Venoarterial-Extracorporeal Membrane Oxygenation. ASAIO J. 70, 565\u2013569 (2024).","journal-title":"ASAIO J."},{"key":"68876_CR24","unstructured":"Jarvik, R. Intraventricular blood pumps anchored by expandable mounting devices. US patent application US20100249489A1 (2010)."},{"key":"68876_CR25","unstructured":"Jarvik, R. Support stent for transvalvular conduit. US patent 9636441B2 (2017)."},{"key":"68876_CR26","doi-asserted-by":"publisher","first-page":"1869","DOI":"10.1038\/s41598-024-52376-x","volume":"14","author":"F Meissner","year":"2024","unstructured":"Meissner, F. et al. Cardioaortic dimensions in German landrace pigs derived from cardiac magnetic resonance imaging. Sci. Rep. 14, 1869 (2024).","journal-title":"Sci. Rep."},{"key":"68876_CR27","doi-asserted-by":"publisher","first-page":"766","DOI":"10.1097\/MAT.0000000000001068","volume":"66","author":"VK Chivukula","year":"2020","unstructured":"Chivukula, V. K. et al. Left Ventricular Assist Device Inflow Cannula Insertion Depth Influences Thrombosis Risk. ASAIO J. 66, 766\u2013773 (2020).","journal-title":"ASAIO J."},{"key":"68876_CR28","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.jbiomech.2018.02.038","volume":"72","author":"S Liao","year":"2018","unstructured":"Liao, S., Neidlin, M., Li, Z., Simpson, B. & Gregory, S. D. Ventricular flow dynamics with varying LVAD inflow cannula lengths: In-silico evaluation in a multiscale model. J. Biomech. 72, 106\u2013115 (2018).","journal-title":"J. Biomech."},{"key":"68876_CR29","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1093\/jisesa\/iew092","volume":"16","author":"PG Weintraub","year":"2016","unstructured":"Weintraub, P. G. The Importance of Publishing Negative Results. J. Insect Sci. 16, 109 (2016).","journal-title":"J. Insect Sci."},{"key":"68876_CR30","doi-asserted-by":"publisher","DOI":"10.1038\/d41586-024-01389-7","author":"R Brazil","year":"2024","unstructured":"Brazil, R. Illuminating \u2018the ugly side of science\u2019: fresh incentives for reporting negative results. Nature https:\/\/doi.org\/10.1038\/d41586-024-01389-7 (2024).","journal-title":"Nature"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-68876-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-68876-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-68876-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T07:43:31Z","timestamp":1788335011000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-68876-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,2]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["68876"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-68876-x","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,2]]},"assertion":[{"value":"13 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"M.C. is a consultant to Terumo Aortic, Medtronic, Endospan, and NEOS, received speaking honoraria from Cryolife-Jotec, and is a shareholder of TEVAR Ltd. and Ascense Medical. The remaining authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"27505"}}