an alternative form of counterpulsation is shown in fig1 . here a pump 10 is implanted in a pacemaker pocket on the patient &# 39 ; s right side . blood fills the pump 10 on one side and air or other fluid fills a sac or bladder ( not shown ) on the other side of the pump 10 . an air drive line 12 is tunneled from the pacemaker pocket to a skin exit site 14 , so the entire pump 10 is under the skin and can remain there chronically . after the driveline 12 exits the skin , it is attached to a small air drive unit 16 that controls shuttling of pressurized air in and out of the pump 10 . a void in the pump 10 may be formed with the sac or bladder . the void fills with air as the heart beats ( less cardiac work in ejecting blood ) and empties to return blood into the circulation ( more flow to the patient ). the pump 10 is attached to the circulation with a conduit 20 . the conduit 20 shuttles blood between the patient &# 39 ; s circulatory system and the pump 10 . this situation allows a patient to have chronic counterpulsation with full mobility . for a patient with severe and potentially non - reversible cardiac dysfunction , this is a great advantage as it is possible to live a relatively normal life — apart from the need to carry a small battery powered drive console 16 . as described , the blood is shuttled in and out of the pump 10 with a conduit 20 which is connected to the circulation . there are a number of considerations related to implantation and use of this conduit 20 . first , almost every conduit has blood flowing in one direction , but this conduit 20 has blood alternating flow direction two times for each heart beat as the pump 10 fills and empties with each cardiac cycle . this creates a number of important issues which will be described . a second potential difficulty with a conduit in this situation is that it will typically be sewn to the subclavian artery 22 or axillary artery which is located beneath the clavicle and often quite deep , so it is technically difficult for a surgeon to suture the end of the conduit 20 to the artery 22 . the problem of a conduit with bidirectional flow relates to the responses of blood and tissues to the interfaces with synthetic materials and the response is dependent on the direction of blood flow . many medical devices , such as blood pumps , are connected to the patient &# 39 ; s circulation with artificial graft material such as polyester materials like dacron ® or expanded , porous teflon ® ( eptfe ) that will promote tissue or ceil ingrowth . the inside of blood pumps are generally smooth and composed of metals or plastics , when blood flows from a smooth metal or plastic blood pump into a synthetic graft ( such as polyester ), the interface where the pump meets the conduit ( plastic or metal to synthetic graft ) is a stable junction and there tends to be little problem when blood flows forward through this junction . unfortunately , experience has shown that when blood instead flows from a synthetic graft such as polyester into a smooth surfaced blood pump , a deposit of blood elements including platelets and fibrin tends to deposit at the junction of the two materials — principally on the synthetic graft and overhanging the inflow to the pump . these deposits , especially platelets , tend to attract more blood elements and large and often fragile deposits occur at this junction . these deposits can break free from the junction and enter the blood pump and be sent through the patient &# 39 ; s circulation . these deposits can flow anywhere , but if they arrive in an artery to the brain , a stroke can result . for this reason , many successful blood pumps employ a smooth synthetic conduit ( such as silicone or urethane ) for blood inflow into the pump . the problem with counterpulsation is that blood is flowing in an alternating bi - directional manner . one solution would be to use a smooth silicone or urethane conduit which would create a stable junction between the pump and the conduit where the blood enters into the pump . this solves the problem at the inflow to the pump . however , when a silicone material is anastomosed ( sewn ) to an artery , the junction develops a heavy deposit of blood material ( fibrin and platelets ). so merely replacing the inflow conduit with a silicone surface is not satisfactory . it is tempting to merely have a silicone conduit and add a fabric extension , but this merely moves the problem that occurs at the junction of the rough textured surface of the graft and the pump to the junction between the graft and the silicone tube or cannula . fig8 shows one potential solution in a cross - sectional view . the subclavian artery 22 is shown at the top of the figure . a “ bubble ” or enlarged area 24 of dacron ®, teflon ® or other material is sewn to the artery 22 . a silicone or other smooth material conduit portion 26 is connected to the other side of the enlarged area 24 . rather than a direct junction , a special interface is created . the smooth silicone surface portion 26 extends with a tip portion 26 a several millimeters inside the enlarged area 24 of fabric or other material . the walls of the silicone tip portion 26 a do not contact the fabric or material of the enlarged area or bubble 24 . this avoids a silicone - to - fabric ( or smooth - to - rough ) point of contact . heart valves have been constructed with arrangements to avoid tissue ingrowth into the valve by creating an elevation — so that there is not a continuous connection between the fabric surface and the smooth surface . this elevation prevents tissue from growing over into junction point and creating a point where platelets and fibrin are deposited . the use of a small washer of material may also be of use . fig8 shows a small washer 28 around the base of the tip 26 a that may help arrest the attachment of blood elements . fig9 shows that this arrangement of the “ bubble ” or enlarged area 24 a of graft material is located away from the anastomosis . specifically , enlarged area 24 a is coupled to or includes an extension 24 b that is anastomosed to the artery 22 . other features may be as described previously . fig1 a and 10b show a similar arrangement can be made at the junction of the pump 10 . here , the plastic , metal or other smooth surfaced junction or tip portion 10 a of the pump 10 is separated from the rough surface of the enlarged graft material by a bubble interface 24 a . an extension 24 b of the graft material is sewn to the artery 22 ( fig9 ) as previously described . another extension 24 c on the opposite end may facilitate connection to the pump interface or tip portion 10 a , along with a suitable connector 28 . the junction or interface 10 a , which serves as an inlet / outlet port that extends into , but does normally not contact , the graft material 24 a in use . these devices with bubbles or enlargements could be made in one piece . as described previously , the subclavian artery 22 is located fairly deep and the incision is small . so a surgeon who is trying to sew a graft with a bubble or enlargement on it is working in a deep hole . the bubble or enlargement on the end of a graft obscures his view of the artery . it would be useful to avoid this problem and also satisfy the need for maintaining the arrangement where the smooth and rough surfaces are not in direct linear contact . such a solution is shown in fig2 and 3 . here , a graft element form from material such as described above is sewn to the artery . the graft element 30 has a flange 32 at one end . the element 30 is small and easy to move around , so does not obscure the view of the surgeon . fig3 shows that it is easy to sew this element 30 around an opening 22 a on the artery 22 . fig4 shows how a junction between the silicone material portion 26 of the conduit 20 and the graft element 30 is recreated when a rim or flange 34 of sewing material or graft material , for example , of the conduit portion 26 is affixed to the flange 32 on the element 30 previously anastomosed to the artery 22 . fig5 shows how the two flanges 32 , 34 are sewn together . this is a very easy anastomosis to perform . it will be appreciated that these flanges 32 , 34 could be joined not just by sutures but by staples , clips , glues , clamps etc . fig6 a shows a side cross sectional view of the two flanges 32 , 34 coming together . fig6 b shows how the bubble or enlarged connector 30 does not have to be flat — it could be beveled . also the connector 30 does not have to be a generally spherical bubble as shown elsewhere herein . the key is only that the enlarged area keeps the silicone and graft surfaces ( that is , smooth and rough flow surfaces ) from direct contact at their junction during use . the bubble or enlarged area 36 is quite useful as it allows the graft to move or “ swivel ” inside the bubble 36 and still not contact the wall of the bubble 36 . fig6 b also shows clips or staples 38 attaching the connector 30 to the artery 22 and attaching the flanges 32 , 34 together . the conduit portion 26 does not have to be entirely silicone . it could have any inner core that presents a compatible surface to the exposed blood . for example , the inside could be metal , have a metal spiral reinforcement , etc . it could also have graft material inside like eptfe or other polyester . the smooth surface does not have to be silicone . this is used as representative of a smooth surface . the surface could be a metal or plastic ( such as in the pump connection shown in fig1 a and 10b .) fig7 shows a bubble or enlarged area 40 constructed by “ splitting ” the bubble in the middle of the hemisphere . it could be equally possible to form the junction 42 anywhere in this arrangement ; the location at the hemisphere is merely an example . alternatively , a more complete bubble could be created and the silicone cannula could be slipped into a defect at the end to perform the same function . it should be noted that the terms used are basically smooth ( silicone , plastics , metals ) and rough or textured surfaces ( dacron , teflon , eptfe ). it is also possible to have a tightly woven or knitted material that is typically called a textile , but could function as a smooth surface . also , it is possible to create a tightly woven polyester that behaves like a smooth surface . it could be possible to bring a tightly woven sewable graft into direct contact with a silicone surface without an intervening “ bubble ” or step . it may also be important to prevent these conduits from collapsing as they can be located below the skin and could be crushed by a patient lying on them . reinforcement of the conduits with plastic or wire spirals or rings can be used here . in addition , extra thicknesses of polymer or plastic could be added make them stronger . while the present invention has been illustrated by a description of various preferred embodiments and while these embodiments have been described in some detail , it is not the intention of the applicant to restrict or in any way limit the scope of the appended claims to such detail . additional advantages and modifications will readily appear to those skilled in the art . the various features discussed herein may be used alone or in any combination depending on the needs and preferences of the user . this has been a description of illustrative aspects and embodiments the present invention , along with the preferred methods of practicing the present invention as currently known .
a blood flow conduit includes a first conduit portion defining a first portion of a lumen ; and a second conduit portion defining a second portion of a lumen . at least one of the first or second conduit portions may include a tip portion and the other of the first or second conduit portions may include an enlarged area .