Evaluation of the HeartWare ventricular assist device Lavare cycle in a particle image velocimetry model and in clinical practice

Abstract

The Lavare cycle effectively generates ventricular washout and the adverse event profiles of ReVOLVE patients with the Lavare cycle on were better than those with the Lavare cycle off. Larger studies are warranted to verify the positive effect of the Lavare cycle and to optimize speed modulation settings, so additional clinically relevant improvements can be realized.

Fluid Dynamics in the HeartMate 3: Influence of the Artificial Pulse Feature and Residual Cardiac Pulsation

“…An important aspect in VADs is pulsation or the lack thereof in rotary blood pumps . Speed modulations as in the HM3 or in the HVAD are a way to induce pulsatility. The speed modulation studied herein resulted in a larger pressure pulse than the corresponding contribution of the residual cardiac function (11 vs. 5 mm Hg).…”

“…Evidence on the beneficial effect of periodic speed changes has been provided by comparative studies in patients with an HVAD (Medtronic, Minneapolis, MN, USA), which features an optional periodic speed modulation. Patients with the modulation enabled had significantly fewer rates of stroke, sepsis, and right heart failure than those without, while overall survival and gastrointestinal bleeding rates were not affected .…”

Coronary Artery Bypass Grafting With Arteriovenous Composite Graft: General Considerations

“…1 Composite grafts are an approach that aims to avoid handling of the ascending aorta during CABG, decreasing the risk of atheroembolism and stroke in this procedure. [2][3][4] Several configurations, either arteriovenous or exclusively arterial, have been proposed, and nowadays, the benefits of using the SV are more prominent in the literature because there may be an increase in infectious or ischemic complications owing to harvesting of multiple arterial grafts in CABG. 4,5 Several authors are indicating better rates patency of the SV graft when it is submitted to better handling and intraoperative treatment.…”

“…4,5 Several authors are indicating better rates patency of the SV graft when it is submitted to better handling and intraoperative treatment. [2][3][4] As an example, we may cite the use of SV harvested with minimal manipulation, or with the no-touch technique, preservation of this venous graft in heparinized arterial blood instead of saline solution, and specifically in the context of this I-conduit and in composite grafts, segments of selected SV preferably should be devoid of valves. 2,4 These structures are prone to thrombus formation and, in situations in which the coronary artery to be revascularized presents noncritical obstructive lesions, the flow competition between the graft and the native artery may lead to early obstruction by stasis mechanism.…”

“…5 The authors also state that the procedure was performed, in some cases, with cardiopulmonary bypass and aortic clamping, an aspect that may impair the neuroprotective effect of the approach with I-conduit and composite grafts. [2][3][4] The publication of complete data on this group of 205 patients undergoing CABG with I-conduit would be of considerable value, especially with further details regarding SV harvesting and preparation, the incidence of infections and major adverse cardiac and cerebrovascular events, and the long-term patency of these grafts.…”