A Compliant Model of the Ventricular Apex to Study Suction in Ventricular Assist Devices

Rocchi, Maria; Fresiello, Libera; Meyns, Bart; Jacobs, Steven; Gross, Christoph; Pauls, Jo P.; Graefe, Roland; Stecka, Anna; Kozarski, Maciej; Zieliński, Krzysztof

doi:10.1097/mat.0000000000001370

Cited by 4 publications

(13 citation statements)

References 27 publications

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“…Nevertheless, the suction module proved to be able to develop different levels of suction severity, from partial to complete occlusion of the inflow cannula as showed in a previous paper. 11…”

Section: Resultsmentioning

confidence: 99%

“…The suction model proposed in this study represents a step forward, not only being able to account for the effect of ventricular suction on the hemodynamics, but also giving the possibility to reproduce different levels of severity of ventricular suction, simulating from partial to complete occlusion of the inflow cannula. 11…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the impact of the position of the inflow cannula is not considered due to the limitation of the suction module. 11 The right and left interdependence is not simulated. The right ventricular systolic function is significantly influenced by the left ventricle.…”

Section: Discussionmentioning

confidence: 99%

“…According to Salamonsen et al , 7 this is the hemodynamic condition for suction to appear in case of ideal positioning of the inflow cannula. More details on the control algorithm used to recreate suction are reported in the article by Rocchi et al 11…”

Section: Methodsmentioning

confidence: 99%

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Potential of Medical Management to Mitigate Suction Events in Ventricular Assist Device Patients

et al. 2022

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Ventricular suction is a common adverse event in ventricular assist device (VAD) patients and can be due to multiple underlying causes. The aim of this study is to analyze the potential of different therapeutic interventions to mitigate suction events induced by different pathophysiological conditions. To do so, a suction module was embedded in a cardiovascular hybrid (hydraulic-computational) simulator reproducing the entire cardiovascular system. An HVAD system (Medtronic) was connected between a compliant ventricular apex and a simulated aorta. Starting from a patient profile with severe dilated cardiomyopathy, four different pathophysiological conditions leading to suction were simulated: hypovolemia (blood volume: −900 ml), right ventricular failure (contractility −70%), hypotension (systemic vascular resistance: 8.3 Wood Units), and tachycardia (heart rate:185 bpm). Different therapeutic interventions such as volume infusion, ventricular contractility increase, vasoconstriction, heart rate increase, and pump speed reduction were simulated. Their effects were compared in terms of general hemodynamics and suction mitigation. Each intervention elicited a different effect on the hemodynamics for every pathophysiological condition. Pump speed reduction mitigated suction but did not ameliorate the hemodynamics. Administering volume and inducing a systemic vasoconstriction were the most efficient interventions in both improving the hemodynamics and mitigating suction. When simulating volume infusion, the cardiac powers increased, respectively, by 38%, 25%, 42%, and 43% in the case of hypovolemia, right ventricular failure, hypotension, and tachycardia. Finally, a management algorithm is proposed to identify a therapeutic intervention suited for the underlying physiologic condition causing suction.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Potential of Medical Management to Mitigate Suction Events in Ventricular Assist Device Patients

et al. 2022

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“…A few MCLs included a collapsible element representing only the ventricular apex. [29][30][31] In Figure 2 a scheme of the set up used by Rocchi et al 29 is shown. In their study a hybrid simulator is used.…”

Section: Implantable Blood Pumpsmentioning

confidence: 99%

Use of 3D anatomical models in mock circulatory loops for cardiac medical device testing

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Using pulsatility responses to breath‐hold maneuvers to predict readmission rates in continuous‐flow left ventricular assist device patients

Krishnaswamy,

Robson,

Gunawan

et al. 2023

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BackgroundDynamic respiratory maneuvers induce heterogenous changes to flow‐pulsatility in continuous‐flow left ventricular assist device patients. We evaluated the association of these pulsatility responses with patient hemodynamics and outcomes.MethodsResponses obtained from HVAD (Medtronic) outpatients during successive weekly clinics were categorized into three ordinal groups according to the percentage reduction in flow‐waveform pulsatility (peak‐trough flow) upon inspiratory‐breath‐hold, (%∆P): (1) minimal change (%∆P ≤ 50), (2) reduced pulsatility (%∆P > 50 but <100), (3) flatline (%∆P = 100). Same‐day echocardiography and right‐heart‐catheterization were performed. Readmissions were compared between patients with ≥1 flatline response (F‐group) and those without (NF‐group).ResultsOverall, 712 responses were obtained from 55 patients (82% male, age 56.4 ± 11.5). When compared to minimal change, reduced pulsatility and flatline responses were associated with lower central venous pressure (14.2 vs. 11.4 vs. 9.0 mm Hg, p = 0.08) and pulmonary capillary wedge pressure (19.8 vs. 14.3 vs. 13.0 mm Hg, p = 0.03), lower rates of ≥moderate mitral regurgitation (48% vs. 13% vs. 10%, p = 0.01), lower rates of ≥moderate right ventricular impairment (62% vs. 25% vs. 27%, p = 0.03), and increased rates of aortic valve opening (32% vs. 50% vs. 75%, p = 0.03). The F‐group (n = 28) experienced numerically lower all‐cause readmissions (1.51 vs. 2.79 events‐per‐patient‐year [EPPY], hazard‐ratio [HR] = 0.67, p = 0.12), reduced heart failure readmissions (0.07 vs. 0.57 EPPY, HR = 0.15, p = 0.008), and superior readmission‐free survival (HR = 0.47, log‐rank p = 0.04). Syncopal readmissions occurred exclusively in the F‐group (0.20 vs. 0 EPPY, p = 0.01).ConclusionResponses to inspiratory‐breath‐hold predicted hemodynamics and readmission risk. The impact of inspiratory‐breath‐hold on pulsatility can non‐invasively guide hemodynamic management decisions, patient optimization, and readmission risk stratification.

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A Compliant Model of the Ventricular Apex to Study Suction in Ventricular Assist Devices

Cited by 4 publications

References 27 publications

Potential of Medical Management to Mitigate Suction Events in Ventricular Assist Device Patients

Potential of Medical Management to Mitigate Suction Events in Ventricular Assist Device Patients

Use of 3D anatomical models in mock circulatory loops for cardiac medical device testing

Using pulsatility responses to breath‐hold maneuvers to predict readmission rates in continuous‐flow left ventricular assist device patients

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