Advantage of Pulsatility in Left Ventricular Reverse Remodeling and Aortic Insufficiency Prevention During Left Ventricular Assist Device Treatment

Imamura, Teruhiko; Kinugawa, Koichiro; Nitta, Daisuke; Hatano, Masaru; Katoh, Osamu; Nawata, Kan; Ōno, Minoru

doi:10.1253/circj.cj-15-0419

Cited by 32 publications

(19 citation statements)

References 31 publications

(18 reference statements)

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“…Garcia et al [10] found no difference in the level of unloading between pVAD and tVAD support, while Klotz et al [19] observed a similar degree of left ventricular (LV) pressure unloading but a significantly higher degree of volume unloading with a pVAD [19]. The general consensus is that pulsatile flow offers potential benefits over non-pulsatile flow [29,30] including increased end organ perfusion [8], better unloading of the LV [23], less risk of right ventricular failure [17], mitigation of aortic valve stenosis and improved vascular remodeling [15], better chances for recovery [20] and reduction of gastrointestinal bleeding [7,30] when compared with a continuous flow support. Although the mechanics of the last point have not fully been explained yet [28,29] it is speculated to be linked to the acquired von Willebrand syndrome due to reduced arterial pulsatility when tVADs are employed [7].…”

Section: Introductionmentioning

confidence: 99%

High-frequency operation of a pulsatile VAD – a simulation study

Rebholz

Amacher

Petrou

et al. 2017

Biomedical Engineering / Biomedizinische Technik

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Ventricular assist devices (VADs) are mechanical blood pumps that are clinically used to treat severe heart failure. Pulsatile VADs (pVADs) were initially used, but are today in most cases replaced by turbodynamic VADs (tVADs). The major concern with the pVADs is their size, which prohibits full pump body implantation for a majority of patients. A reduction of the necessary stroke volume can be achieved by increasing the stroke frequency, while maintaining the same level of support capability. This reduction in stroke volume in turn offers the possibility to reduce the pump's overall dimensions. We simulated a human cardiovascular system (CVS) supported by a pVAD with three different stroke rates that were equal, two-or threefold the heart rate (HR). The pVAD was additionally synchronized to the HR for better control over the hemodynamics and the ventricular unloading. The simulation results with a HR of 90 bpm showed that a pVAD stroke volume can be reduced by 71%, while maintaining an aortic pulse pressure (PP) of 30 mm Hg, avoiding suction events, reducing the ventricular stroke work (SW) and allowing the aortic valve to open. A reduction by 67% offers the additional possibility to tune the interaction between the pVAD and the CVS. These findings allow a major reduction of the pVAD's body size, while allowing the physician to tune the pVAD according to the patient's needs.

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Section: Introductionmentioning

confidence: 99%

High-frequency operation of a pulsatile VAD – a simulation study

Rebholz

Amacher

Petrou

et al. 2017

Biomedical Engineering / Biomedizinische Technik

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“…In our study, the AV was closed in more than 60% of the CF‐LVAD recipients. Previous research has shown that HF patients who are supported by CF‐LVAD had more severe aortic insufficiency than those with a pulsatile flow (PF)‐LVAD . In CF‐LVAD recipients whose AV failed to open regularly, a greater progression of aortic insufficiency was observed compared to those with AVs that opened almost every beat .…”

Section: Discussionmentioning

confidence: 99%

Neurohormone levels remain elevated in continuous flow left ventricular assist device recipients

et al. 2018

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The findings that aldosterone, norepinephrine, and renin were elevated after restoration of hemodynamic functions during LVAD support suggest that the levels of neurohormones did not normalize. Future studies should investigate whether AV status in CF-LVAD recipients affects the levels of RAAS neurohormones and the mechanisms and clinical implications of elevated levels of neurohormones in CF-LVAD patients.

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“…Long-term follow-up studies of patients who underwent LVAD explant show good survival and low complication rates; however, the rate of recovery in LVAD patients may be as low as 2%, and patients still face the risk of recurring heart failure. 6) The durability of recovery is significantly higher when combined with pharmacologic therapy, especially when considering the rates only in those with dilated cardiomyopathy, thus demonstrating the potential of reverse remodeling. [2][3][4] In our experience, we have found that patients with the highest potential of myocardial recovery are those with acute-onset, nonischemic cardiomyopathy, such as viral myocarditis (as seen in this case), postpartum cardiomyopathy, or tachycardiainduced cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Recovery with Explantation of Continuous-Flow Left Ventricular Assist Device after 5 Years of Support

Critsinelis

Kurihara

Kawabori

et al. 2021

ATCS

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Mechanical circulatory support may result in sufficient myocardial recovery to allow for explantation of the left ventricular assist device (LVAD). The duration of support associated with left ventricular recovery has generally been 6-12 months. In this report, we present a patient in whom the left ventricle recovered after 5 years of support with a LVAD. Our report demonstrates that long-term monitoring for left ventricular recovery is prudent and may allow for late device explantation.

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Advantage of Pulsatility in Left Ventricular Reverse Remodeling and Aortic Insufficiency Prevention During Left Ventricular Assist Device Treatment

Cited by 32 publications

References 31 publications

High-frequency operation of a pulsatile VAD – a simulation study

High-frequency operation of a pulsatile VAD – a simulation study

Neurohormone levels remain elevated in continuous flow left ventricular assist device recipients

Left Ventricular Recovery with Explantation of Continuous-Flow Left Ventricular Assist Device after 5 Years of Support

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