Clinical implications of hemodynamic assessment during left ventricular assist device therapy

Imamura, Teruhiko; Chung, B.; Nguyen, A.; Sayer, Gabriel; Uriel, Nir

doi:10.1016/j.jjcc.2017.12.001

Cited by 36 publications

(41 citation statements)

References 68 publications

(75 reference statements)

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“…As a proof of concept, we showed that this algorithm can be used to adapt a cardiovascular model to patient specific data and to benchmark simulations of personalized LVAD control policies. The importance of achieving hemodynamic optimization in LVAD patients is highlighted by a significantly lower rate of hospital readmissions [12], and could benefit from in silico analysis such as the presented speed profile evaluations. Moreover, we have demonstrated realistic simulations of a model that is based on AVPD instead of using the widespread time-varying elastance model and examined thereby the heart to LVAD interactions.…”

Section: Discussionmentioning

confidence: 99%

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A Personalized Switched Systems Approach for the Optimal Control of Ventricular Assist Devices based on Atrioventricular Plane Displacement

Zeile

Rauwolf

Schmeißer

et al. 2020

Preprint

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Objective: A promising treatment for congestive heart failure is the implementation of a left ventricular assist device (LVAD) that works as a mechanical pump. Modern LVADs work with adjustable constant rotor speed and provide therefore continuous blood flow; however, recently undertaken efforts try to mimic pulsatile blood flow by oscillating the pump speed. This work proposes an algorithmic framework to construct and evaluate optimal pump speed policies. Methods: We use a model that captures the atrioventricular plane displacement, which is a physiological indicator for heart failure. We employ mathematical optimization to adapt this model to patient specific data and to find optimal pump speed policies with respect to ventricular unloading and aortic valve opening. To this end, we reformulate the cardiovascular dynamics into a switched system and thereby reduce nonlinearities. We consider system switches that stem from varying the constant pump speed and that are state dependent such as valve opening or closing. Results: As a proof of concept study, we personalize the model to a selected patient with respect to ventricular pressure. The model fitting results in a root-mean-square deviation of about 6 mmHg. Optimized constant and piecewise constant rotor speed profiles improve the default initialized solution by 31% and 68% respectively. Conclusion: These in silico findings demonstrate the potential of personalized hemodynamical optimization for the LVAD therapy. Significance: LVADs and their optimal configuration are active research fields. Mathematical optimization enhances our understanding of how LVADs should provide pulsatility.

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Section: Discussionmentioning

confidence: 99%

“…Examples of these devices and modes are HeartMate 3 with the Pulse mode, HeartWare HVAD with the Lavare Cycle and EXCOR/INCOR [8]. For further details on the devices, the medical background, therapy planning and prognosis we refer to the reviews [9]- [12].…”

mentioning

confidence: 99%

A Personalized Switched Systems Approach for the Optimal Control of Ventricular Assist Devices based on Atrioventricular Plane Displacement

Zeile

Rauwolf

Schmeißer

et al. 2020

Preprint

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show abstract

“…Nearly 50% of LVAD patients show normal central venous and pulmonary capillary wedge pressure at baseline speed settings [50]. It is reported that patients with AF show even higher central venous pressure during LVAD support [51] and LVAD flow tends to be lower in AF patients than controls despite comparable LVAD speed settings [52]. The irregularity of ventricular rate, when compared with a regular rate at the same average frequency, leads to a 6–7% reduction in cardiac output and to a significant increase in right atrial pressure and pulmonary capillary wedge pressure [53, 54].…”

Section: Hemodynamics Effects Of Af In Lvad Patientsmentioning

confidence: 99%

Insight into Atrial Fibrillation in LVAD Patients: From Clinical Implications to Prognosis

Sisti¹,

Mandoli²,

Sciaccaluga³

et al. 2020

Pulse

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The use of left ventricular assist devices (LVADs), whether for destination therapy or bridge to transplantation, has gained increasing validation in recent years in patients with advanced heart failure. Arrhythmias can be the most challenging variables in the management of such patients but the main attention has always been focused on ventricular arrhythmias given the detrimental impact on mortality. Nevertheless, atrial fibrillation (AF) is the most common rhythm disorder associated with advanced heart failure and may therefore characterize the LVADs' pre-and postimplantation periods. Indeed, the consequences of AF in the population suffering from standard heart failure may require a more comprehensive evaluation in the presence of or in sight of an LVAD, making the AF clinical management in these patients potentially complex. Several studies have been based on this subject with different and often conflicting results, leaving many questions unresolved. The purpose of this review is to summarize the main pieces of evidence about the clinical impact of AF in LVAD patients, underlining the main implications in terms of hemodynamics, thromboembolic risk, bleeding and prognosis. Therapeutic considerations about the clinical management of these patients are also made according to the latest evidence.

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“…Instead of just decreasing the LVAD's speed, hemodynamic optimization by LVAD speed adjustment through a ramp test may have an advantage in suppressing GIB. 3,52 Our team recently demonstrated that optimized hemodynamics were associated with reduced HRAEs, including a lower rate of GIB. 53 HRAEs can be affected by hemodynamics.…”

Section: Secondary Prevention Of Gibmentioning

confidence: 99%

“…1,2 However, a high readmission rate following implantation is still reported with all LVADs. 3 In general, hemocompatibilityrelated adverse events (HRAEs), 4 comprsing both bleeding and thrombotic events (gastrointestinal bleeding [GIB], neurologic events, pump thrombosis and other thromboembolic events) are the leading causes of readmission, and specifically, GIB is the most common comorbidity. 5 The incidence of GIB varies with institute and device type (≈10-40%).…”

mentioning

confidence: 99%

Therapeutic Strategy for Gastrointestinal Bleeding in Patients With Left Ventricular Assist Device

Imamura

Kinugawa

Uriel

2018

Circ J

Self Cite

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tain number of Japanese patients still suffer from refractory GIB. Considering the current, increasing number of LVAD implantations, together with the upcoming approval of destination therapy indication, Japanese clinicians should also understand the management of GIB. In this review, we will approach the mechanism of GIB considering recent accumulating evidence, and introduce conventional and several updated therapeutic strategies for GIB. Pathophysiology of GIB in LVAD Patients Antiplatelet and Anticoagulation Therapies Multiple conditions in the field of cardiology require the chronic use of antiplatelet and anticoagulation drugs alone or in combination, but none report such a high rate of GIB as we experience in LVAD patients. For example, significant all-cause bleeding occurred at 3.57% per year during anticoagulation therapy in patients with atrial fibrillation in the RELY trial. 15 Significant all-cause bleeding occurred at 0.9% per year in patients receiving anticoagulation therapy to treat deep venous thrombosis in the PREVENT trial. 16 The rate of GIB during a 6-month antiplatelet therapy with aspirin and clopidogrel following percutaneous coronary intervention was 1.1% with a proton pump inhibitor and 2.9% with a placebo in the COGENT trial. 17 GIB during LVAD support is not similar to these other conventional situations 18 and is sometimes refractory to discontinuation of antiplatelet and anticoagulation therapies. 19 The mechanism of GIB during LVAD support may not be simply explained by concomitant antiplatelet and anticoagulation therapies.

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Clinical implications of hemodynamic assessment during left ventricular assist device therapy

Cited by 36 publications

References 68 publications

A Personalized Switched Systems Approach for the Optimal Control of Ventricular Assist Devices based on Atrioventricular Plane Displacement

A Personalized Switched Systems Approach for the Optimal Control of Ventricular Assist Devices based on Atrioventricular Plane Displacement

Insight into Atrial Fibrillation in LVAD Patients: From Clinical Implications to Prognosis

Therapeutic Strategy for Gastrointestinal Bleeding in Patients With Left Ventricular Assist Device

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