Detection of inflow obstruction in left ventricular assist devices by accelerometer: A porcine model study

Lilja, Didrik; Schalit, Itai; Espinoza, Andreas; Fiane, Arnt E.; Dahle, Gry; Littorin-Sandbu, Helen; Pettersen, Fred-Johan; Russell, Kristoffer Engh; Thiara, Amrit P S; Elle, Ole Jakob; Halvorsen, Per Steinar

doi:10.1016/j.healun.2023.03.017

Cited by 2 publications

(3 citation statements)

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“…The indices of external work evaluated in this study reflect changes in the H-Q behavior of the LVAD and the native heart. EW Heart_LVAD is sensitive to PO > 50%, which is similar to other novel approaches, such as accelerometer vibrations [6,25]. The flow mechanics within the LV are altered during LVAD support, with the majority of flow exiting through the apex rather than the native AV.…”

Section: Discussionmentioning

confidence: 77%

“…Obstruction of the LVAD flow path can occur when blood clots or tissue overgrowth form within the inflow cannula, pump body or outflow graft, and may lead to thrombus, embolism, and stroke [1][2][3][4]. This prepump source of pump obstruction (PO) accounts for 25% of LVAD obstructions, and they form gradually, not suddenly, which makes detection difficult and likely underreported [5][6][7]. Early detection of PO is critical for improving outcomes and relies primarily on changes in LVAD power consumption followed by echocardiographic or computerized tomography evaluation, but they can detect only large obstructions (>75% area) [6,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…This prepump source of pump obstruction (PO) accounts for 25% of LVAD obstructions, and they form gradually, not suddenly, which makes detection difficult and likely underreported [5][6][7]. Early detection of PO is critical for improving outcomes and relies primarily on changes in LVAD power consumption followed by echocardiographic or computerized tomography evaluation, but they can detect only large obstructions (>75% area) [6,[8][9][10]. Innovative strategies such as thromboelastography to assess hypercoagulability and changes in the acoustic vibrations to signal additional inertia within the LVAD have yet to gain widespread traction [11,12].…”

Section: Introductionmentioning

confidence: 99%

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Left Ventricular Assist Device Pump Obstruction Reduces Native Heart Efficiency

Montes,

Ueckert,

et al. 2023

Bioengineering

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Obstruction of the LVAD flow path can occur when blood clots or tissue overgrowth form within the inflow cannula, pump body, or outflow graft, and it can lead to thrombus, embolism, and stroke. The goal of this study was to measure the impact of progressive pump inflow obstruction on the pressure and flow dynamics of the LVAD-supported heart using a mock circulatory loop. Pump obstruction (PO) was produced by progressively blocking a fraction of the LVAD inlet area. Pressures, flows, and the midplane velocity field of the LV were measured for three LVAD speeds and six PO levels. Pressure and flow decreased with PO, shifting more of the flow through the aortic valve such that the total flow decreased by 6–11% and decreased the efficiency of the work of the native heart up to 60%. PO restricts diastolic flow through the LVAD, which reduces mitral inflow and decreases the strength and energy of the intraventricular vortices. The changes in flow architecture produced by PO include flow stasis and increased shear, which predispose the system to thromboembolic risk. Analysis of the contributions to external work may enable early detection, which allows time for therapeutic intervention, reducing the likelihood of pump replacement and the risk of complications.

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Section: Discussionmentioning

confidence: 77%