Limitations to Chronic Right Ventricular Assist Device Support

Karimov, Jamshid H.; Sunagawa, Gengo; Horvath, David J.; Starling, Randall C.; Moazami, Nader

doi:10.1016/j.athoracsur.2016.02.006

Cited by 41 publications

(28 citation statements)

References 50 publications

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“…For RV support devices that draw blood from the RA and pump to the PA, the dynamics are fundamentally the same, but because variations in RA and PA pressures are not as great as in the LV, variations in RVAD flow are generally significantly less than for LVADs. 51 In the case of RV failure, most MCS systems will include cannulation of the RA and PA to deliver flow into and out of a continuous-flow pump, respectively. H in this case is determined by RA pressure (preload) and PA pressure (afterload).…”

Section: Mcs For Rv Failurementioning

confidence: 99%

“…For this reason, surgeons have begun to use commercially available LVADs, including the Jarvik and HeartWare devices, in the RV position to support isolated RV or biventricular failure. [51][52][53][54][55][56] A major limitation of this approach is that the operating H-Q curve for a surgical LVAD is better suited for the systemic circulation with higher pressure and resistance. Furthermore, because the RV tends to operate in a lower-pressure, less resistant, and more compliant system, surgical LVADs connected to the RA and PA may be more prone to suction events.…”

Section: Durable Mcs Options For Rv Failurementioning

confidence: 99%

“…To overcome this limitation, operators have placed gap spacers to reduce protrusion of the LVAD inlet cannula into the RV and restricted the outflow graft of an LVAD by up to 50%, thereby increasing resistance to VAD outflow to a level that approximates the systemic circulation. [51][52][53][54][55][56] Several surgically implanted devices for more durable RV support are emerging. The HeartWare MVAD is an axial-flow pump that has a unique outflow port that originates at a 90° angle from the impeller, thereby functioning in part like a centrifugalflow pump.…”

Section: Durable Mcs Options For Rv Failurementioning

confidence: 99%

See 2 more Smart Citations

Mechanical Circulatory Support Devices for Acute Right Ventricular Failure

et al. 2017

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Right ventricular (RV) failure remains a major cause of global morbidity and mortality for patients with advanced heart failure, pulmonary hypertension, or acute myocardial infarction and after major cardiac surgery. Over the past 2 decades, percutaneously delivered acute mechanical circulatory support pumps specifically designed to support RV failure have been introduced into clinical practice. RV acute mechanical circulatory support now represents an important step in the management of RV failure and provides an opportunity to rapidly stabilize patients with cardiogenic shock involving the RV. As experience with RV devices grows, their role as mechanical therapies for RV failure will depend less on the technical ability to place the device and more on improved algorithms for identifying RV failure, patient monitoring, and weaning protocols for both isolated RV failure and biventricular failure. In this review, we discuss the pathophysiology of acute RV failure and both the mechanism of action and clinical data exploring the utility of existing RV acute mechanical circulatory support devices.

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Section: Mcs For Rv Failurementioning

confidence: 99%

Section: Durable Mcs Options For Rv Failurementioning

confidence: 99%

Section: Durable Mcs Options For Rv Failurementioning

confidence: 99%

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Mechanical Circulatory Support Devices for Acute Right Ventricular Failure

et al. 2017

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“…Right-sided circulation, anatomy, and physiology impose specific restrictions on the ideal mechanical pump for right ventricular (RV) support, which is currently not available for durable support. 19 Despite adaptations of various LVAD configurations for RV failure that have produced somewhat acceptable clinical outcomes, at this time, the urgent need for effective and safe MCS therapy for RV support remains unmet, and dedicated devices are believed to bring significant meaningful changes to close this gap and provide reliable chronic application of rotary devices, both for RV and left ventricular support. 20 | 819…”

Section: Progress In Mechanical Circulatory Support: Challenges and Omentioning

confidence: 99%

Human Fitting Studies of Cleveland Clinic Continuous-Flow Total Artificial Heart

et al. 2015

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Implantation of mechanical circulatory support devices is challenging, especially in patients with a small chest cavity. We evaluated how well the Cleveland Clinic continuous-flow total artificial heart (CFTAH) fit the anatomy of patients about to receive a heart transplant. A mock pump model of the CFTAH was rapid-prototyped using biocompatible materials. The model was brought to the operative table, and the direction, length, and angulation of the inflow/outflow ports and outflow conduits were evaluated after the recipient's ventricles had been resected. Thoracic cavity measurements were based on preoperative computed tomographic data. The CFTAH fit well in all five patients (height, 170 ± 9 cm; weight, 75 ± 24 kg). Body surface area was 1.9 ± 0.3 m2 (range, 1.6-2.1 m2). The required inflow and outflow port orientation of both the left and right housings appeared consistent with the current version of the CFTAH implanted in calves. The left outflow conduit remained straight, but the right outflow direction necessitated a 73 ± 22 degree angulation to prevent potential kinking when crossing over the connected left outflow. These data support the fact that our design achieves the proper anatomical relationship of the CFTAH to a patient's native vessels.

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“…Right‐sided circulation, anatomy, and physiology impose specific restrictions on the ideal mechanical pump for right ventricular (RV) support, which is currently not available for durable support . Despite adaptations of various LVAD configurations for RV failure that have produced somewhat acceptable clinical outcomes, at this time, the urgent need for effective and safe MCS therapy for RV support remains unmet, and dedicated devices are believed to bring significant meaningful changes to close this gap and provide reliable chronic application of rotary devices, both for RV and left ventricular support …”

mentioning

confidence: 99%