Pulsatile versus nonpulsatile blood flow during cardiopulmonary bypass

Chaney, Mark A.

doi:10.1097/aia.0000000000000378

Cited by 3 publications

(4 citation statements)

References 85 publications

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“…Recent studies have reported the advantages of pulsatile perfusion. 19,20 The implementation of pulsatile perfusion in mechanical circulatory support devices incurs an increase in complexity, which is a crucial consideration in terms of the durability of such devices. These study results suggest that UVAD was able to preserve pulsatility, even during BVAD use, through an uncomplicated mechanism.…”

Section: Discussionmentioning

confidence: 99%

“…The longstanding debate regarding the superiority of pulsatile flow versus non‐pulsatile flow has been ongoing for some time, and remains a controversial topic. Recent studies have reported the advantages of pulsatile perfusion 19,20 . The implementation of pulsatile perfusion in mechanical circulatory support devices incurs an increase in complexity, which is a crucial consideration in terms of the durability of such devices.…”

Section: Discussionmentioning

confidence: 99%

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Preservation of pulsatility with universal ventricular assist device: In vitro assessment for biventricular support

Kuroda,

Miyagi,

Polakowski

et al. 2023

Artificial Organs

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BackgroundThe objective of this study was to assess the pulsatility preservation capability of the universal ventricular assist device (UVAD) when used as a biventricular assist device (BVAD). This evaluation was conducted through an in vitro experiment, utilizing a pulsatile biventricular circulatory mock loop.MethodsTwo UVAD pumps were tested in a dual setup (BVAD) in the circulatory model with the simulated conditions of left heart failure (HF), right HF, and moderate/severe biventricular HF (BHF). The total flow, aortic pulse pressure, the pulse augmentation factor (PAF), the energy‐equivalent pressure (EEP), and the surplus hemodynamic energy (SHE) were observed at various pump speeds to evaluate the pulsatility.ResultsThe aortic pulse pressure increased from the baseline (without pump) in all simulated hemodynamic conditions. The PAF ranged from 17%–35% in healthy, left HF, right HF, and mild BHF conditions, with the highest PAF of 90% being observed in the severe BHF condition. The EEP correlated with LVAD flow in all groups (R2 = 0.87–0.97) and increased from the baseline in all cases. The SHE peaked at approximately 5–6 L/min of LVAD support and was likely to decrease at higher LVAD pump flow. The largest decrease in SHE from the baseline, 53%, was observed in the mild BHF conditions with the highest LVAD and RVAD support.ConclusionsThe UVAD successfully demonstrated the ability to preserve pulsatility in vitro, and to optimize the cardiac output, as an isolated circulatory support device option (RVAD or LVAD) and when used for BVAD support.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Preservation of pulsatility with universal ventricular assist device: In vitro assessment for biventricular support

Kuroda,

Miyagi,

Polakowski

et al. 2023

Artificial Organs

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“…IABP can increase diastolic blood pressure, decrease afterload as well as myocardial oxygen consumption, increase coronary artery perfusion, and moderately enhance cardiac output [ 19 , 20 , 21 ]. In the 2000s, Onorati’s group focused on the pulsatile property generated by IABP during cardiopulmonary bypass (CPB), and their studies proved the superiority of pulsatile flow over non-pulsatile flow [ 22 , 23 ]. IABP is no longer routinely recommended in patients diagnosed with CS complicated by acute myocardial infarction [ 24 , 25 ] because the IABP-SHOCK II trial revealed that it did not improve their short and long-term outcomes [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Effect of Pulsatile on Blood Flow Distribution with VA ECMO: A Numerical Study

Gao

Zhang

et al. 2022

Bioengineering

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The pulsatile properties of arterial flow and pressure have been thought to be important. Nevertheless, a gap still exists in the hemodynamic effect of pulsatile flow in improving blood flow distribution of veno-arterial extracorporeal membrane oxygenation (VA ECMO) supported by the circulatory system. The finite-element models, consisting of the aorta, VA ECMO, and intra-aortic balloon pump (IABP) are proposed for fluid-structure interaction calculation of the mechanical response. Group A is cardiogenic shock with 1.5 L/min of cardiac output. Group B is cardiogenic shock with VA ECMO. Group C is added to IABP based on Group B. The sum of the blood flow of cardiac output and VA ECMO remains constant at 4.5 L/min in Group B and Group C. With the recovery of the left ventricular, the flow of VA ECMO declines, and the effective blood of IABP increases. IABP plays the function of balancing blood flow between left arteria femoralis and right arteria femoralis compared with VA ECMO only. The difference of the equivalent energy pressure (dEEP) is crossed at 2.0 L/min to 1.5 L/min of VA ECMO. PPI’ (the revised pulse pressure index) with IABP is twice as much as without IABP. The intersection with two opposing blood generates the region of the aortic arch for the VA ECMO (Group B). In contrast to the VA ECMO, the blood intersection appears from the descending aorta to the renal artery with VA ECMO and IABP. The maximum time-averaged wall shear stress (TAWSS) of the renal artery is a significant difference with or not IABP (VA ECMO: 2.02 vs. 1.98 vs. 2.37 vs. 2.61 vs. 2.86 Pa; VA ECMO and IABP: 8.02 vs. 6.99 vs. 6.62 vs. 6.30 vs. 5.83 Pa). In conclusion, with the recovery of the left ventricle, the flow of VA ECMO declines and the effective blood of IABP increases. The difference between the equivalent energy pressure (EEP) and the surplus hemodynamic energy (SHE) indicates the loss of pulsation from the left ventricular to VA ECMO. 2.0 L/min to 1.5 L/min of VA ECMO showing a similar hemodynamic energy loss with the weak influence of IABP.

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“…In this interesting review, the author highlights the importance and advantages of pulsatile flow compared with non-pulsatile flow. Multiple studies that have evaluated the efficacy of pulsatile flow during CPB have reported controversial results [ 1 ].…”

mentioning

confidence: 99%

Relative and absolute blood flow values during cardiopulmonary bypass

Condello¹

2023

J Extra Corpor Technol

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Pulsatile versus nonpulsatile blood flow during cardiopulmonary bypass

Cited by 3 publications

References 85 publications

Preservation of pulsatility with universal ventricular assist device: In vitro assessment for biventricular support

Preservation of pulsatility with universal ventricular assist device: In vitro assessment for biventricular support

Hemodynamic Effect of Pulsatile on Blood Flow Distribution with VA ECMO: A Numerical Study

Relative and absolute blood flow values during cardiopulmonary bypass

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