Right–Left Ventricular Interaction in Left-Sided Heart Failure With and Without Venoarterial Extracorporeal Membrane Oxygenation Support—A Simulation Study

Donker, Dirk W.; Broomé, Michael

doi:10.1097/mat.0000000000001242

Cited by 22 publications

(37 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, the right ventricular end-systolic elastance considered in the present study ranged between 0.3 and 0.8 mmHg/ml as per previously reported values observed in clinical practice [1], [28], [29]. According to [19], increased native cardiac output is observed in the presence of left ventricular systolic impairment when right ventricular end-systolic elastance increases from 0.1 to 1.0 mmHg/ml. An increased native cardiac output is still observed during VA ECMO support following stepwise increase in right ventricular end-systolic elastance but to a lesser degree.…”

Section: Discussionsupporting

confidence: 69%

“…In the second step, the slope of right ESPVR Ees RIGHT =0.3 mmHg/ml was set to 0.4, 0.5, 0.6, 0.7 and 0.8 mmHg/ml [1],[19] and for each value the parameters described above were measured.…”

Section: Methodsmentioning

confidence: 99%

“…According to the available literature, normal values for right ventricular elastance fluctuate around 1 mmHg/ml [15], [16] and range from 1.6 to 5 mmHg/ml for left ventricular elastance [17], [18]. In the second step, the slope of right ESPVR Ees RIGHT =0.3 mmHg/ml was set to 0.4, 0.5, 0.6, 0.7 and 0.8 mmHg/ml [1], [19] and for each value the parameters described above were measured.…”

Section: Simulation Protocolmentioning

confidence: 99%

See 2 more Smart Citations

Ventricular and Atrial Pressure-Volume Loops: Analysis of the Effects Induced by Right Centrifugal Pump Assistance

Lazzari

Iacovoni

Capoccia

et al. 2022

Preprint

View full text Add to dashboard Cite

Background and Objective: The main indications for right ventricular assist device (RVAD) support are right heart failure after implantation of a left ventricular assist device (LVAD) or early graft failure following heart transplantation. About 30-40% of patients will need RVAD support after LVAD implantation. Pulmonary hypertension is also an indication for right heart assistance. Several types of RVAD generating pulsatile or continuous flow are available on the market. These assist devices can be connected to the cardiovascular system in different ways. We sought to analyse the effects induced by different RVAD connections when right ventricular elastance is modified using a numerical simulator. The analysis was based on the behaviour of both left and right ventricular and atrial loops in the pressure-volume plane. Methods: New modules of the cardiovascular network and a right ventricular centrifugal pump were implemented in CARDIOSIM software simulator platform. The numerical pump model generated continuous flow when connected in series or parallel to the right ventricle. When the RVAD was connected in series (parallel), the pump removed blood from the right ventricle (atrium) and ejected it into the pulmonary artery. In our study, we analysed the effects induced by RVAD support on left/right ventricular/atrial loops when right ventricular elastance slope (EesRIGHT) changed from 0.3 to 0.8 mmHg/ml with the pump connected either in series or parallel. The effect of low and high rotational pump speed was also addressed. Results: Percentage changes up to 60% were observed for left ventricular pressure-volume area and external work during in-parallel RVAD support at 4000 rpm with EesRIGHT = 0.3mmHg/ml. The same pump setting and connection type led to percentage variation up to 20% for left ventricular ESV and up to 25% for left ventricular EDV with EesRIGHT = 0.3mmHg/ml. Again the same pump setting and connection generated up to 50% change in left atrial pressure-volume loop area (PVLAL-A ) and only 3% change in right atrial pressure-volume loop area (PVLAR-A) when EesRIGHT = 0.3mmHg/ml. Percentage variation was lower when EesRIGHT was increased up to 0.8 mmHg/ml. Conclusion: Early recognition of right ventricular failure followed by aggressive treatment is desirable to achieve a more favourable outcome. RVAD support remains an option for advanced right ventricular failure although onset of major adverse events may preclude its use.

show abstract

Section: Discussionsupporting

confidence: 69%

“…In the second step, the slope of right ESPVR Ees RIGHT =0.3 mmHg/ml was set to 0.4, 0.5, 0.6, 0.7 and 0.8 mmHg/ml [1],[19] and for each value the parameters described above were measured.…”

Section: Methodsmentioning

confidence: 99%

Section: Simulation Protocolmentioning

confidence: 99%

See 1 more Smart Citation

Ventricular and Atrial Pressure-Volume Loops: Analysis of the Effects Induced by Right Centrifugal Pump Assistance

Lazzari

Iacovoni

Capoccia

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Signs of LV overload should be monitored based on serial non-invasive and invasive methods, including clinical examination (increased ventilation efforts, tracheal secretions, bloody or watery sputum), vital signs (hypoxemia), transthoracic echocardiography (increased LV end-diastolic dimensions, decreased LVEF, mitral valve regurgitation or impaired aortic valve opening), chest radiography (pulmonary congestion) and pulmonary artery catheter measurements (pulmonary artery pressure, increased PCWP and mean right atrial pressure). Recovery of cardiac function is indicated by increasing pulse pressure and MAP, whereas deterioration of cardiac function is indicated by the opposite combined with increasing LVEDP and PCWP (18).…”

Section: Clinical Considerationsmentioning

confidence: 99%

Case report: Refractory cardiac arrest supported with veno-arterial-venous extracorporeal membrane oxygenation and left-ventricular Impella CP®–Physiological insights and pitfalls of ECMELLA

Thevathasan

Füreder

Donker

et al. 2022

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

IntroductionTo the best of our knowledge, this is the first case report which provides insights into patient-specific hemodynamics during veno-arterio-venous-extracorporeal membrane oxygenation (VAV ECMO) combined with a left-ventricular (LV) Impella® micro-axial pump for therapy-refractory cardiac arrest due to acute myocardial infarction, complicated by acute lung injury (ALI).Patient presentationA 54-year-old male patient presented with ST-segment elevation acute coronary syndrome complicated by out-of-hospital cardiac arrest with ventricular fibrillation upon arrival of the emergency medical service. As cardiac arrest was refractory to advanced cardiac life support, the patient was transferred to the Cardiac Arrest Center for immediate initiation of extracorporeal cardiopulmonary resuscitation (ECPR) with peripheral VA ECMO and emergency percutaneous coronary intervention using drug eluting stents in the right coronary artery. Due to LV distension and persistent asystole after coronary revascularization, an Impella® pump was inserted for LV unloading and additional hemodynamic support (i.e., “ECMELLA”). Despite successful unloading by ECMELLA, post-cardiac arrest treatment was further complicated by sudden differential hypoxemia of the upper body. This so called “Harlequin phenomenon” was explained by a new onset of ALI, necessitating escalation of VA ECMO to VAV ECMO, while maintaining Impella® support. Comprehensive monitoring as derived from the Impella® console allowed to illustrate patient-specific hemodynamics of cardiac unloading. Ultimately, the patient recovered and was discharged from the hospital 28 days after admission. 12 months after the index event the patient was enrolled in the ECPR Outpatient Care Program which revealed good recovery of neurologic functions while physical exercise capacities were impaired.ConclusionA combined mechanical circulatory support strategy may successfully be deployed in complex cases of severe cardio-circulatory and respiratory failure as occasionally encountered in clinical practice. While appreciating potential clinical benefits, it seems of utmost importance to closely monitor the physiological effects and related complications of such a multimodal approach to reach the most favorable outcome as illustrated in this case.

show abstract

“…This concept was illustrated by means of simulation studies finding lower left atrial pressures during ECMO support in patients with reduced RV function. 4 As such, it could well be that patients with poor RV function have less benefit from LV unloading than those with preserved RV function, and they may only experience the increased complication rate imposed by a second device.…”

Section: To the Editormentioning

confidence: 99%

Letter by Meuwese et al Regarding Article, “Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study”

2021

Self Cite

View full text Add to dashboard Cite

Right–Left Ventricular Interaction in Left-Sided Heart Failure With and Without Venoarterial Extracorporeal Membrane Oxygenation Support—A Simulation Study

Abstract: Supplemental Digital Content is available in the text.

Cited by 22 publications

References 39 publications

Ventricular and Atrial Pressure-Volume Loops: Analysis of the Effects Induced by Right Centrifugal Pump Assistance

Ventricular and Atrial Pressure-Volume Loops: Analysis of the Effects Induced by Right Centrifugal Pump Assistance

Case report: Refractory cardiac arrest supported with veno-arterial-venous extracorporeal membrane oxygenation and left-ventricular Impella CP®–Physiological insights and pitfalls of ECMELLA

Letter by Meuwese et al Regarding Article, “Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study”

Contact Info

Product

Resources

About