The Impact of Pump Speed and Inlet Cannulation Site on Left Ventricular Unloading with a Rotary Blood Pump

Vandenberghe, Stijn; Nishida, Takahiro; Segers, Patrick; Meyns, Bart; Verdonck, Pascal

doi:10.1111/j.1525-1594.2004.07374.x

Cited by 11 publications

(18 citation statements)

References 17 publications

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“…The tVAD simulation was intended as a baseline experiment that represents the use of tVADs in clinical application today. There are numerous studies that have investigated augmented pulsatility in tVADs through speed modulation [1,3,4,16,26,27,33,34]. These studies have shown improved levels of pulsatility, left ventricular unloading and blood flow through the aortic valve, but were exceeded by the values of our pVAD simulation.…”

Section: Discussionmentioning

confidence: 91%

“…Previous studies have investigated synchronization ratios (1:2 and 1:4) lower than the HR under one given phase-shift setting [24] with the intention of establishing a weaning protocol. The importance of considering the pump timing and systolic fraction as an integral part of the investigation has been shown in vivo by [2] for pVADs and by [1,3,4,26,33,34] both in silico and in vivo for tVADs.…”

Section: Discussionmentioning

confidence: 99%

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High-frequency operation of a pulsatile VAD – a simulation study

Rebholz

Amacher

Petrou

et al. 2017

Biomedical Engineering / Biomedizinische Technik

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Ventricular assist devices (VADs) are mechanical blood pumps that are clinically used to treat severe heart failure. Pulsatile VADs (pVADs) were initially used, but are today in most cases replaced by turbodynamic VADs (tVADs). The major concern with the pVADs is their size, which prohibits full pump body implantation for a majority of patients. A reduction of the necessary stroke volume can be achieved by increasing the stroke frequency, while maintaining the same level of support capability. This reduction in stroke volume in turn offers the possibility to reduce the pump's overall dimensions. We simulated a human cardiovascular system (CVS) supported by a pVAD with three different stroke rates that were equal, two-or threefold the heart rate (HR). The pVAD was additionally synchronized to the HR for better control over the hemodynamics and the ventricular unloading. The simulation results with a HR of 90 bpm showed that a pVAD stroke volume can be reduced by 71%, while maintaining an aortic pulse pressure (PP) of 30 mm Hg, avoiding suction events, reducing the ventricular stroke work (SW) and allowing the aortic valve to open. A reduction by 67% offers the additional possibility to tune the interaction between the pVAD and the CVS. These findings allow a major reduction of the pVAD's body size, while allowing the physician to tune the pVAD according to the patient's needs.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

High-frequency operation of a pulsatile VAD – a simulation study

Rebholz

Amacher

Petrou

et al. 2017

Biomedical Engineering / Biomedizinische Technik

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“…For instance, previous in vitro (8) and in vivo (20) studies have shown that left atrial cannulation reduced left ventricular SW compared with left ventricular cannulation that may encourage myocardial recovery (35). For instance, previous in vitro (8) and in vivo (20) studies have shown that left atrial cannulation reduced left ventricular SW compared with left ventricular cannulation that may encourage myocardial recovery (35).…”

Section: Discussionmentioning

confidence: 99%

“…The hemodynamic effect of LVAD inflow cannulation site has been researched extensively through numerical simulations (19), in vitro evaluation (8), and in vivo animal models (20)(21)(22). Most agree that left ventricular cannulation is the preferred interface site for implantable LVADs (15,21).…”

mentioning

confidence: 99%

Evaluation of Inflow Cannulation Site for Implantation of Right‐Sided Rotary Ventricular Assist Device

Gregory

Pearcy

Timms³

2013

Artificial Organs

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Right heart dysfunction is one of the most serious complications following implantation of a left ventricular assist device, often leading to the requirement for short- or long-term right ventricular assist device (RVAD) support. The inflow cannulation site induces major hemodynamic changes and so there is a need to optimize the site used depending on the patient's condition. Therefore, this study evaluated and compared the hemodynamic influence of right atrial cannulation (RAC) and right ventricular cannulation (RVC) inflow sites. An in vitro variable heart failure mock circulation loop was used to compare RAC and RVC in mild and severe biventricular heart failure (BHF) conditions. In the severe BHF condition, higher ventricular ejection fraction (RAC: 13.6%, RVC: 32.7%) and thus improved heart chamber and RVAD washout were observed with RVC, which suggested this strategy might be preferable for long-term support (i.e., bridge-to-transplant or destination therapy) to reduce the risk of thrombus formation. In the mild BHF condition, higher pulmonary valve flow (RAC: 3.33 L/min, RVC: 1.97 L/min) and lower right ventricular stroke work (RAC: 0.10 W, RVC: 0.13 W) and volumes were recorded with RAC. These results indicate an improved potential for myocardial recovery, thus RAC should be chosen in this condition. This in vitro study suggests that RVAD inflow cannulation site should be chosen on a patient-specific basis with a view to the support strategy to promote myocardial recovery or reduce the risk of long-term complications.

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“…Via modified Seldinger technique, the inflow cannula is implanted between the right superior and inferior pulmonary veins and positioned in the left atrium. Left atrial versus left ventricular cannulation with a continuous-flow LVAD provide similar flow rates, and left ventricular volumes and energetic parameters decrease with increasing pump speed irrespective of cannulation site 72 . These data and the clinical experience described below support the use of the left atrium as a cannulation site for continuous-flow devices.…”

Section: Partial-support Devices: Rotary Pumpsmentioning

confidence: 95%

The Future of Adult Cardiac Assist Devices: Novel Systems and Mechanical Circulatory Support Strategies

Bartoli

Dowling

2011

Cardiology Clinics

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Synopsis The recent, widespread success of mechanical circulatory support has ushered in a new era of cardiovascular medicine in which numerous implantable devices exist to treat advanced heart failure. As cardiac assist devices gain prevalence in the clinical management of cardiovascular disease, it is increasingly important to raise awareness of novel device systems, the unique mechanisms by which they function, and implications for patient management. In this article, we present state-of-the-art devices that are currently under development or in clinical trials. Devices are categorized as Standard Full-Support (HeartMate III, CorAide, Evaheart LVAS), Less-Invasive Full-Support (MVAD), Partial-Support (CircuLite Synergy Pocket Micro-Pump, Reitan Catheter Pump, Procyrion CAD, C-Pulse, Symphony Counterpulsation Device) Right Ventricular Assist Device (RVAD; DexAide, Impella RD Recover, Impella RP), and Total Artificial Heart (TAH; CardioWest, AbioCor II, Continuous-Flow TAH, Continuous-Flow BiVAD). Implantation strategy, mechanism of action, durability, efficacy, hemocompatibility, and human factors such as quality of life during device support are considered. The feasibility of novel strategies for unloading the failing heart is examined.

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The Impact of Pump Speed and Inlet Cannulation Site on Left Ventricular Unloading with a Rotary Blood Pump

Abstract: LV assist with a rotary blood pump can provide sufficient unloading with atrial cannulation.

Cited by 11 publications

References 17 publications

High-frequency operation of a pulsatile VAD – a simulation study

High-frequency operation of a pulsatile VAD – a simulation study

Evaluation of Inflow Cannulation Site for Implantation of Right‐Sided Rotary Ventricular Assist Device

The Future of Adult Cardiac Assist Devices: Novel Systems and Mechanical Circulatory Support Strategies

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