Vascular pulsatility in patients with a pulsatile- or continuous-flow ventricular assist device

Travis, Adam R.; Giridharan, Guruprasad A.; Pantalos, George M.; Dowling, Robert D.; Prabhu, Sumanth D.; Slaughter, Mark S.; Sobieski, Michael A.; Ündar, Akif; Farrar, David J.; Koenig, Steven C.

doi:10.1016/j.jtcvs.2006.09.057

Cited by 132 publications

(120 citation statements)

References 23 publications

(16 reference statements)

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“…2, dashed line). This magnitude of reduction in aortic pulsatile flow is consistent with the reported reduction of ejection fraction in patients with congestive heart failure (21) and in patients and experimental animals with implanted left-ventricular assist devices (26,32,44,72,73,81). To maintain mean pressure, peripheral resistances were increased.…”

Section: Methodssupporting

confidence: 85%

Aortic pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses

Nguyen

Tüzün²,

Quick

2016

American Journal of Physiology-Regulatory, Integrative and Comp

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Nguyen PH, Tuzun E, Quick CM. Aortic pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses. Am J Physiol Regul Integr Comp Physiol 311: R522-R531, 2016. First published June 15, 2016 doi:10.1152/ajpregu.00402.2015.-Aortic pulse pressure arises from the interaction of the heart, the systemic arterial system, and peripheral microcirculations. The complex interaction between hemodynamics and arterial remodeling precludes the ability to experimentally ascribe changes in aortic pulse pressure to particular adaptive responses. Therefore, the purpose of the present work was to use a human systemic arterial system model to test the hypothesis that pulse pressure homeostasis can emerge from physiological adaptation of systemic arteries to local mechanical stresses. First, we assumed a systemic arterial system that had a realistic topology consisting of 121 arterial segments. Then the relationships of pulsatile blood pressures and flows in arterial segments were characterized by standard pulse transmission equations. Finally, each arterial segment was assumed to remodel to local stresses following three simple rules: 1) increases in endothelial shear stress increases radius, 2) increases in wall circumferential stress increases wall thickness, and 3) increases in wall circumferential stress decreases wall stiffness. Simulation of adaptation by iteratively calculating pulsatile hemodynamics, mechanical stresses, and vascular remodeling led to a general behavior in response to mechanical perturbations: initial increases in pulse pressure led to increased arterial compliances, and decreases in pulse pressure led to decreased compliances. Consequently, vascular adaptation returned pulse pressures back toward baseline conditions. This behavior manifested when modeling physiological adaptive responses to changes in cardiac output, changes in peripheral resistances, and changes in local arterial radii. The present work, thus, revealed that pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses. vascular adaptation; compliance resetting; pulsatile hemodynamics; multiscale modeling AORTIC PULSE PRESSURE APPEARS to be homeostatic despite the lack of global regulatory mechanisms affecting elastic arteries. Cardiac output, peripheral resistances, and arterial compliances are the primary mechanical determinants of aortic pressures (40,47). Whereas mean pressure is predominantly determined by cardiac output and peripheral resistance, pulse pressure (systolic-diastolic) is also affected by compliance (the change in volume per change in transmural pressure) of the large elastic arteries (69). As arterial compliances decrease, pulse pressures tend to increase (40,41,47,48). Acutely, mean pressure and pulse pressure are physiologically coupled by feedback mechanisms: when pulse pressure rises, stretch-sensitive baroreceptors lower peripheral resistance, i.e., the baroreflex, which, in turn, lowers mean pressure. Furthe...

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Section: Methodssupporting

confidence: 85%

Aortic pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses

Nguyen

Tüzün²,

Quick

2016

American Journal of Physiology-Regulatory, Integrative and Comp

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“…Interaction between the native heart and the VAD as two pumps in parallel versus in a series leads to the presence or absence of a pulse pressure. 8 Aortic valve opening in the presence of a CF-LVAD is an imaging surrogate marker of pulsatility, and studies from our institution and others have shown a prevalence of aortic valve opening in up to 69% of patients. 9,10 Even with a closed aortic valve, pulsatility seems to be present, 11 possibly due to a contracting left ventricle that transmits a pulsatile flow change through the pump rotor.…”

Section: Pulsatility In Cf-lvadsmentioning

confidence: 87%

Physiological Impact of Continuous Flow on End-Organ Function: Clinical Implications in the Current Era of Left Ventricular Assist Devices

Bhimaraj¹,

Uribe²,

Suarez

2015

Methodist DeBakey Cardiovascular Journal

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“…Furthermore, continuous-flow devices lead to a reduction in pulse pressure that in turn increases systemic vascular resistance. 17 Eventually this interference with the circulatory system's mechanical properties may lead to an increased afterload and impact the regulatory properties of blood flow to end organs. 14,18 In a retrospective study analyzing the possibility of weaning after left ventricular assist therapy, pulsatile devices showed a three-fold higher recovery rate when compared to continuous-flow devices.…”

Section: Discussionmentioning

confidence: 99%

Review of Recent Results using Computational Fluid Dynamics Simulations in Patients Receiving Mechanical Assist Devices for End-Stage Heart Failure

Farag¹,

Karmonik²,

Rengier³

et al. 2014

Methodist DeBakey Cardiovascular Journal

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Vascular pulsatility in patients with a pulsatile- or continuous-flow ventricular assist device

Abstract: These results suggest that selection of device type and flow rate can influence vascular pulsatility and input impedance, which might affect clinical outcomes.

Cited by 132 publications

References 23 publications

Aortic pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses

Aortic pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses

Physiological Impact of Continuous Flow on End-Organ Function: Clinical Implications in the Current Era of Left Ventricular Assist Devices

Review of Recent Results using Computational Fluid Dynamics Simulations in Patients Receiving Mechanical Assist Devices for End-Stage Heart Failure

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