TY - JOUR
T1 - Mitral Valve Regurgitation with a Rotary Left Ventricular Assist Device
T2 - The Haemodynamic Effect of Inlet Cannulation Site and Speed Modulation
AU - Gregory, Shaun D.
AU - Stevens, Michael C.
AU - Wu, Eric L.
AU - Pauls, Jo P.
AU - Kleinheyer, Matthias
AU - Fraser, John F.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Mitral valve regurgitation (MVR) is common in patients receiving left ventricular assist device (LVAD) support, however the haemodynamic effect of MVR is not entirely clear. This study evaluated the haemodynamic effect of MVR with LVAD support and the influence of inflow cannulation site and LVAD speed modulation. Left atrial (LAC) and ventricular (LVC) cannulation was evaluated in a mock circulation loop with no, mild, moderate and severe MVR with constant speed and speed modulation (±600 RPM) modes. The use of an LVAD relieved pulmonary congestion during severe MVR, by reducing left atrial pressure from 20.5 to 10.8 (LAC) and 11.5 (LVC) mmHg. However, LAC resulted in decreased left ventricular stroke work (−0.08 J), ejection fraction (−7.9%) and higher MVR volume (+12.7 mL) and pump speed (+100 RPM) compared to LVC. This suggests that LVC, in addition to reducing MVR severity, also improves ventricular washout over LAC. LVAD speed modulation in synchrony with ventricular systole reduced MVR volume and increased ejection fraction with LAC and LVC, thus demonstrating the potential benefits of this mode, despite a reduction in cardiac output.
AB - Mitral valve regurgitation (MVR) is common in patients receiving left ventricular assist device (LVAD) support, however the haemodynamic effect of MVR is not entirely clear. This study evaluated the haemodynamic effect of MVR with LVAD support and the influence of inflow cannulation site and LVAD speed modulation. Left atrial (LAC) and ventricular (LVC) cannulation was evaluated in a mock circulation loop with no, mild, moderate and severe MVR with constant speed and speed modulation (±600 RPM) modes. The use of an LVAD relieved pulmonary congestion during severe MVR, by reducing left atrial pressure from 20.5 to 10.8 (LAC) and 11.5 (LVC) mmHg. However, LAC resulted in decreased left ventricular stroke work (−0.08 J), ejection fraction (−7.9%) and higher MVR volume (+12.7 mL) and pump speed (+100 RPM) compared to LVC. This suggests that LVC, in addition to reducing MVR severity, also improves ventricular washout over LAC. LVAD speed modulation in synchrony with ventricular systole reduced MVR volume and increased ejection fraction with LAC and LVC, thus demonstrating the potential benefits of this mode, despite a reduction in cardiac output.
KW - Cannula
KW - Heart failure
KW - Mitral valve regurgitation
KW - Speed modulation
KW - Ventricular assist device
UR - http://www.scopus.com/inward/record.url?scp=84959321804&partnerID=8YFLogxK
U2 - 10.1007/s10439-016-1579-5
DO - 10.1007/s10439-016-1579-5
M3 - Article
C2 - 26932840
AN - SCOPUS:84959321804
VL - 44
SP - 2674
EP - 2682
JO - Annals of Biomedical Engineering
JF - Annals of Biomedical Engineering
SN - 0090-6964
IS - 9
ER -