The impact of right ventricular hemodynamics on the performance of a left ventricular assist device in a numerical simulation model
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Date
2023-10-26
Publication Type
Journal Article
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yes
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Abstract
Objectives
Left ventricular assist devices (LVADs) have been established as alternative to heart transplantation for patients with end-stage heart failure refractory to medical therapy. Right heart failure (RHF) after LVAD implantation is associated with inferior outcome. Its preoperative anticipation may influence the selection between a pure left ventricular and a biventricular device type and, thus, improve outcomes. Reliable algorithms to predict RHF are missing.
Methods
A numerical model was used for simulation of a cardiovascular circulation. The LVAD was placed as parallel circuit between left ventricle and aorta. In contrast to other studies, the dynamic hydraulic behavior of a pulsatile LVAD was replaced by that of a continuous LVAD. A variety of hemodynamic states was tested mimicking different right heart conditions. Adjustable parameters included heart rate (HR), pulmonary vascular resistance (PVR), tricuspid regurgitation (TR), right ventricular contractility (RVC) and pump speed. Outcome parameters comprised central venous pressure (CVP), mean pulmonary artery pressure (mPAP), cardiac output (CO) and occurrence of suction.
Results
Alteration of HR, PVR, TR, RVC and pump speed resulted in diverse effects on CO, CVP and mPAP, resulting in improvement, impairment or no change of the circulation, depending on the degree of alteration.
Conclusions
The numerical simulation model allows prediction of circulatory changes and LVAD behaviour following variation of hemodynamic parameters. Such a prediction may be of particular advantage to anticipate RHF after LVAD implantation. It may help preoperatively to choose the appropriate strategy of only left ventricular or both left and right ventricular support.
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Publication status
published
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Editor
Book title
Journal / series
Volume
68 (5)
Pages / Article No.
503 - 510
Publisher
De Gruyter
Event
Edition / version
Methods
Software
Geographic location
Date collected
Date created
Subject
advanced heart failure; hemodynamic parameters; left ventricular assist device; numerical simulation; right heart failure
Organisational unit
03943 - Meboldt, Mirko / Meboldt, Mirko
Notes
It was possible to publish this article open access thanks to a Swiss National Licence with the publisher.