Assessment of right pump outflow banding and speed changes on pulmonary hemodynamics during biventricular support with two rotary left ventricular assist devices

Timms, Daniel, Gude, Einar, Gaddum, Nicholas, Lim, Einly, Greatrex, Nicholas, Wong, Kai, Steinseifer, Ulrich, Lovell, Nigel, Fraser, John and Fiane, Arnt (2011) Assessment of right pump outflow banding and speed changes on pulmonary hemodynamics during biventricular support with two rotary left ventricular assist devices. Artificial Organs, 35 8: 807-813. doi:10.1111/j.1525-1594.2011.01283.x


Author Timms, Daniel
Gude, Einar
Gaddum, Nicholas
Lim, Einly
Greatrex, Nicholas
Wong, Kai
Steinseifer, Ulrich
Lovell, Nigel
Fraser, John
Fiane, Arnt
Title Assessment of right pump outflow banding and speed changes on pulmonary hemodynamics during biventricular support with two rotary left ventricular assist devices
Journal name Artificial Organs   Check publisher's open access policy
ISSN 0160-564X
1525-1594
Publication date 2011-08
Sub-type Article (original research)
DOI 10.1111/j.1525-1594.2011.01283.x
Volume 35
Issue 8
Start page 807
End page 813
Total pages 7
Place of publication Hoboken, NJ, U.S.A.
Publisher Wiley-Blackwell Publishing
Collection year 2012
Language eng
Formatted abstract
The absence of an effective, easily implantable right ventricular assist device (RVAD) significantly diminishes long-term treatment options for patients with biventricular heart failure. The implantation of a second rotary left ventricular assist device (LVAD) for right heart support is therefore being considered; however, this approach exhibits technical challenges when adapting current devices to produce the lower pressures required of the pulmonary circulation. Hemodynamic adaptation may be achieved by either reducing the rotational speed of the right pump impeller or reducing the diameter of the right outflow cannula by the placement of a restricting band; however, the optimal value and influence of changes to each parameter are not well understood. Hemodynamics were therefore investigated using different banding diameters of the right outflow cannula (3–6.5 mm) and pump speeds (500–4500 rpm), using two identical rotary blood pumps coupled to a pulsatile mock circulation loop. Reducing the speed of the right pump from 4900 rpm (for left ventricle support) to 3500 rpm, or banding the Ø10 mm (area 78.5 mm2) right outflow graft to Ø5.4 mm (22.9 mm2) produced suitable hemodynamics. Pulmonary pressures were most sensitive to banding diameters, especially when RVAD flow exceeded LVAD flow. This occurred between Ø5.3 and Ø6.5 mm (22.05–38.5 mm2) and speeds between 3200 and 4400 rpm, with the flow imbalance potentially leading to pulmonary congestion. Total flow was not affected by banding diameters and speeds below this range, and only increased slightly at higher values. Both right outflow banding or right pump speed reduction were found to be effective techniques to allow a rotary LVAD to be used directly for right heart support. However, the observed sensitivity to diameter and speed indicate that challenges may be presented when setting appropriate values for each patient, and control over these parameters is desirable.
Keyword Rotary blood pump
Biventricular heart failure
Left ventricular assist device
Biventricular assist device
Mock circulation loop
Blood pump
Head estimation
Pressure-head
Flow-rate
Cardiomyopathy
Identification
Pulsatile
Recovery
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published under "Thoughts and Progress".

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 11 times in Thomson Reuters Web of Science Article | Citations
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