The effect of ventricular assist devices on cerebral autoregulation: A preliminary study

Bellapart, Judith, Chan, Gregory S, Tseng, Yu-Chieh, Ainslie, Philip, Barnett, Adrian G., Dunster, Kimble R., Boots, Rob and Fraser, John F. (2011) The effect of ventricular assist devices on cerebral autoregulation: A preliminary study. BMC Anesthesiology, 11 4-1-4-8. doi:10.1186/1471-2253-11-4

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Author Bellapart, Judith
Chan, Gregory S
Tseng, Yu-Chieh
Ainslie, Philip
Barnett, Adrian G.
Dunster, Kimble R.
Boots, Rob
Fraser, John F.
Title The effect of ventricular assist devices on cerebral autoregulation: A preliminary study
Journal name BMC Anesthesiology   Check publisher's open access policy
ISSN 1471-2253
Publication date 2011-02-22
Sub-type Article (original research)
DOI 10.1186/1471-2253-11-4
Open Access Status DOI
Volume 11
Start page 4-1
End page 4-8
Total pages 8
Place of publication London, U.K.
Publisher BioMed Central
Collection year 2012
Language eng
Formatted abstract
Background: The insertion of Ventricular Assist Devices is a common strategy for cardiovascular support in patients with refractory cardiogenic shock. This study sought to determine the impact of ventricular assist devices on the dynamic relationship between arterial blood pressure and cerebral blood flow velocity.

Methods:
A sample of 5 patients supported with a pulsatile ventricular assist device was compared with 5 control patients. Controls were matched for age, co-morbidities, current diagnosis and cardiac output state, to cases. Beatto-beat recordings of mean arterial pressure and cerebral blood flow velocity, using transcranial Doppler were
obtained. Transfer function analysis was performed on the lowpass filtered pressure and flow signals, to assess gain, phase and coherence of the relationship between mean arterial blood pressure and cerebral blood flow velocity. These parameters were derived from the very low frequency (0.02-0.07 Hz), low frequency (0.07-0.2 Hz) and high frequency (0.2-0.35 Hz).

Results:
No significant difference was found in gain and phase values between the two groups, but the low frequency coherence was significantly higher in cases compared with controls (mean ± SD: 0.65 ± 0.16 vs 0.38 ± 0.19, P = 0.04). The two cases with highest coherence (~0.8) also had much higher spectral power in mean arterial blood pressure.

Conclusions: Pulsatile ventricular assist devices affect the coherence but not the gain or phase of the cerebral pressure-flow relationship in the low frequency range; thus whether there was any significant disruption of cerebral autoregulation mechanism was not exactly clear. The augmentation of input pressure fluctuations might contribute in part to the higher coherence observed.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article no.4.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Medicine Publications
 
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Created: Fri, 09 Sep 2011, 15:40:13 EST by Sia Athanasas on behalf of Anaesthesiology and Critical Care - RBWH