Banding the right ventricular assist device outflow conduit: is it really necessary with current devices?

Lo, Casey, Gregory, Shaun, Stevens, Michael, Murphy, Deirdre and Marasco, Silvana (2015) Banding the right ventricular assist device outflow conduit: is it really necessary with current devices?. Artificial Organs, 39 12: 1055-1061. doi:10.1111/aor.12497

Author Lo, Casey
Gregory, Shaun
Stevens, Michael
Murphy, Deirdre
Marasco, Silvana
Title Banding the right ventricular assist device outflow conduit: is it really necessary with current devices?
Journal name Artificial Organs   Check publisher's open access policy
ISSN 1525-1594
Publication date 2015-05-21
Sub-type Article (original research)
DOI 10.1111/aor.12497
Open Access Status Not yet assessed
Volume 39
Issue 12
Start page 1055
End page 1061
Total pages 7
Place of publication Hoboken, NJ, United States
Publisher Wiley-Blackwell Publishing
Collection year 2016
Language eng
Abstract Implantable left ventricular assist devices (LVADs) have been adapted clinically for right-sided mechanical circulatory support (RVAD). Previous studies on RVAD support have established the benefits of outflow cannula restriction and rotational speed reduction, and recent literature has focused on assessing either the degree of outflow cannula restriction required to simulate left-sided afterload, or the limitation of RVAD rotational speeds. Anecdotally, the utility of outflow cannula restriction has been questioned, with suggestion that banding may be unnecessary and may be replaced simply by varying the outflow conduit length. Furthermore, many patients have a high pulmonary vascular resistance (PVR) at the time of ventricular assist device (VAD) insertion that reduces with pulmonary vascular bed remodeling. It is therefore important to assess the potential changes in flow through an RVAD as PVR changes. In this in vitro study, we observed the use of dual HeartWare HVAD devices (HeartWare Inc., Framingham, MA, USA) in biventricular support (BiVAD) configuration. We assessed the pumps' ability to maintain hemodynamic stability with and without banding; and with varying outflow cannulae length (20, 40, and 60 cm). Increased length of the outflow conduit was found to produce significantly increased afterload to the device, but this was not found to be necessary to maintain the device within the manufacturer's recommended operational parameters under a simulated normal physiological setting of mild and severe right ventricular (RV) failure. We hypothesize that 40 cm of outflow conduit, laid down along the diaphragm and then up over the RV to reach the pulmonary trunk, will generate sufficient resistance to maintain normal pump function.
Keyword Biventricular assist device
Heart failure
Heart transplant
Left ventricular assist device
Mechanical circulatory support
Mock circulation loop
Pulmonary hypertension
Pulmonary vascular resistance
Right ventricular assist device
Right ventricular failure
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
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