The impact of right ventricular hemodynamics on the performance of a left ventricular assist device in a numerical simulation model.
advanced heart failure
hemodynamic parameters
left ventricular assist device
numerical simulation
right heart failure
Journal
Biomedizinische Technik. Biomedical engineering
ISSN: 1862-278X
Titre abrégé: Biomed Tech (Berl)
Pays: Germany
ID NLM: 1262533
Informations de publication
Date de publication:
26 Oct 2023
26 Oct 2023
Historique:
received:
16
07
2020
accepted:
03
04
2023
medline:
6
10
2023
pubmed:
26
4
2023
entrez:
26
4
2023
Statut:
epublish
Résumé
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. 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. 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. 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.
Identifiants
pubmed: 37099745
pii: bmt-2020-0188
doi: 10.1515/bmt-2020-0188
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
503-510Informations de copyright
© 2023 Walter de Gruyter GmbH, Berlin/Boston.
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