In Vitro Pulsatility Analysis of Axial-Flow and Centrifugal-Flow Left Ventricular Assist Devices.
ABSTRACT Recently, continuous-flow ventricular assist devices (CF-VADs) have supplanted older, pulsatile-flow pumps, for treating patients with advanced heart failure. Despite the excellent results of the newer generation devices, the effects of long-term loss of pulsatility remain unknown. The aim of this study is to compare the ability of both axial and centrifugal continuous-flow pumps to intrinsically modify pulsatility when placed under physiologically diverse conditions. Four VADs, two axial- and two centrifugal-flow, were evaluated on a mock circulatory flow system. Each VAD was operated at a constant impeller speed over three hypothetical cardiac conditions: normo-tensive, hypertensive, and hypotensive. Pulsatility index (PI) was compared for each device under each condition. Centrifugal-flow devices had a higher PI than that of axial-flow pumps. Under normo-tension, flow PI was 0.98 ± 0.03 and 1.50 ± 0.02 for the axial and centrifugal groups, respectively (p < 0.01). Under hypertension, flow PI was 1.90 ± 0.16 and 4.21 ± 0.29 for the axial and centrifugal pumps, respectively (p = 0.01). Under hypotension, PI was 0.73 ± 0.02 and 0.78 ± 0.02 for the axial and centrifugal groups, respectively (p = 0.13). All tested CF-VADs were capable of maintaining some pulsatile-flow when connected in parallel with our mock ventricle. We conclude that centrifugal-flow devices outperform the axial pumps from the basis of PI under tested conditions.
- SourceAvailable from: Teruhiko Imamura[Show abstract] [Hide abstract]
ABSTRACT: Background:Predicting the occurrence of aortic insufficiency (AI) during left ventricular assist device (LVAD) support has remained unsolved.Methods and Results:We enrolled 52 patients who had received continuous flow LVAD (14 axial and 38 centrifugal pumps) and who been followed for ≥6 months between Jun 2006 and Dec 2013. Native aortic valve (AV) opening was observed in 18 patients (35%) with improved LV systolic function, and none of them had AI. On multivariate logistic regression analysis preoperative shorter heart failure duration was the only independent predictor of postoperative native AV opening (P=0.042; odds ratio [OR], 0.999). Of the remaining 34 patients (65%) with closed AV, 11 had AI with enlargement of the aortic root and narrow pulse pressure. Among those with closed AV, axial pump use (n=13) was the only significant predictor of the development of AI (P=0.042; OR, 4.950). Patients with AI had lower exercise capacity and a higher readmission rate than those without AI during 2-year LVAD support (55% vs. 8%; P<0.001).Conclusions:Native AV opening during LVAD support is profoundly associated with reversal of LV systolic function, especially in patients with preoperative shorter heart failure duration. Among those in whom the native AV remains closed, low pulsatility of axial flow pump may facilitate aortic root remodeling and post-LVAD AI development that results in worse clinical outcome.Circulation Journal 11/2014; 79(1). DOI:10.1253/circj.CJ-14-0944 · 3.69 Impact Factor
- ASAIO journal (American Society for Artificial Internal Organs: 1992) 03/2014; 60(2):137-9. DOI:10.1097/MAT.0000000000000055 · 1.39 Impact Factor
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ABSTRACT: The Jarvik 2000 adult ventricular assist device (VAD) is a second-generation blood pump with mechanical contact bearings. The original configuration of the pump employed a pin bearing and a more recent configuration uses a cone bearing. We compare the hydrodynamic performance of the two designs under steady-state and pulsatile flow conditions in vitro. Furthermore, we employ the Intermittent Low Speed (ILS) Flowmaker Controller to demonstrate the effect on pulsatility index (PI) performance of both device configurations. We use an open-loop flow system in both steady-state and pulsatile arrangements, complete with pressure transducers and flow probes. Working fluid was a 3.6 cP blood-analog, glycerin-water solution. Steady-state flow tests were carried out to determine pressure-flow (H-Q) performance curves. Pulsatile tests under normotensive, hypertensive, and hypotensive conditions were executed with controller speed 3 (10 710 ± 250 rpm) at 100 beats per minute. Steady-state tests show greater capacity for pressure and flow with the cone bearing, compared with pin bearing, with best efficiency point (BEP) 68% greater for cone bearing. Pulsatile tests show the cone bearing design to yield a 20% increase in Qavg , a 17% decrease in pulsatility index (PIQ ), and a qualitative increase in pressure responsivity. The ILS mode (for both bearing designs) decreases Qavg by 68% and likewise increases PIQ by 360% and pulsatility ratio (Rpul ) by 200%. The ILS controller regularly reduces the flow, increasing pulsatility index during device operation. The Jarvik 2000 continuous-flow VAD can sustain pulsatile flow under pulsating pressure conditions. The new cone bearing design yields increased flow rates over the earlier pin bearing design.Artificial Organs 08/2013; DOI:10.1111/aor.12160 · 1.87 Impact Factor