Detection of inflow obstruction in left ventricular assist devices by accelerometer: A porcine model study.

Autor: Lilja D; The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: didlil@ous-hf.no., Schalit I; The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway., Espinoza A; The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway., Fiane AE; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway., Dahle G; Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway., Littorin-Sandbu H; The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway., Pettersen FJ; Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway; Department of Physics, University of Oslo, Oslo, Norway., Russell KE; Department of Cardiology, Oslo University Hospital, Oslo, Norway., Thiara APS; Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway., Elle OJ; The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway; Department of Informatics, University of Oslo, Norway., Halvorsen PS; The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Jazyk: angličtina
Zdroj: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2023 Aug; Vol. 42 (8), pp. 1005-1014. Date of Electronic Publication: 2023 Apr 05.
DOI: 10.1016/j.healun.2023.03.017
Abstrakt: Background: Left ventricular assist devices (LVAD) provide circulatory blood pump support for severe heart failure patients. Pump inflow obstructions may lead to stroke and pump malfunction. We aimed to verify in vivo that gradual inflow obstructions, representing prepump thrombosis, are detectable by a pump-attached accelerometer, where the routine use of pump power (P LVAD ) is deficient.
Method: In a porcine model (n = 8), balloon-tipped catheters obstructed HVAD inflow conduits by 34% to 94% in 5 levels. Afterload increases and speed alterations were conducted as controls. We computed nonharmonic amplitudes (NHA) of pump vibrations captured by the accelerometer for the analysis. Changes in NHA and P LVAD were tested by a pairwise nonparametric statistical test. Detection sensitivities and specificities were investigated by receiver operating characteristics with areas under the curves (AUC).
Results: NHA remained marginally affected during control interventions, unlike P LVAD . NHA elevated during obstructions within 52-83%, while mass pendulation was most pronounced. Meanwhile, P LVAD changed far less. Increased pump speeds tended to amplify the NHA elevations. The corresponding AUC was 0.85-1.00 for NHA and 0.35-0.73 for P LVAD .
Conclusion: Elevated NHA provides a reliable indication of subclinical gradual inflow obstructions. The accelerometer can potentially supplement P LVAD for earlier warnings and localization of pump.
(Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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