Vascular pulsatility in patients with a pulsatile- or continuous-flow ventricular assist device
| Autor: | Mark S. Slaughter, Akif Ündar, M.A. Sobieski, David J. Farrar, Robert D. Dowling, Adam R. Travis, Sumanth D. Prabhu, Guruprasad A. Giridharan, Steven C. Koenig, George M. Pantalos |
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| Rok vydání: | 2007 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.medical_treatment Pulsatile flow Hemodynamics Risk Assessment Ventricular Dysfunction Left Reference Values Internal medicine Humans Medicine Aged Heart Failure Cardiopulmonary Bypass business.industry Stroke Volume Stroke volume Middle Aged medicine.disease Survival Rate Treatment Outcome medicine.anatomical_structure Ventricle Case-Control Studies Pulsatile Flow Ventricular assist device Heart failure Heart Function Tests Cardiology Aortic pressure Ventricular pressure Female Surgery Heart-Assist Devices Cardiology and Cardiovascular Medicine business Blood Flow Velocity Follow-Up Studies |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 133:517-524 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2006.09.057 |
| Popis: | Objective We sought to investigate differences in indices of pulsatility between patients with normal ventricular function and patients with heart failure studied at the time of implantation with continuous-flow or pulsatile-flow left ventricular assist devices. Methods Eight patients with normal ventricular function and 22 patients with heart failure were studied. A high-fidelity aortic and left ventricular pressure catheter was inserted retrograde through the aortic valve into the left ventricle, and transit-time flow probes were placed on the aorta and device outflow graft. Hemodynamic waveforms were recorded at native heart rate before cardiopulmonary bypass and over a range of device flow rates controlled by adjusting beat rate or rpm. These data were used to calculate vascular input impedance and 2 indices of vascular pulsatility: energy-equivalent pressure and surplus hemodynamic energy. Results At low support levels, pulsatile support restored surplus hemodynamic energy to within 2.5% of normal values, whereas continuous support diminished surplus energy by more than 93%. At high support levels, pulsatile support augmented surplus energy by 49% over normal values, whereas continuous support further diminished surplus energy by 97%. Pulsatile support diminished vascular impedance from baseline failure values, whereas continuous support increased impedance. Vascular impedances at baseline for patients undergoing pulsatile and continuous support and during pulsatile support revealed normal vascular compliance, whereas impedance during continuous support indicated a loss of compliance (or "stiffening") of the vasculature. Conclusion These results suggest that selection of device type and flow rate can influence vascular pulsatility and input impedance, which might affect clinical outcomes. |
| Databáze: | OpenAIRE |
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