Physiologic-insensitive left ventricular assist predisposes right-sided circulatory failure: a pilot simulation and validation study.

Right-sided circulatory failure (RSCF) is a serious complication in 15-30% of patients receiving a left ventricular assist device (LVAD). It is hypothesized that left ventricular support which lacks physiologic properties predisposes to RSCF. An integral computer simulation and experimental validation protocol was performed. The results suggest that with conventional insensitive left ventricular support right-sided circulatory function is compromised, which may form a substrate for the onset or progress of RSCF. Feedback control of the LVAD could provide a means to counter this problem. A control concept for the LVAD which aims to preserve right-sided circulatory function, while supporting peripheral perfusion, is proposed

[1]  B. Griffith,et al.  Assessment of the response of right ventricular performance to decreasing levels of mechanical assistance by on-line pressure area relationships. , 1994, ASAIO journal.

[2]  B Buis,et al.  Continuous measurement of left ventricular volume in animals and humans by conductance catheter. , 1984, Circulation.

[3]  P. Havlík,et al.  Control of a rotary pulsatile cardiac assist pump driven by an electric motor without a pressure sensor to avoid collapse of the pump inlet. , 1993, ASAIO journal.

[4]  B. McInnis,et al.  Adaptive control of left ventricular bypass assist devices , 1985 .

[5]  C. Mélot,et al.  Pulmonary arterial pressure-flow plots in dogs: effects of isoflurane and nitroprusside. , 1987, Journal of applied physiology.

[6]  J F Antaki,et al.  Dynamic systemic vascular resistance in a sheep supported with a Nimbus AxiPump. , 1994, ASAIO journal.

[7]  M. Leeman,et al.  The pulmonary circulation in acute lung injury: A review of some recent advances , 2005, Intensive Care Medicine.

[8]  D. Farrar,et al.  Right ventricular function in an operating room model of mechanical left ventricular assistance and its effects in patients with depressed left ventricular function. , 1985, Circulation.

[9]  J R Jansen,et al.  Left ventricular pressure-volume relationships before and after cardiomyoplasty in patients with heart failure. , 1997, Circulation.

[10]  E Müller,et al.  Servoregulation of Centrifugal Pumps: A New Technical Approach to Improve Patient Safety During Long-Term Extracorporeal Life Support , 1996, ASAIO journal.

[11]  Ulrich Schotten,et al.  The role of atrial dilatation in the domestication of atrial fibrillation. , 2003, Progress in biophysics and molecular biology.

[12]  P. McCarthy,et al.  Left ventricular assist device bridge to recovery: a review of the current status. , 2001, The Annals of thoracic surgery.

[13]  Ventricular/vascular interaction in health and heart failure. , 1992 .

[14]  W. Dassen,et al.  Right ventricular support for off-pump coronary artery bypass grafting studied with bi-ventricular pressure--volume loops in sheep. , 2001, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.