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Energetic parameter changes with mechanical ventilation in conjunction with BVAD assistance.

C De Lazzari1, M Darowski, G Ferrari

  • 1Istituto di Tecnologie Biomediche CNR, Reparto di Ingegneria Cardiovasculare, Rome, Italy. dela@itbm.rm.cnr.it

Journal of Medical Engineering & Technology
|July 10, 2002
PubMed
Summary

Biventricular assist device (BVAD) use decreases ventricular work but lowers cardiac efficiency. Positive intrathoracic pressure during BVAD support negatively impacts ventricular energetics, increasing oxygen consumption.

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Area of Science:

  • Cardiovascular Physiology
  • Biomedical Engineering
  • Medical Simulation

Background:

  • Ventricular assist devices (VADs) are crucial for heart failure management.
  • Understanding the interaction between mechanical ventilation and VADs is essential for optimizing patient care.
  • Biventricular assist devices (BVADs) support both ventricles but their impact on energetics under ventilation requires detailed study.

Purpose of the Study:

  • To evaluate the effects of a biventricular assist device (BVAD) on ventricular energetics.
  • To assess how mechanical ventilation influences BVAD performance on cardiac function.
  • To analyze changes in external work, oxygen consumption, and mechanical efficiency of both ventricles during BVAD support with varying intrathoracic pressures.

Main Methods:

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  • Utilized the CARDIOSIM computer simulator of the cardiovascular system.
  • Modeled a pathological left ventricular state and increased pulmonary resistance.
  • Simulated mechanical ventilation by altering mean intrathoracic pressure from 0 to +5 mmHg.

    • Main Results:

    • BVAD application reduced external work for both ventricles, an effect amplified by positive intrathoracic pressure.
    • Cardiac mechanical efficiency decreased with BVAD use, showing minimal sensitivity to intrathoracic pressure.
    • Oxygen consumption increased with BVAD support, though this increase was mitigated by positive intrathoracic pressure.
    • An increase in potential energy indicated ventricular unloading, evidenced by a rightward shift in the ventricular work cycle.

    Conclusions:

    • BVAD support generally unloads the ventricles, shifting the ventricular work cycle.
    • Positive intrathoracic pressure during BVAD assistance adversely affects overall ventricular energetics.
    • The interplay between BVADs and mechanical ventilation necessitates careful consideration to optimize hemodynamic support.