Ventricular assist device outflow-graft site: effect on myocardial blood flow

Recent advances in left ventricular assist device (LVAD) technology have resulted in small, durable, energy-efficient, continuous-flow blood pumps that can support patients with end-stage heart failure. However, the effects of reduced or nonpulsatile flow on end-organ function are unclear. We performed a pilot study in calves with a continuous-flow LVAD to assess the effects of the pump's outflow-graft location (ascending versus descending aorta) on myocardial blood flow.

In 8 healthy calves, we implanted the Jarvik 2000 LVAD in the left ventricular apex without the use of cardiopulmonary bypass. We anastomosed the outflow graft to either the ascending aorta (group 1; n = 4) or the descending aorta (group 2; n = 4). Hemodynamic parameters, myocardial oxygen consumption, and regional myocardial blood flow (analyzed with colored microspheres) were assessed at baseline (pump off) and during pump operation at 8000, 10,000, and 12,000 rpm.

No intergroup differences were found in the aortic pressure, heart rate, central venous pressure, pump-flow to total-cardiac-flow ratio, or blood flow in the left anterior descending and right posterior descending coronary arteries at increasing pump speeds. Neither myocardial oxygen consumption nor myocardial tissue perfusion differed significantly between the two groups.

Regardless of the outflow-graft location (ascending versus descending aorta), the continuous-flow LVAD unloaded the left ventricle and did not adversely affect myocardial perfusion in either the right or left ventricle. Owing to the small number of animals studied, however, the most we can conclude is that neither outflow-graft location appeared to be inferior to the other.