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Hemodynamic changes and retrograde flow in LVAD failure.

Guruprasad A Giridharan1, Steven C Koenig, Kevin G Soucy

  • 1From the *Department of Bioengineering, Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky 40292; †Department of Cardiovascular and Thoracic Surgery, Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky 40202; ‡Eidgenössische Technische Hochschule Hönggerberg, Zürich, Switzerland; and §Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|January 31, 2015
PubMed
Summary
This summary is machine-generated.

Left ventricular assist device (LVAD) failure causes significant retrograde flow in rotary blood pumps, leading to adverse physiological responses. This impacts heart function and end-organ perfusion, highlighting risks associated with device malfunction.

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Area of Science:

  • Cardiovascular Engineering
  • Biomedical Engineering
  • Medical Device Research

Background:

  • Left ventricular assist devices (LVADs) are crucial for end-stage heart failure treatment.
  • Understanding LVAD failure modes is critical for patient safety and device development.
  • Rotary blood pumps are commonly used in modern LVADs, but their behavior during failure is not fully characterized.

Purpose of the Study:

  • To investigate the hemodynamic and physiological consequences of catastrophic left ventricular assist device (LVAD) failure.
  • To determine if rotary blood pumps experience significant retrograde flow during LVAD failure.
  • To compare the effects of different LVAD types (pulsatile, axial, centrifugal) on physiological responses during failure.

Main Methods:

  • Computer simulations of LVAD failure scenarios.
  • Mock flow loop experiments with pulsatile and centrifugal pumps.
  • In vivo studies using healthy and ischemic heart failure bovine models with pulsatile, axial, and centrifugal LVADs.
  • Hemodynamic, echocardiographic, and end-organ perfusion measurements.

Main Results:

  • Retrograde flow was consistently observed in axial and centrifugal rotary pumps during simulated and actual LVAD failure across all models.
  • Significant retrograde flow occurred in axial (-2.2 L/min) and centrifugal (-1.9 L/min) pumps in healthy bovine models.
  • LVAD failure-induced retrograde flow increased ventricular volumes and workload, while decreasing myocardial and end-organ perfusion.

Conclusions:

  • Rotary blood pumps, specifically axial and centrifugal types, are susceptible to significant retrograde flow during LVAD failure.
  • This retrograde flow induces adverse physiological responses, including impaired cardiac function and reduced end-organ perfusion.
  • Findings underscore the importance of addressing pump design and failure management strategies to mitigate risks associated with LVAD malfunction.