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Related Concept Videos

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Changes in Aortic Wall Structure, Composition, and Stiffness With Continuous-Flow Left Ventricular Assist Devices: A

Amrut V Ambardekar1, Kendall S Hunter2, Ashok N Babu2

  • 1From the Department of Medicine, Division of Cardiology (A.V.A.), Department of Bioengineering (K.S.H., R.B.D.), Department of Pediatrics, Division of Cardiology (K.S.H.), Department of Surgery, Division of Cardiothoracic Surgery (A.N.B.), Department of Medicine, Divisions of Pulmonary Sciences and Critical Care Medicine (R.M.T.), and Department of Surgery, Division of Pediatric Surgery (R.B.D.), University of Colorado, Aurora; and Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.). Amrut.Ambardekar@ucdenver.edu.

Circulation. Heart Failure
|July 3, 2015
PubMed
Summary

Continuous-flow left ventricular assist devices (LVADs) increase aortic wall stiffness and alter aortic composition. These changes in patients with heart failure (HF) suggest nonpulsatile flow impacts aortic structure.

Keywords:
aortacollagenelastinheart failureheart-assist devicesmuscle, smoothvascular stiffness

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Area of Science:

  • Cardiovascular Research
  • Biomedical Engineering
  • Translational Medicine

Background:

  • The impact of nonpulsatile blood flow from continuous-flow left ventricular assist devices (LVADs) on aortic structure and function remains largely unknown.
  • Understanding these effects is crucial for managing patients with advanced heart failure (HF).

Purpose of the Study:

  • To investigate the structural and compositional changes in the aorta of patients with continuous-flow LVADs.
  • To directly measure aortic wall stiffness in these patients.

Main Methods:

  • Aortic wall samples were collected from heart failure (HF) patients (with and without LVADs) and nonfailing donors.
  • Stereological methods quantified aortic morphometry and composition.
  • Biomechanical testing assessed aortic wall stiffness (stress-strain relationship).

Main Results:

  • Aortic walls from HF patients with LVADs showed increased thickness, collagen, and smooth muscle.
  • Elastin and mucinous ground substance content were reduced in the HF+LVAD group.
  • Aortic stiffness significantly increased in HF+LVAD patients compared to HF patients and nonfailing donors (P<0.001).

Conclusions:

  • Continuous-flow LVADs, in the absence of aortic valve opening, induce significant changes in aortic structure and composition.
  • Aortic wall stiffness is markedly increased in LVAD patients.
  • Further research is needed to explore the systemic consequences of nonpulsatile flow on aortic function.