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Flow Patterns in the Carotid Arteries of Patients with Left Ventricular Assist Devices
Loay S Kabbani1, Semeret Munie1, Judith Lin1
1Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI.
Insights
Left ventricular assist device (LVAD) implantation alters carotid artery ultrasound waveforms, decreasing peak systolic velocity and increasing end-diastolic velocity. Mean flow velocity in the carotid arteries remains stable post-LVAD.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Vascular Surgery
Background:
- Left ventricular assist device (LVAD) implantation is a critical intervention for advanced heart failure.
- Understanding hemodynamic changes post-LVAD is crucial for patient management and monitoring.
- Carotid artery duplex ultrasound is a key non-invasive tool for vascular assessment.
Purpose of the Study:
- To evaluate and define expected changes in carotid artery flow patterns following LVAD implantation.
- To analyze alterations in waveform morphology and velocity parameters in the carotid arteries post-LVAD.
Main Methods:
- Retrospective review of patients undergoing LVAD placement between March 2008 and July 2012.
- Inclusion criteria: carotid artery duplex scans pre- and post-LVAD within 2 years, with <50% stenosis.
- Analysis of waveform type, peak systolic velocity, and end-diastolic velocities.
Main Results:
- 13 patients with LVAD underwent serial carotid duplex scans.
- Post-LVAD Doppler imaging revealed a 'parvus tardus' waveform.
- Peak systolic velocity decreased (P < 0.0001), while end-diastolic velocity increased (P < 0.0001) in carotid arteries.
- Mean flow velocities in common and internal carotid arteries remained stable.
Conclusions:
- LVAD placement significantly alters carotid artery duplex waveform morphology and velocity parameters.
- Despite changes in pulse pressure, mean carotid artery blood flow velocity is maintained post-LVAD.
- These findings provide important insights for interpreting carotid ultrasound in LVAD patients.
Background:
The aim of this study is to evaluate and define the expected flow pattern changes of carotid artery duplex ultrasound after left ventricular assist device (LVAD) placement.
Methods:
Retrospective review of Henry Ford Hospital database of patients who had undergone LVAD placement between March 2008 and July 2012 was performed. All patients who had carotid artery duplex scanning before and after LVAD placement within 2 years of each other and showed <50% stenosis were included in this study. Type of waveform, carotid peak systolic velocity, and end-diastolic velocities were analyzed, and the values were compared before and after LVAD placement.
Results:
A total of 13 patients with LVAD had at least 2 carotid duplex studies before and after LVAD placement within 2 years of each other. Of those, 92% (n = 12) were men, and 61% (n = 8) were Caucasian. Mean age was 61 years old. The HeartWare ventricular assist device was implanted in 4 patients and the HeartMate II left ventricular assist device was implanted in 9 patients. Post-LVAD Doppler imaging demonstrated parvus tardus waveform. Analysis of flow velocities revealed that peak systolic velocity was diminished after LVAD placement in both the internal and common carotid arteries (P = 0.006 and P < 0.0001, respectively). End-diastolic velocity, however, increased post-LVAD (P < 0.0001). Interestingly, mean flow velocities in both the common and internal carotid arteries remained stable after LVAD placement.
Conclusions:
This study reveals changes in waveform morphology and peak systolic and diastolic velocities in the common and internal carotid arteries on carotid duplex after LVAD placement. Additionally, it shows that despite changes in post-LVAD pulse pressure in the carotid arteries, the mean flow velocity remained unchanged.
