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Left Ventricular Assist Device Pump Obstruction Reduces Native Heart Efficiency

Ricardo Montes1, Saniya Salim Ueckert1, Vi Vu1

  • 1Bioengineering Program, San Diego State University, San Diego, CA 92182, USA.

Bioengineering (Basel, Switzerland)
|December 23, 2023
PubMed

Insights

Progressive obstruction in left ventricular assist device (LVAD) inflow pathways significantly reduces cardiac function and increases thromboembolic risk. Early detection of these obstructions is crucial for timely intervention and improved patient outcomes.

Area of Science:

  • Biomedical Engineering
  • Cardiovascular Physiology
  • Medical Device Research

Background:

  • Left ventricular assist devices (LVADs) are crucial for end-stage heart failure treatment.
  • Obstruction in the LVAD flow path, caused by thrombus or tissue overgrowth, can lead to serious complications like embolism and stroke.
  • Understanding the hemodynamic impact of LVAD obstruction is vital for patient management.

Purpose of the Study:

  • To quantify the effects of progressive pump inflow obstruction on pressure and flow dynamics in LVAD-supported hearts.
  • To investigate the influence of obstruction on native heart function and intraventricular flow patterns.
  • To identify potential indicators for early detection of LVAD obstruction.

Main Methods:

  • Utilized a mock circulatory loop to simulate LVAD function under controlled conditions.
  • Introduced progressive pump obstruction (PO) by gradually occluding the LVAD inlet area.
  • Measured pressures, flows, and left ventricular (LV) midplane velocity fields across varying LVAD speeds and PO levels.

Main Results:

  • Increasing pump obstruction led to decreased pressures and flows within the LVAD system.
  • A significant portion of flow was diverted through the aortic valve, reducing total flow by 6-11%.
  • Native heart efficiency decreased by up to 60%, with restricted diastolic LVAD flow, reduced mitral inflow, and weakened intraventricular vortices.

Conclusions:

  • LVAD pump obstruction alters intraventricular flow architecture, promoting flow stasis and increased shear stress, thereby increasing thromboembolic risk.
  • The observed changes in flow dynamics and reduced cardiac efficiency highlight the clinical significance of LVAD obstruction.
  • Analyzing the contributions to external work may offer a method for early detection, enabling therapeutic intervention to prevent device failure and complications.

Keywords:
LVADflowheartthrombusventriclevortex

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