HeartMate 3 for Heart Failure with Preserved Ejection Fraction: In Vitro Hemodynamic Evaluation and Anatomical...

Area of Science:

• Cardiovascular Medicine
• Biomedical Engineering
• Medical Devices

Background:

• Heart failure with preserved ejection fraction (HFpEF) accounts for about 50% of heart failure cases and presents diverse phenotypes.
• Many HFpEF patients have smaller left ventricular cavities, complicating the use of ventricular assist devices (VADs).
• A left atrial to aortic (LA-Ao) VAD configuration may alleviate elevated mean left atrial pressure (MLAP) and improve quality of life.

Purpose of the Study:

• To assess the anatomical compatibility and left atrial unloading capacity of a VAD in a simulated HFpEF patient.
• To evaluate the efficacy of a HeartMate3 VAD in an LA-Ao configuration for reducing MLAP in HFpEF.

Main Methods:

• A cardiovascular simulator modeled a HeartMate3 VAD in an LA-Ao configuration for HFpEF.
• Hemodynamic parameters were recorded at rest and during exercise across seven pump flow rates.
• CT scans from HFpEF and heart failure with reduced ejection fraction patients were used for anatomical comparison and virtual fit assessment.

Main Results:

• A HeartMate3 flow of 1 L/min reduced MLAP from 15 to 11 mmHg at rest.
• During exercise simulation, 6 L/min HM3 support was needed to decrease MLAP from 29 to 16 mmHg.
• The HM3 device fit anatomically in 6 HFpEF patients; the remaining experienced impingement (4-14 mm).

Conclusions:

• The HeartMate3 VAD in an LA-Ao configuration shows promise for unloading the left atrium and mitigating pulmonary congestion in specific HFpEF patients.
• Pre-surgical anatomical fit analysis is crucial for addressing size-related limitations and ensuring suitability for LA-Ao VAD implantation in HFpEF.