Interpreting central hemodynamics in durable biventricular circulatory support patients

Area of Science:

• Cardiology
• Biomedical Engineering
• Cardiovascular Surgery

Background:

• Mechanical circulatory support (MCS) devices, including biventricular assist devices (BiVAD), are increasingly used to augment pulmonary blood flow.
• BiVADs introduce complex hemodynamic interactions not fully characterized compared to left ventricular assist devices (LVADs).

Purpose of the Study:

• To investigate the effect of BiVAD support on central hemodynamics.
• To assess pulmonary flow and vascular properties in BiVAD versus LVAD patients.

Main Methods:

• Retrospective cohort study comparing LVAD and BiVAD patients.
• Right heart catheterization (RHC) data analyzed pre- and post-MCS implantation.
• Comparison of traditional RHC parameters, native stroke volume (SV), pulmonary arterial compliance (PAC), and pulmonary elastance (E_PA).

Main Results:

• BiVAD patients exhibited significantly higher systolic and diastolic pulmonary artery pressures compared to LVAD patients.
• Pulmonary vascular resistance remained significantly higher in BiVAD patients despite a reduction post-implantation.
• Pulmonary arterial compliance calculations varied depending on whether total or native right ventricular stroke volume was used.

Conclusions:

• Combined pulsatile and continuous flow in BiVAD significantly influences hemodynamic profiles, particularly pulmonary pressures.
• Conventional pulmonary vascular hemodynamic indices may present challenges in patients with continuous flow components from BiVADs.