Limitations to Chronic Right Ventricular Assist Device Support

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Presentation transcript:

Limitations to Chronic Right Ventricular Assist Device Support Jamshid H. Karimov, MD, PhD, Gengo Sunagawa, MD, David Horvath, MSME, Kiyotaka Fukamachi, MD, PhD, Randall C. Starling, MD, MPH, Nader Moazami, MD The Annals of Thoracic Surgery Volume 102, Issue 2, Pages 651-658 (August 2016) DOI: 10.1016/j.athoracsur.2016.02.006 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Right ventricular pressure–volume loops at low, medium, and high loading conditions. Slopes of maximum time vary in elastance (Emax), maximum pressure/volume ratio (max PV), and end ejection pressure/volume (EEPV) are displayed by lines of best fit passing through 3 points of each pressure-volume loop. (Reproduced from [52] by permission.) The Annals of Thoracic Surgery 2016 102, 651-658DOI: (10.1016/j.athoracsur.2016.02.006) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Ventricular interdependence. Three-dimensional transesophageal echocardiographic reconstruction of the right ventricle (RV) from pulmonary valve (PV) to tricuspid valve (TV). (A) Cross section showing the crescent shape of right ventricle. (B) Sagittal section, showing triangular shape of right ventricle. Ventricular interdependence between left ventricle and right ventricle during systole relies on position of interventricular septum (IVS), as shown in cross section within different clinical scenarios. (LVAD = left ventricular assist device.) (Reproduced from [10] by permission.) The Annals of Thoracic Surgery 2016 102, 651-658DOI: (10.1016/j.athoracsur.2016.02.006) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Right ventricular (RV) architecture. This series of magnetic resonance images shows RV architecture composed of tracks originating from parietal walls of left ventricle. Pathways (a-d) intrude from epicardium to endocardium by means of a right-hand helix movement about transverse circular axis. Image (e) shows the left ventricular basal circumference. In their study, Smerup and associates [19] indicated on tracks commencing within the endocardial layers and oriented according to the pattern of a right hand helix, while epicardial tracks follow the pattern of a left hand helix. The tracks originating from the middle parts of the walls follow circular pathways around the cavity of the left ventricle. Almost every generated track was shown to extend to encompass endocardial, midwall, and epicardial component. Tracks entering the walls of the right ventricle, in their greater part, originated either from the septum or the parietal left ventricular walls. (Reproduced from [19] by permission.) The Annals of Thoracic Surgery 2016 102, 651-658DOI: (10.1016/j.athoracsur.2016.02.006) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Pump operation head curve. Typical left ventricular assist device (LVAD) centrifugal pump head curve for 2 speeds, illustrating relative ranges in flow and pressure requirements for the LVAD (red) and right ventricular assist device (RVAD) (blue). The Annals of Thoracic Surgery 2016 102, 651-658DOI: (10.1016/j.athoracsur.2016.02.006) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions