Use of continuous flow ventricular assist devices in patients with heart failure and a normal ejection fraction: A computer-simulation study Francesco.

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Use of continuous flow ventricular assist devices in patients with heart failure and a normal ejection fraction: A computer-simulation study Francesco Moscato, PhD, Christian Wirrmann, Marcus Granegger, MSc, Farsad Eskandary, MD, Daniel Zimpfer, MD, Heinrich Schima, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 145, Issue 5, Pages 1352-1358 (May 2013) DOI: 10.1016/j.jtcvs.2012.06.057 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Schematic diagram of the hemodynamic model structure, including the systemic and pulmonary circulation, continuous flow left ventricular assist device (CF-LVAD), central command, baroreflex and muscle mechanoreflex and metabolic reflex. MV, Mitral valve; AoV, aortic valve; TV, tricuspid valve; PV, pulmonary valve; SVR, systemic vascular resistance; PVR, pulmonary vascular resistance; Vusv, unstressed volume in the systemic veins; Emax, maximal ventricular elastance; HR, heart rate. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1352-1358DOI: (10.1016/j.jtcvs.2012.06.057) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Simulation results for the pressure–volume loops for A, a normal condition and B, heart failure with normal ejection fraction (HFNEF). Simulation results for the pressure and flow tracings for C, a normal condition and D, heart failure with normal ejection fraction. AoF, Aortic flow; AoP, aortic pressure; EDPVR, end-diastolic pressure volume relationship; LAP, left atrial pressure; LVP, left ventricular pressure; MVF, mitral valve flow. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1352-1358DOI: (10.1016/j.jtcvs.2012.06.057) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Comparison of the hemodynamic variables calculated from the simulation and the pooled published data.10-13,16,17,19-22 The pooled published data are represented by bars for mean values and error bars for standard deviations. §Pulmonary capillary wedge pressure from the published data were used for comparison. CO, Cardiac output; EDP, end-diastolic pressure; EDV, end-diastolic volume; HR, heart rate; LAP, left atrial pressure; PAP, pulmonary arterial pressure; SAP, systemic arterial pressure; SVR, systemic vascular resistance. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1352-1358DOI: (10.1016/j.jtcvs.2012.06.057) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Hemodynamic changes induced by the continuous flow left ventricular assist device (CF-LVAD) running at 3 different speeds (2.5, 3.0, and 3.5 krpm) at rest and during exercise. Data for the unsupported condition are also shown (indicated as “no pump”). #Complete empting of the left ventricular chamber and possible suction occurring at rest in the 3.5-krpm pump speed setting. During exercise, an increase in cardiac output (CO) and a reduction in both end-diastolic pressure (EDP) and left atrial pressure (LAP) for increasing pump speeds (black arrows). EDV, End diastolic volume; HR, heart rate; PAP, pulmonary arterial pressure; SAP, systemic arterial pressure; SVR, systemic vascular resistance. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1352-1358DOI: (10.1016/j.jtcvs.2012.06.057) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions