Dominique Shum-Tim, MD, Brian W

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Presentation transcript:

Evaluation of a Pulsatile Pediatric Ventricular Assist Device in an Acute Right Heart Failure Model Dominique Shum-Tim, MD, Brian W. Duncan, MD, Victor Hraska, MD, Ingeborg Friehs, MD, Toshiharu Shin’oka, MD, Richard A. Jonas, MD The Annals of Thoracic Surgery Volume 64, Issue 5, Pages 1374-1380 (November 1997) DOI: 10.1016/S0003-4975(97)00901-6 Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) The MEDOS HIA-VAD system consists of pneumatically driven polyurethane blood pumps. Pumps with stroke volumes of 10, 25, and 60mL are shown (clockwise from top). (B) Top: Integrated control unit with touch screen monitor for the MEDOS HIA-VAD. Bottom: Internal power supply unit and pneumatic compressor and vacuum. The Annals of Thoracic Surgery 1997 64, 1374-1380DOI: (10.1016/S0003-4975(97)00901-6) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Hemodynamic measurements after acute right ventricular failure in the control group were characterized by significantly elevated right atrial (RA) pressure (A), as well as significant decreases in systemic pressure (B), left atrial (LA) pressure (C), and cardiac output (D). The Annals of Thoracic Surgery 1997 64, 1374-1380DOI: (10.1016/S0003-4975(97)00901-6) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Normalization of systemic mean arterial pressure in group 2 was maintained for 6 hours by the MEDOS HIA right ventricular assist device (RVAD). The Annals of Thoracic Surgery 1997 64, 1374-1380DOI: (10.1016/S0003-4975(97)00901-6) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Left atrial (LA) filling pressure was significantly reduced by right ventricular failure and effectively normalized by the institution of right ventricular assist device (RVAD) support. The Annals of Thoracic Surgery 1997 64, 1374-1380DOI: (10.1016/S0003-4975(97)00901-6) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Low cardiac output induced by acute right ventricular failure was reversed by the pulsatile MEDOS HIA right ventricular assist device (RVAD) system. The Annals of Thoracic Surgery 1997 64, 1374-1380DOI: (10.1016/S0003-4975(97)00901-6) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Significant reduction of the elevated mean right atrial (RA) pressure after right ventricular injury in group 2 was observed after the onset of right ventricular assist device (RVAD) use. The Annals of Thoracic Surgery 1997 64, 1374-1380DOI: (10.1016/S0003-4975(97)00901-6) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Evidence of severe tricuspid regurgitation after surgical induction of right ventricular failure was shown by significantly elevated right atrial (RA) pulse pressure compared with baseline value. Note the effect of the right ventricular assist device (RVAD) in ameliorating the hemodynamic characteristics of severe tricuspid regurgitation. The Annals of Thoracic Surgery 1997 64, 1374-1380DOI: (10.1016/S0003-4975(97)00901-6) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig 8 After the right ventricular injury, there was a transient elevation of mean pulmonary arterial (PA) pressure, possibly secondary to reactive pulmonary vasoconstriction after surgical injury. Significant reduction of pulmonary blood flow characterized by reduction of mean PA pressure was observed after 2 hours when the right ventricular assist device (RVAD) was turned off. The use of the RVAD reestablished the increased PA pressure. The Annals of Thoracic Surgery 1997 64, 1374-1380DOI: (10.1016/S0003-4975(97)00901-6) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig 9 Pulmonary vascular resistance (PVR) was acutely elevated by the surgical procedure of inflow occlusion, blood transfusion, and reduced left-sided pressure. The right ventricular assist device (RVAD) partially offset this elevated PVR and maintained it at the same level throughout the 6-hour period of experiment. (LAP = left atrial pressure; PAP = pulmonary arterial pressure.) The Annals of Thoracic Surgery 1997 64, 1374-1380DOI: (10.1016/S0003-4975(97)00901-6) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions