Cardiac remodeling in patients with centrifugal left ventricular assist devices assessed by serial echocardiography

Mulzer, Johanna; Krastev, H.; Hoermandinger, Christoph; Merke, Nicolas; Alhaloush, Mazen; Schoenrath, Felix; Falk, Volkmar; Potapov, Evgenij; Knierim, Jan

doi:10.1111/echo.15338

Cited by 6 publications

(12 citation statements)

References 26 publications

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“…At 12 months of HM3 support, the mean reported prevalence of significant MR was 15.0% (Δ 0.8%). 13,17 No significant pattern of decreased or increased prevalence over time was revealed in either of these two studies. 13,17 General MR exhibited well consistency in a limited number of studies (n = 2), generating low to moderate level of evidence due to the limited number of studies.…”

Section: Mitral Regurgitation (Mr)mentioning

confidence: 71%

“…13,17 No significant pattern of decreased or increased prevalence over time was revealed in either of these two studies. 13,17 General MR exhibited well consistency in a limited number of studies (n = 2), generating low to moderate level of evidence due to the limited number of studies. A limited number of studies (n = 2) did not reveal any significant pattern of changing prevalence over time, generating low to moderate level of evidence due to the limited number of studies.…”

Section: Mitral Regurgitation (Mr)mentioning

confidence: 71%

“…At 12 months of HM3 support, the mean reported prevalence of significant TR was 28.5% (Δ 8.3%). 13,17 Both studies showed a statistically un-confirmed trend of increased TR prevalence over time. Prevalence of general RVD was only reported by study in relation to AR, (36.8%) in the non-AR group and 12 (75%) in the AR group at baseline (P = 0.02).…”

Section: Right Ventricular Functionmentioning

confidence: 93%

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Echocardiographic haemodynamic monitoring in the context of HeartMate 3™ therapy: a systematic review

Ohlsson,

Papageorgiou,

Ebbers

et al. 2024

ESC Heart Failure

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AimsWhile echocardiography remains essential within haemodynamic monitoring of durable mechanical circulatory support, previous echocardiographic guidelines are missing scientific evidence for the novel HeartMate 3™ (HM3) system. Accordingly, this review aims to summarize available echocardiographic evidence including HM3.Methods and resultsThis systematic review adhered to the PRISMA 2020 guidelines. Searches were conducted during August 2023 across PubMed, Embase, and Google Scholar using specific echocardiographic terms combined with system identifiers. Study quality was assessed using the Newcastle–Ottawa Scale (NOS) for cohort studies and Critical Appraisal Instrument (PCAI) for cross‐sectional studies. Nine studies met the inclusion criteria, of which eight cohort studies and one cross‐sectional study. Aortic regurgitation (AR) prevalence at approximately 12 months of support exhibited heterogenicity (33.5% (Δ 33%)) in a limited number of studies (n = 3). Several studies (n = 5) demonstrated an increasing prevalence and severity of AR during HM3 support, generating moderate to high level of evidence. One AR study showed a higher cumulative incidence of death and heart failure (HF) readmission compared with those without significant AR, hazard ratio 3.42 (95% CI 1.48–8.76). A second study showed that a worsening AR group had significantly lower survival‐free from HF readmission (59% vs. 89%, P = 0.023) with a hazard ratio of 5.18 (95% CI 1.07–25.0), while a third study did not reveal any differences in cardiac‐related hospitalizations in the 12 months follow‐up or non‐cardiac‐related hospitalization. Mitral regurgitation (MR) prevalence at approximately 12 months of support exhibited good consistency 15.0% (Δ 0.8%) in both included studies, which did not reveal any significant pattern of changing prevalence over time. Tricuspid regurgitation (TR) prevalence at approximately 12 months of support exhibited fair consistency 28.5% (Δ 8.3%) in a limited number of studies (n = 2); both studies showed a statistically un‐confirmed trend of increased TR prevalence over time. The evidence of general prevalence of right ventricular dysfunction (RVD) was insufficient due to lack of studies.ConclusionsThere are few methodologically consistent studies with focus on long‐term haemodynamic effects. Aortic regurgitation still seems to be a prevalent and potentially significant finding. The available evidence concerning right heart function is limited despite clinical relevance and potential prognostic value. Potential interventricular and haemodynamic interplay are identified as a white field for future research.

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Section: Mitral Regurgitation (Mr)mentioning

confidence: 71%

Section: Mitral Regurgitation (Mr)mentioning

confidence: 71%

Section: Right Ventricular Functionmentioning

confidence: 93%

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Echocardiographic haemodynamic monitoring in the context of HeartMate 3™ therapy: a systematic review

Ohlsson,

Papageorgiou,

Ebbers

et al. 2024

ESC Heart Failure

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“…After LVAD implantation, the distances from the apex to AV and MV decreased by about one‐third. While the decrease in LV diameter is explained by improved LV unloading, 19 we assume that the longitudinal LV shortening is caused by inserting the pump in between the rib cage and the LV apex. In our study, before LVAD implantation, the sternum‐to‐heart distance was only about 19 mm.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal cardiac dimensions in patients undergoing LVAD implantation

Meissner,

Szvetics,

Galbas

et al. 2024

Artificial Organs

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BackgroundIn conventional left ventricular assist devices (LVAD), a separate outflow graft is sutured to the ascending aorta. Novel device designs may include a transventricular outflow cannula crossing the aortic valve (AV). While transversal ventricular dimensions are well investigated in patients with severe heart failure, little is known about the longitudinal dimensions. These dimensions are, however, particularly critical for the design and development of mechanical circulatory support (MCS) devices with transaortic outflow cannula.MethodsIn an explorative retrospective cohort study at the University Medical Center Freiburg, Germany, the longitudinal cardiac dimensions of patients undergoing computed tomography angiography (CTA) before and, if available, after LVAD implantation were analyzed. Among others, the following dimensions were assessed: (a) apex to AV, (b) apex to mitral valve, (c) AV to sinotubular junction (STJ), (d) apex to STJ, (e) apex to brachiocephalic artery (BCA), and (f) AV to BCA.ResultsIn total, 44 LVAD patients (36 male, age 55.8 years, height 1.75 m) were included. The longitudinal cardiac dimensions were (a) 114.5 ± 12.1 mm, (b) 108.0 ± 12.4 mm, (c) 20.9 ± 2.9, (d) 135.4 ± 13.4 mm, (e) 206.0 ± 18.3, and (f) 91.5 ± 9.8 mm. Postoperatively, (a) and (b) decreased by 31.5% and 39.5%, respectively (N = 14).ConclusionsLongitudinal cardiac dimensions may be reduced by up to 40% after LVAD implantation. A better knowledge of these dimensions and their postoperative alterations in LVAD patients may improve surgical planning and help to design MCS devices with transventricular outflow cannula.

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“…Computational and numerical modeling in the context of LVAD monitoring mainly involve computational fluid dynamics, which use software to mathematically and visually model blood flow through the cardiovascular system ( Figure 7 ) ( 29 , 35 – 37 , 39 , 54 – 57 ). Computational fluid dynamics models have been used specifically to model hemodynamic risk factors such as wall shear stress (WSS), cardiac pressures, particle residence times, and blood flow patterns in the chambers and vessels ( 58 – 61 ).…”

Section: Benchtop Evaluation Of General Lvad Performancementioning

confidence: 99%

The role of innovative modeling and imaging techniques in improving outcomes in patients with LVAD

Wilson,

Ingram,

et al. 2023

Front. Cardiovasc. Med.

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Heart failure remains a significant cause of mortality in the United States and around the world. While organ transplantation is acknowledged as the gold standard treatment for end stage heart failure, supply is limited, and many patients are treated with left ventricular assist devices (LVADs). LVADs extend and improve patients' lives, but they are not without their own complications, particularly the hemocompatibility related adverse events (HRAE) including stroke, bleeding and pump thrombosis. Mainstream imaging techniques currently in use to assess appropriate device function and troubleshoot complications, such as echocardiography and cardiac computed tomography, provide some insight but do not provide a holistic understanding of pump induced flow alterations that leads to HRAEs. In contrast, there are technologies restricted to the benchtop—such as computational fluid dynamics and mock circulatory loops paired with methods like particle image velocimetry—that can assess flow metrics but have not been optimized for clinical care. In this review, we outline the potential role and current limitations of converging available technologies to produce novel imaging techniques, and the potential utility in evaluating hemodynamic flow to determine whether LVAD patients may be at higher risk of HRAEs. This addition to diagnostic and monitoring capabilities could improve prevention and treatment of LVAD-induced complications in heart failure patients.

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Cardiac remodeling in patients with centrifugal left ventricular assist devices assessed by serial echocardiography

Cited by 6 publications

References 26 publications

Echocardiographic haemodynamic monitoring in the context of HeartMate 3™ therapy: a systematic review

Echocardiographic haemodynamic monitoring in the context of HeartMate 3™ therapy: a systematic review

Longitudinal cardiac dimensions in patients undergoing LVAD implantation

The role of innovative modeling and imaging techniques in improving outcomes in patients with LVAD

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