Echocardiographic markers of left ventricular unloading using a centrifugal-flow rotary pump

Sauer, Andrew J.; Meehan, Karen; Gordon, Robert A.; Abicht, Travis; Rich, Jonathan D.; Anderson, Allen S.; Yancy, Clyde; McGee, Edwin C.

doi:10.1016/j.healun.2013.12.013

Cited by 18 publications

(7 citation statements)

References 3 publications

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“…Notable physiological differences exist between the two pumps designs including increased flow pulsatility and afterload sensitivity (flat pressure-head vs. flow curves) seen in centrifugal pumps, which may in turn lead to differential patterns of unloading and reduction in wall stress in the failing heart. A recent in-vitro study suggested inadequate hemodynamic unloading of the centrifugal-flow pumps using an experimental mock-circulatory loop model 27 , which was further supported by the clinical observations from RAMP studies demonstrating a relatively flat LVEDD slope in patients supported by a centrifugal-flow pumps 28–30 . These findings were challenged by a recent in-vivo study of bovine model of ischemic HF as well as a clinical hemodynamic RAMP study, both of which suggested comparable unloading between the two pump designs.…”

Section: Discussionmentioning

confidence: 77%

Myocardial Recovery in Patients Receiving Contemporary Left Ventricular Assist Devices

Topkara

Garan

Fine

et al. 2016

Circ: Heart Failure

122

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Background Time course and predictors of myocardial recovery on contemporary LVAD support is poorly defined due to limited number of recovery patients at any implanting center. This study sought to investigate myocardial recovery using multicenter data from INTERMACS. Methods and Results 13,454 adult patients were studied. Device explant rates for myocardial recovery were 0.9% at 1-year, 1.9% at 2-year, and 3.1% at 3-year follow-up. Independent predictors of device explantation for recovery were age < 50 years (OR 2.5), non-ischemic etiology (OR 5.4), time since initial diagnosis < 2 years (OR 3.4), suboptimal HF therapy prior to implant (OR 2.2), LVEDD < 6.5 cm (OR 1.7), pulmonary systolic artery pressure < 50 mmHg (OR 2.0), BUN <30 mg/dL (OR 3.3), and axial-flow device (OR 7.6). Patients with myocarditis (7.7%), postpartum (4.4%) and adriamycin-induced cardiomyopathy (4.1%) had highest rates of device explantation for recovery. Use of neurohormonal blockers on LVAD support was significantly higher in patients who were explanted for recovery. Importantly, 9% of all LVAD patients who were not explanted for recovery have demonstrated substantial improvement in LVEF (partial recovery), and had remarkable overlap in clinical characteristic profile compared to patients who were explanted for recovery (complete recovery). Complete and partial recovery rates have declined in parallel with recent changes observed in device indications and technology. Conclusions Myocardial recovery is a spectrum of improvement rather than a binary clinical end-point. One in every ten LVAD patients demonstrates partial or complete myocardial recovery and should be targeted for functional assessment and optimization.

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Section: Discussionmentioning

confidence: 77%

Myocardial Recovery in Patients Receiving Contemporary Left Ventricular Assist Devices

Topkara

Garan

Fine

et al. 2016

Circ: Heart Failure

122

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show abstract

“…Performing a ramp test in patients with HVADs was not associated with linear LVEDD reduction in response to speed changes as seen with the HeartMate II pumps. 10,11 …”

Section: Two-dimensional and 3-dimensional Echocardiographic Optimizamentioning

confidence: 99%

Hemodynamic Pump-Patient Interactions and Left Ventricular Assist Device Imaging

et al. 2018

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“…However, robust outcomes data are limited, and applicability to HVAD patients, for whom there is less evidence, has not been demonstrated at this time. 58 LV Systolic Function.-Accurate determination of LV volumes is challenging after device implantation. So, too, is accurate and meaningful determination of overall LV systolic function, as based on the LVEF.…”

Section: Key Pointsmentioning

confidence: 99%

Echocardiography in the Management of Patients with Left Ventricular Assist Devices: Recommendations from the American Society of Echocardiography

Stainback¹,

Estep

Agler

et al. 2015

Journal of the American Society of Echocardiography

262

139

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Echocardiographic markers of left ventricular unloading using a centrifugal-flow rotary pump

Cited by 18 publications

References 3 publications

Myocardial Recovery in Patients Receiving Contemporary Left Ventricular Assist Devices

Myocardial Recovery in Patients Receiving Contemporary Left Ventricular Assist Devices

Hemodynamic Pump-Patient Interactions and Left Ventricular Assist Device Imaging

Echocardiography in the Management of Patients with Left Ventricular Assist Devices: Recommendations from the American Society of Echocardiography

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