Fluid structure interaction model analysis of cerebrospinal fluid circulation in patients with continuous-flow left ventricular assist devices

Luc, Jessica G.Y.; Pierre, Clifford; Phan, Kevin; Vahedein, Yashar Seyed; Liberson, Alexander S.; Cornwell, William K.; Phillips, Steven J.; Tchantchaleishvili, Vakhtang

doi:10.5301/ijao.5000657

Cited by 5 publications

(6 citation statements)

References 12 publications

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“…The results of this hypothesis remain unclear as CSF flow models in LVAD patients have not been successful to date [ 3 ]. One study using a computational model demonstrated that continuous flow resulted in a reduction in CSF pressure amplitude and velocity though the overall flow rate was unchanged [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, it has been postulated that the altered circulatory physiology in LVAD patients could alter cerebrospinal fluid (CSF) flow given the lack of traditional pulsatile blood pressure [ 3 ]. The efficacy of CT myelograms has thus been questioned in these patients, increasing the level of diagnostic complexity in already inherently difficult cases.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Evaluation and Cervical Spine Surgery in the Setting of a Cardiac Left Ventricular Assist Device: Challenges and a Case Illustration

Carroll¹,

Dowlati²,

Miller³

et al. 2021

Cureus

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Due to incompatibility with magnetic resonance imaging, patients with left ventricular assist devices (LVADs) presenting with pathologies of the spinal soft tissues or neural elements represent diagnostically complex cases. We present a case of a patient undergoing a CT (computed tomography) myelogram and subsequent successful cervical posterior laminectomy. A C1-C2 lateral puncture approach CT myelogram revealed nearly a complete block of contrast movement at the level of the C2-C3 vertebrae concerning a compressive etiology. The cervical lateral approach was chosen based on patient symptomology and concern that contrast dye injected in the lumbar spine would not travel to the region of interest due to altered CSF pulsatility caused by the LVAD device. A C3-C7 posterior laminectomy was then successfully performed. Intra-operatively, however, there was no sign of a compressive lesion, and ultrasound confirmed a decompressed spinal cord. This case highlights the diagnostic challenges of pre-operative evaluation in patients with LVADs in which the efficacy of performing CT myelograms is also questionable due to potential alterations in cerebrospinal fluid movement due to variations in arterial pulsatility due to LVAD physiology.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic Evaluation and Cervical Spine Surgery in the Setting of a Cardiac Left Ventricular Assist Device: Challenges and a Case Illustration

Carroll¹,

Dowlati²,

Miller³

et al. 2021

Cureus

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“…In patients with end-stage heart failure refractory to maximum medical therapy, treatment options include heart transplantation, mechanical circulatory support, or palliative care. [4][5][6][7] Potentially life-saving transplants, the current standard of care, are limited by a lack of donors. Thousands are registered awaiting a donor heart; 40% of those who are on the waiting list die.…”

Section: Introductionmentioning

confidence: 99%

“…Progression of this disease is slowed by the use of cardiac drug therapy to mitigate symptoms of the disease. In patients with end‐stage heart failure refractory to maximum medical therapy, treatment options include heart transplantation, mechanical circulatory support, or palliative care . Potentially life‐saving transplants, the current standard of care, are limited by a lack of donors.…”

Section: Introductionmentioning

confidence: 99%

Clinical implications of LDH isoenzymes in hemolysis and continuous‐flow left ventricular assist device‐induced thrombosis

et al. 2019

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Pump‐induced thrombosis continues to be a major complication of continuous‐flow left ventricular assist devices (CF‐LVADs), which increases the risks of thromboembolic stroke, peripheral thromboembolism, reduced pump flow, pump failure, cardiogenic shock, and death. This is confounded by the fact that there is currently no direct measure for a proper diagnosis during pump support. Given the severity of this complication and its required treatment, the ability to accurately differentiate CF‐LVAD pump thrombosis from other complications is vital. Hemolysis measured by elevated lactate dehydrogenase (LDH) enzyme levels, when there is clinical suspicion of pump‐induced thrombosis, is currently accepted as an important metric used by clinicians for diagnosis; however, LDH is a relatively nonspecific finding. LDH exists as five isoenzymes in the body, each with a unique tissue distribution. CF‐LVAD pump thrombosis has been associated with elevated serum LDH‐1 and LDH‐2, as well as decreased LDH‐4 and LDH‐5. Herein, we review the various isoenzymes of LDH and their utility in differentiating hemolysis seen in CF‐LVAD pump thrombosis from other physiologic and pathologic conditions as reported in the literature.

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“…However, none of these milestones has been achieved yet. From this particular standpoint, his research interests include cerebrospinal fluid circulation in LVAD patients with diminished or absent pulse, algorithms for full adjustability of continuous flow, energy sources allowing full device implantability (among others, Plutonium 238), and development of biohybrid and bioartificial organs . He has worked as a research fellow at Bern University Hospital in Bern, Switzerland, Medical University of Innsbruck in Innsbruck, Austria, and Brigham and Women's Hospital in Boston, MA, USA studying various stem cells types for myocardial recovery .…”

mentioning

confidence: 99%

Vakhtang Tchantchaleishvili, MD to Serve as a Co‐Editor of Adult Circulatory Support for Artificial Organs

Malchesky¹

2019

Artificial Organs

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Fluid structure interaction model analysis of cerebrospinal fluid circulation in patients with continuous-flow left ventricular assist devices

Cited by 5 publications

References 12 publications

Diagnostic Evaluation and Cervical Spine Surgery in the Setting of a Cardiac Left Ventricular Assist Device: Challenges and a Case Illustration

Diagnostic Evaluation and Cervical Spine Surgery in the Setting of a Cardiac Left Ventricular Assist Device: Challenges and a Case Illustration

Clinical implications of LDH isoenzymes in hemolysis and continuous‐flow left ventricular assist device‐induced thrombosis

Vakhtang Tchantchaleishvili, MD to Serve as a Co‐Editor of Adult Circulatory Support for Artificial Organs

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