Impact of turbulent blood flow in the aortic root on de novo aortic insufficiency during continuous‐flow left ventricular‐assist device support

Yoshida, Shohei; Toda, Köichi; Miyagawa, Shigeru; Yoshikawa, Yasushi; Hata, Hiroyuki; Yoshioka, Daisuke; Kainuma, Satoshi; Kawamura, Takuji; Kawamura, Akira; Nakatani, Satoshi; Sawa, Yoshiki

doi:10.1111/aor.13671

Cited by 12 publications

(14 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[9][10][11] Few reports are available regarding the clinical implications of LVAD--not only Jarvik 2000--outflow-graft anastomotic site and they mostly refer to single center experience with varying results. [12][13][14] However, no clinical studies have been reported to date for comparison of ascending versus descending aortic anastomosis in Jarvik 2000. Our unique multicenter series revealed that the site of outflow graft anastomosis to the ascending aorta is safe and technically feasible.…”

Section: Discussionmentioning

confidence: 99%

“…Jarvik 2000 LVAD is a widely used device and it was originally conceived for left thoracotomy implantation on beating‐heart through anastomosis onto the descending aorta 9‐11 . Few reports are available regarding the clinical implications of LVAD––not only Jarvik 2000––outflow‐graft anastomotic site and they mostly refer to single center experience with varying results 12‐14 . However, no clinical studies have been reported to date for comparison of ascending versus descending aortic anastomosis in Jarvik 2000.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

From bench to bedside: Impact of left ventricular assist device outflow conduit anastomosis position on outcome

et al. 2020

View full text Add to dashboard Cite

Continuous flow left ventricular assist devices (LVADs) have become a valuable therapy for end‐stage heart failure. In vitro research highlighted a role of outflow cannula position on the pattern of blood flow in the aorta. However, the clinical effects of the alterations of flow remain unclear. We investigate short‐ and long‐term outcomes of patients implanted with Jarvik 2000 LVAD, according to the ascending (Group 1) versus descending (Group 2) outflow graft connection to the aorta in a multicenter study. From May 2008 to October 2014, 140 consecutive end‐stage heart failure patients underwent Jarvik 2000 LVAD implantation in 17 Italian centers. According with a preliminary multivariate analysis, we selected the 90 patients implanted in the four high‐volume centers to avoid bias (Group 1 n = 39, Group 2 n = 51). Among the groups, no differences were recorded in the hospital mortality and the main complications occurring after LVAD implantation were similar. In multivariable analysis, the ascending aorta outflow cannula position and higher creatinine at discharge were significant predictors for long‐term survival. Postimplant hemolysis was more pronounced in descending aorta outflow graft anastomosis. Outflow graft anastomosis to the ascending aorta is associated with better long‐term survival, independent of age and perfusion techniques, reflecting the previous in vitro results.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

From bench to bedside: Impact of left ventricular assist device outflow conduit anastomosis position on outcome

et al. 2020

View full text Add to dashboard Cite

show abstract

“…CFD is necessary to obtain the local distribution of some key parameters such as WSS, velocity vectors, etc. A few CFD studies combining the aorta and LVADs were based on the long-term, durable, and surgically-implanted LVADs (Mazzitelli et al, 2016 ; Yoshida et al, 2020 ), which have different outlets and outflows compared with short-term percutaneously inserted devices. Furthermore, short-term LVADs are used for patients with different indications compared with durable LVADs.…”

Section: Introductionmentioning

confidence: 99%

Effects of a Short-Term Left Ventricular Assist Device on Hemodynamics in a Heart Failure Patient-Specific Aorta Model: A CFD Study

Wang

Peng

et al. 2021

Front. Physiol.

View full text Add to dashboard Cite

Patients with heart failure (HF) or undergoing cardiogenic shock and percutaneous coronary intervention require short-term cardiac support. Short-term cardiac support using a left ventricular assist device (LVAD) alters the pressure and flows of the vasculature by enhancing perfusion and improving the hemodynamic performance for the HF patients. However, due to the position of the inflow and outflow of the LVAD, the local hemodynamics within the aorta is altered with the LVAD support. Specifically, blood velocity, wall shear stress, and pressure difference are altered within the aorta. In this study, computational fluid dynamics (CFD) was used to elucidate the effects of a short-term LVAD for hemodynamic performance in a patient-specific aorta model. The three-dimensional (3D) geometric models of a patient-specific aorta and a short-term LVAD, Impella CP, were created. Velocity, wall shear stress, and pressure difference in the patient-specific aorta model with the Impella CP assistance were calculated and compared with the baseline values of the aorta without Impella CP support. Impella CP support augmented cardiac output, blood velocity, wall shear stress, and pressure difference in the aorta. The proposed CFD study could analyze the quantitative changes in the important hemodynamic parameters while considering the effects of Impella CP, and provide a scientific basis for further predicting and assessing the effects of these hemodynamic signals on the aorta.

show abstract

“…What we have known for a while is that moderate to severe AI in CF-LVADs portends a worse clinical outcome in terms of heart failure admissions and overall survival. 2 The progression of the AI with the CF-LVAD has been hypothesized to be related to turbulent blood flow in the root, 3 potentially associated with outflow graft location and angle of anastomosis. Recognizing the importance of the influence of moderate to severe AI on CF-LVAD outcomes has led to most addressing the AI by repairing the aortic valve with a central coaptation stitch (ie, Park's stitch) or aortic valve replacement with reasonably equivalent results.…”

mentioning

confidence: 99%

Commentary: Stop the leak before it floods

Whitson

2020

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

Impact of turbulent blood flow in the aortic root on de novo aortic insufficiency during continuous‐flow left ventricular‐assist device support

Cited by 12 publications

References 34 publications

From bench to bedside: Impact of left ventricular assist device outflow conduit anastomosis position on outcome

From bench to bedside: Impact of left ventricular assist device outflow conduit anastomosis position on outcome

Effects of a Short-Term Left Ventricular Assist Device on Hemodynamics in a Heart Failure Patient-Specific Aorta Model: A CFD Study

Commentary: Stop the leak before it floods

Contact Info

Product

Resources

About