Late de Novo Aortic Regurgitation with the Jarvik 2000 Flowmaker® left ventricular assist device

Rossi, Michele; Serraino, Giuseppe Filiberto; Jiritano, Federica; Renzulli, Attilio

doi:10.1177/039139881203501207

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…The progression of AI during cf-LVAD support may negatively impact the patients' clinical outcomes; the aggravation of the continuous retrograde flow loop can cause severe restriction of forward blood circulation and induce malperfusion of the vital organs [1]. In view of minimizing these adverse effects, recent studies have suggested reducing the LVAD pump speed to promote aortic valve opening, as progressive AI has been consistently shown to associate with a closed aortic valve [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. In this context, LVADs that are equipped with the ILS technology, which facilitates aortic valve opening, may have the potential to prevent AI.…”

Section: Discussionmentioning

confidence: 99%

“…With accumulating evidence that AI occurs more frequently in patients with a persistently closed aortic valve during cf-LVAD support [1][2][3][4][5][6][7][8][9][10], strategies to prevent AI have now focused on the optimization of the pump speed to promote aortic valve opening [1,2,[4][5][6][7][8][9][10][11][12][13][14][15]. In some cf-LVADs, including the HeartWare HVAD (HeartWare, Inc., Framingham, MA, USA), the HeartMate III (Abbott Laboratories, Abbott Park, IL, USA), and the Jarvik 2000 (Jarvik Heart Inc., New York, NY, USA), the devices are equipped with a function that facilitates intermittent aortic valve opening by periodically minimizing pump flow.…”

Section: Introductionmentioning

confidence: 99%

“…In some cf-LVADs, including the HeartWare HVAD (HeartWare, Inc., Framingham, MA, USA), the HeartMate III (Abbott Laboratories, Abbott Park, IL, USA), and the Jarvik 2000 (Jarvik Heart Inc., New York, NY, USA), the devices are equipped with a function that facilitates intermittent aortic valve opening by periodically minimizing pump flow. This function thus offers the prospect of preventing AI progression; however, there is only a paucity of studies that have addressed this potential benefit [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Can the intermittent low-speed function of left ventricular assist device prevent aortic insufficiency?

et al. 2021

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Aortic insufficiency (AI) is known to associate with a persistently closed aortic valve during continuous-flow ventricular assist device support. Some devices carry an intermittent low-speed (ILS) function, which facilitates aortic valve opening, but whether this function prevents AI is unknown. In this study, the Jarvik 2000 device, which is programmed to reduce the pump speed each minute for 8 s, was chosen to examine this potential effect. Prospectively collected data of 85 heart transplant-eligible Jarvik 2000 recipients who met the study criteria (no pre-existing AI and aortic valve surgery) were retrospectively analyzed for the incidence, correlating factors, and clinical outcomes of de novo AI. All data were provided by the Japanese Registry for Mechanically Assisted Circulatory Support. De novo AI occurred in 58 patients, 23 of whom developed at least moderate AI during a median support duration of 23.5 months. Freedom from moderate or greater AI was 84.4%, 66.1% and 60.2% at 1, 2 and 3 years, respectively. Multivariate analyses revealed that progressive AI was correlated with decreased pulse pressure after implantation (hazard ratio 1.060, 95% confidence interval 1.001–1.127, p = 0.045). No correlation was found for mortality or other adverse events, including stroke, bleeding, infection, pump failure, hemolysis, and readmission. The benefit of the Jarvik 2000′s current ILS mode against AI appears to be minimal. However, in this limited cohort where all recipients underwent implantation as a bridge to transplantation, the impact of de novo progressive AI on other clinical adversities was also minimal.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Can the intermittent low-speed function of left ventricular assist device prevent aortic insufficiency?

et al. 2021

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“…Moreover, different complications related to the loss of pulsatility and to the prolonged interaction between the human body and the mechanical device (e.g. late aortic regurgitation, infections, hemolysis, thromboembolic events and acquired bleeding disorders) remain high, which might jeopardize the long-term duration of the LVAD therapy [2][3][4][5]. Many of these complications are related to hemodynamic changes, such as modification on flow rate, that can cause recirculation or stagnation areas, and shear stress pattern, that influences the atherosclerosis.…”

Section: Introductionmentioning

confidence: 99%

A computational fluid dynamics comparison between different outflow graft anastomosis locations of Left Ventricular Assist Device (LVAD) in a patient‐specific aortic model

Caruso

Gramigna

Rossi

et al. 2015

Numer Methods Biomed Eng

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Left ventricular assist devices (LVADs) are mechanical supports used in case of heart failure. Little is known as the height of the anastomosis in aorta might influence the hemodynamic. The aim of the study was to evaluate the fluid dynamic behavior due to the outflow graft placement of a continuous flow LVAD in ascending aorta and to identify the insertion site with the best hemodynamic profile. Computational fluid dynamic studies were carried out to analyze 4 different anastomosis locations in a patient-specific aorta 3D model coupled with a lumped parameters model: 1 cm (case 1), 2 cm (case 2), 3 cm (case 3) and 4 cm (case 4) above the ST junction. In cases 1 and 2, epiaortic vessels presented a steady flow, while in cases 3 and 4 the flow was whirling. Moreover, maximum velocity occurred before: brachiocephalic trunk (case 1), brachiocephalic and left carotid arteries (case 2), left carotid and left subclavian artery (case 3) and left subclavian vessel and upper wall of aortic arch (case 4). Maximum time averaged wall shear stress (TAWSS) was located in: the ascending aorta (cases 1 and 2), the inferior curvature of the arch (case 3); at the origin of epiaortic vessels (case 4). Furthermore, a flow recirculation (cases 1 and 2), a blood stagnation and chaotic flow (cases 3 and 4) occurred above the aortic valve. The results suggested that the placement of the outflow graft at 2 cm above the ST junction gave the most favorable hemodynamic profile.

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“…This cyclic speed change is designed to decrease potential areas of blood stasis and to promote intermittent aortic valve opening. The Jarvik 2000 uses an intermittent low-speed (ILS) cycle to allow for conditions promoting aortic valve opening (14). The ILS cycle slows the pump speed to 6000 rpm once each minute for 8 s, before returning to the original set speed.…”

Section: Discussionmentioning

confidence: 99%

Pump Speed Waveform Analysis to Detect Aortic Valve Opening in Patients on Ventricular Assist Device Support

et al. 2015

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As the aortic valve (AV) opens, the pump pressure head remains constant, which is reflected as a "notch/plateau" in pump pressure and flow signals. However, instantaneous flow estimation may be influenced by friction and is particularly difficult in axial pumps. Therefore, a new method to determine the duration of AV opening based on the area under the curve (AUC) of the power spectral density analysis of pump speed signal was developed. Data from patients implanted with HeartWare HVAD left ventricular assist device were studied at different pump speeds, with simultaneous transthoracic echocardiography in two cohorts. In the first group, pump data of 15 patients were used to investigate the ability to discriminate between an open and closed AV. In the second cohort of a further 13 patients, the duration of AV opening was measured from digitized M-mode images, and the relationship between the AV opening time and the new method assessed. In 14 of the initial 15 patients, AV status could be discriminated using only one threshold for all patients. In the second cohort, gradual speed reduction resulted in aortic valve opening in 12 of the 13 patients. The correlation between AV opening duration and AUC was 0.96 ± 0.03. Regression analysis indicated a linear relationship in each of the patients with a small error between the fit and the measured opening time (root mean square error = 11.0 ± 7.6 ms). However, the slopes (69.0 ± 52.8) and intercepts (-31.4 ± 78.0) varied widely between patients. The sensitivity and specificity for the new method using AUC threshold of 0.95 for aortic valve closure was 95% and 91%, respectively. The newly developed method to detect AV opening not only provides information on the AV status during LVAD support (open/closed) but also gives insight into the duration of AV opening. Because the slope of the relationship varies from patient to patient, initial training and adaptation of the method to each patient seems to be required.

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Late de Novo Aortic Regurgitation with the Jarvik 2000 Flowmaker® left ventricular assist device

Cited by 5 publications

References 7 publications

Can the intermittent low-speed function of left ventricular assist device prevent aortic insufficiency?

Can the intermittent low-speed function of left ventricular assist device prevent aortic insufficiency?

A computational fluid dynamics comparison between different outflow graft anastomosis locations of Left Ventricular Assist Device (LVAD) in a patient‐specific aortic model

Pump Speed Waveform Analysis to Detect Aortic Valve Opening in Patients on Ventricular Assist Device Support

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