Right ventricular assist device thrombosis during biventricular heart assistance

Decoene, Christophe; Fayad, Georges; Al‐Ruzzeh, Sharif; Modine, Thomas; Crépin, F.; Pol, Annie; Warembourg, H

doi:10.1191/0267659104pf764oa

Cited by 5 publications

(4 citation statements)

References 6 publications

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“…In clinical terms, where PVR has a reference range of 155 to 255 dyne/s/cm 5 , a conduit of 40 cm should always function within the manufacturer's guidelines based on our in vitro results. This is important, as low flow through devices have been reported as contributory factors to intrapump thrombosis , while higher than recommended speeds result in excessive power consumption. We note that a variation in banding diameter may achieve a similar outcome.…”

Section: Discussionmentioning

confidence: 99%

Banding the Right Ventricular Assist Device Outflow Conduit: Is It Really Necessary With Current Devices?

Gregory

Stevens

et al. 2015

Artificial Organs

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Implantable left ventricular assist devices (LVADs) have been adapted clinically for right-sided mechanical circulatory support (RVAD). Previous studies on RVAD support have established the benefits of outflow cannula restriction and rotational speed reduction, and recent literature has focused on assessing either the degree of outflow cannula restriction required to simulate left-sided afterload, or the limitation of RVAD rotational speeds. Anecdotally, the utility of outflow cannula restriction has been questioned, with suggestion that banding may be unnecessary and may be replaced simply by varying the outflow conduit length. Furthermore, many patients have a high pulmonary vascular resistance (PVR) at the time of ventricular assist device (VAD) insertion that reduces with pulmonary vascular bed remodeling. It is therefore important to assess the potential changes in flow through an RVAD as PVR changes. In this in vitro study, we observed the use of dual HeartWare HVAD devices (HeartWare Inc., Framingham, MA, USA) in biventricular support (BiVAD) configuration. We assessed the pumps' ability to maintain hemodynamic stability with and without banding; and with varying outflow cannulae length (20, 40, and 60 cm). Increased length of the outflow conduit was found to produce significantly increased afterload to the device, but this was not found to be necessary to maintain the device within the manufacturer's recommended operational parameters under a simulated normal physiological setting of mild and severe right ventricular (RV) failure. We hypothesize that 40 cm of outflow conduit, laid down along the diaphragm and then up over the RV to reach the pulmonary trunk, will generate sufficient resistance to maintain normal pump function.

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Section: Discussionmentioning

confidence: 99%

Banding the Right Ventricular Assist Device Outflow Conduit: Is It Really Necessary With Current Devices?

Gregory

Stevens

et al. 2015

Artificial Organs

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“…Most often, fibrin or thrombus formation in the VAD is generated near the inflow or outflow valve or in the pump chamber as the result of insufficient anticoagulation or a poorly adjusted system. 12,13 In addition, particular flow characteristics inside the VAD, such as vortex formation, flow reversal, and thus increased residence times, may explain the high rate of thromboembolic events after VAD implantation and the described changes in von Willebrand factor. 13 A number of studies based on different imaging modalities (ultrasound, particle imaging velocimetry [PIV]) or numeric simulations (computational fluid dynamics) have investigated flow patterns inside assist devices.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the effect of different operating conditions, often observed in the clinical routine (optimal vs suboptimal driving of the device), on regional flow characteristics, and thus risk for thrombus formation, is poorly understood. 12,13,18 The purpose of this study was to use flow-sensitive 4D MRI for a detailed analysis of 3D flow dynamics and function of the inlet and outlet valve systems in a clinical routine VAD for different system adjustments representing optimal and impaired operating conditions. In a second set of experiments, the effect of different valve designs on regional flow patterns and valve dynamics were directly compared.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional flow characteristics in ventricular assist devices: Impact of valve design and operating conditions

Benk

Lorenz

Beyersdorf

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

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“…Right atrial cannulation is an obvious alternative method for placement of the inflow cannula of the RVAD. However, thrombosis inside the right atrial inflow cannula can pose a serious complication for chronic RVAD support (10). Our recent animal study (11) showed that the DexAide RVAD with the inflow cannula inserted through the diaphragmatic surface of the right ventricle demonstrates good biocompatibility.…”

Section: Discussionmentioning

confidence: 99%

Human Clinical Fitting Study of the DexAide Right Ventricular Assist Device

Ootaki

Massiello

et al. 2009

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The DexAide right ventricular assist device (RVAD) has been developed as an implantable RVAD. The purpose of this study was to determine the final design and optimal anatomical placement of the DexAide RVAD when implanted simultaneously with either of two commercially available left ventricular assist devices (LVADs) in patients. A mock-up DexAide RVAD was used to assess configuration with each of two types of commercially available LVADs at the time of LVAD implantation in three human clinical cases. The pump body of the DexAide RVAD was placed either in the preperitoneal space or in the right thoracic cavity. The DexAide RVAD placed into the right thoracic cavity is suitable for use with the Novacor or HeartMate II LVADs. The results of this study will guide the finalization of the inflow cannula and optimal placement of the DexAide RVAD for human clinical trials.

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Right ventricular assist device thrombosis during biventricular heart assistance

Cited by 5 publications

References 6 publications

Banding the Right Ventricular Assist Device Outflow Conduit: Is It Really Necessary With Current Devices?

Banding the Right Ventricular Assist Device Outflow Conduit: Is It Really Necessary With Current Devices?

Three-dimensional flow characteristics in ventricular assist devices: Impact of valve design and operating conditions

Human Clinical Fitting Study of the DexAide Right Ventricular Assist Device

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