Ventricular Assist Device Outflow-Graft Site: Effect on Myocardial Blood Flow

Improved diabetic control in advanced heart failure patients treated with left ventricular assist devices

“…This finding, if validated in a larger cohort and accounting for dietary intake, would strongly underscore the existence of a unique diabetes phenotype induced by cardiovascular decompensation and likely completely reversible. Which mechanisms are responsible for this reversal is currently unclear, although it is likely that improved cardiac output resulting in increased blood flow to peripheral and cardiac muscle16 as well as improved physical activity plays a significant role.…”

Left ventricular assist device implantation improves glycaemic control: a systematic review and meta‐analysis

“…To our knowledge, this is the first meta-analysis evaluating glycaemic improvement after LVAD implantations. 25,28,29 Animal studies confirm these findings, showing improved cardiac glucose oxidation and free fatty acid oxidation to normal levels after HF recovery. In fact, some studies showed that patients could discontinue their oral diabetes medications entirely following LVAD implantation.…”

“…28 The LVAD-associated increases in cardiac output correct these metabolic disturbances 24 and enhance blood flow to both cardiac and peripheral tissues (including the pancreas), improving glucose homeostasis and reducing whole-body and cardiac insulin resistance. 25,28,29 Animal studies confirm these findings, showing improved cardiac glucose oxidation and free fatty acid oxidation to normal levels after HF recovery. 30 Mechanical LVADs improve glycaemia LV unloading also reduces inflammation evidenced by lower retinal binding protein 4, 26 tumour necrosis factor-α, 31 and interleukins 32 6 and 8 and many help explain the reversal of insulin resistance in these patients.…”

Anastomosis of the outflow cannula to the descending aorta in a HeartWare left ventricular assist device

“…In a calf animal model using the Jarvik 2000 LVAD, placement of the outflow graft in either the ascending aorta (n = 4) or the descending aorta (n = 4) did not affect the device ability to unload the left ventricle. There was no significant difference in myocardial perfusion and oxygen consumption, aortic pressure, heart rate, central venous pressure, pump-flow to total-cardiac-flow ratio, or coronary artery blood flow at equivalent speed intervals [3]. The HeartWare ''Lavare'' Cycle, a feature that is currently not approved by the US Food and Drug Administration, increases the amount of flow through the aortic valve by decreasing the device speed, allowing less flow through the pump and more through the aortic valve [4].…”