Key result
Continuous flow pump reduces resting left atrial pressure ~135% vs interatrial shunt in in-vitro HFpEF.
Why the study?
HFpEF often presents with elevated LA pressure, and interatrial shunt devices or off-label rotary blood pumps have been developed or used to decompress the left atrium.
Does a continuous flow rotary blood pump compared to an interatrial shunt device improve pulmonary decompression and hemodynamics in an in-vitro model of HFpEF?
Does a continuous flow rotary blood pump compared to an interatrial shunt device improve pulmonary decompression and hemodynamics in an in-vitro model of HFpEF?
In an in-vitro HFpEF model, a continuous flow pump provided greater left atrial decompression and increased cardiac output compared to an interatrial shunt device, which reduced cardiac output.
Does not support clinical use in HFpEF; leaves open in-vivo validation of continuous flow pumps versus shunts.
Heart failure with preserved ejection fraction (HFpEF) often presents with elevated left atrial (LA) pressure. Interatrial shunt devices (IASD) were developed and rotary blood pumps implanted off-label to reduce LA pressure in HFpEF patients. This study modeled an HFpEF patient in a mock circulation loop, comparing pulmonary decompression using an IASD (2-12 mm diameter) and a continuous flow (CF) centrifugal rotary blood pump (HeartMate 3; Abbott Laboratories, Abbott Park, IL) in LA to aortic configuration (1-6 L/min support). Left atrial pressure, pulmonary artery pressure (PAP), and cardiac output (CO) at 12 mm shunt diameter and 6 L/min pump support were primarily used to quantify pulmonary decompression. The IASD reduced LA pressure by 28% and 45%, while the CF reduced LA pressure by 135% and 51% at rest and exercise, respectively. Both devices reduced mean PAP by 13% (IASD) and 57% (CF) at rest and by 21% (IASD) and 32% (HM3) at exercise. The IASD resulted in reduced CO (rest: 14%, exercise 8%), but the CF increased CO (rest: 63%, exercise: 28%) and ventricular loading due to the LA to aortic configuration. Automated changes to rotary blood pump speed or IASD diameter may assist with unloading as physiologic conditions change.
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Langer et al. (2025) studied Heart failure with preserved ejection fraction (HFpEF). Continuous flow (CF) centrifugal rotary blood pump vs. Interatrial shunt device (IASD) was evaluated on Left atrial pressure, pulmonary artery pressure (PAP), and cardiac output (CO) at 12 mm shunt diameter and 6 L/min pump support. A continuous flow pump reduced left atrial pressure by 135% at rest and 51% at exercise, compared to 28% and 45% with an interatrial shunt device in an in-vitro HFpEF model.
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