Key result
In a computational model, an LVAD reduced left ventricular pressure by up to 34% and end-diastolic volume by up to 80% under mitral regurgitation, whereas aortic regurgitation diminished its pumping function.
Why the study?
Does continuous flow LVAD support improve ventricular mechanics and maintain cardiac output in the presence of mitral or aortic regurgitation in a computational model of a failing heart?
Does continuous flow LVAD support improve ventricular mechanics and maintain cardiac output in the presence of mitral or aortic regurgitation in a computational model of a failing heart?
Computational modeling demonstrates that aortic regurgitation, but not mitral regurgitation, significantly diminishes the pumping efficacy of left ventricular assist devices.
Suggests caution with LVAD in aortic regurgitation; leaves open prospective validation in clinical heart failure cohorts.
Valvular insufficiency affects cardiac responses and the pumping efficacy of left ventricular assist devices (LVADs) when patients undergo LVAD therapy. Knowledge of the effect of valvular regurgitation on the function of LVADs is important when treating heart failure patients. The goal of this study was to examine the effect of valvular regurgitation on the ventricular mechanics of a heart under LVAD treatment and the pumping efficacy of an LVAD using a computational model of the cardiovascular system. For this purpose, a 3D electromechanical model of failing ventricles in a human heart was coupled with a lumped-parameter model of valvular regurgitation and an LVAD-implanted vascular system. We used the computational model to predict cardiac responses with respect to the severity of valvular regurgitation in the presence of LVAD treatment. An LVAD could reduce left ventricle (LV) pressure (up to 34%) and end-diastolic ventricular volume (up to 80%) and maintain cardiac output at the estimated flow rate from the LVAD under the condition of mitral regurgitation (MR); however, the opposite would occur under the condition of aortic regurgitation (AR). Considering these physiological responses, we conclude that AR, and not MR, diminishes the pumping function of LVADs.
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Kim et al. (2017) studied Heart failure with mitral or aortic regurgitation. Left ventricular assist device (LVAD) vs. No LVAD support was evaluated on Ventricular mechanics and pumping efficacy (LV pressure, end-diastolic volume, cardiac output). In a computational model, an LVAD reduced left ventricular pressure by up to 34% and end-diastolic volume by up to 80% under mitral regurgitation, whereas aortic regurgitation diminished its pumping function.
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