Coronary Blood Flow Dynamics During Continuous Flow Left Ventricular Assist Device Support: Insights From a Virtual Cohort and In‐Silico Simulations

Understanding the interaction between the Continuous Flow Left Ventricular Assist Device (CF‐LVAD) and physiological mechanisms regulating coronary blood flow may help optimize CF‐LVAD support. A virtual cohort for patients implanted with HeartMate3 CF‐LVAD was created by generating datasets. The datasets consist of the cardiac and coronary parameters in a numerical model simulating cardiac function, blood flow in the circulatory system, blood flow rate regulatory mechanisms, and HeartMate3 CF‐LVAD support. Sensitivity and correlation analyses were performed to evaluate the influence of the cardiac and coronary parameters on the average left and right coronary blood flow rates. Interdependencies between the hemodynamic data in the coronary circulation during HeartMate3 support were evaluated as well. Simulation results and statistical analyses showed that the left coronary blood flow rate is highly influenced by the blood flow regulatory mechanisms, whereas the right coronary blood flow rate is highly influenced by the CF‐LVAD operating speed and left ventricular elastance. Left coronary blood flow rate is not strongly correlated with hemodynamic, physiological, and CF‐LVAD parameters. However, right coronary blood flow rate is strongly correlated with mean aortic pressure and coronary perfusion pressure during partial CF‐LVAD support and flow rate through HeartMate3 is an additional factor during full support.