Key result
In numerical simulations of pediatric VAD support, the LCF + RPF configuration maximized hemodynamic benefits, increasing cardiac output by 21% in biventricular and 35% in Fontan physiology.
Why the study?
Does the LCF + RPF configuration improve hemodynamics compared to RCF + LPF in pediatric patients with biventricular or Fontan physiology?
Does the LCF + RPF configuration improve hemodynamics compared to RCF + LPF in pediatric patients with biventricular or Fontan physiology?
Numerical modeling suggests that combining a continuous flow VAD for the systemic circulation and a pulsatile flow VAD for the pulmonary circulation maximizes hemodynamic benefits in pediatric patients with biventricular or Fontan physiology.
INTRODUCTION: To develop and test a lumped parameter model to simulate and compare the effects of the simultaneous use of continuous flow (CF) and pulsatile flow (PF) ventricular assist devices (VADs) to assist biventricular circulation vs. single ventricle circulation in pediatrics. METHODS: Baseline data of 5 patients with biventricular circulation eligible for LVAD and of 5 patients with Fontan physiology were retrospectively collected and used to simulate patient baselines. Then, for each patient the following simulations were performed: (a) CF VAD to assist the left ventricle (single ventricle) + a PF VAD to assist the right ventricle (cavo-pulmonary connection) (LCF + RPF); (b) PF VAD to assist the left ventricle (single ventricle) + a CF VAD to assist the right ventricle (cavo-pulmonary connection) (RCF + LPF). RESULTS: In biventricular circulation, the following results were found: cardiac output (17% RCF + LPF, 21% LCF + RPF), artero-ventricular coupling (-36% for the left ventricle and -21.6% for the right ventricle), pulsatility index (+6.4% RCF + LPF, p = 0.02; -8.5% LCF + RPF, p = 0.00009). Right (left) atrial pressure and right (left) ventricular volumes are decreased by the RCF + LPF (by RPF + LCF). Pulmonary arterial pressure decreases in the LCF + RPF configuration. In Fontan physiology: cardiac output (LCF + RPF 35% vs. 8% in RCF + LPF), ventricular preload (+4% RCF + LPF, -10% LCF + RPF), Fontan conduit pressure (-5% RCF + LPF, +7% LCF + RPF), artero-ventricular coupling (-14% RCF + LPF vs. -41% LCF + RPF) and pulsatility (+13% RCF + LPF, - 8% LCF + RPF). CONCLUSIONS: A numerical model supports clinicians in defining and innovating the VAD implantation strategy to maximize the hemodynamic benefits. Results suggest that the hemodynamic benefits are maximized by the LCF + RPF configuration.
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Molfetta et al. (2017) studied Pediatric patients eligible for LVAD or with Fontan physiology (n=10). LCF + RPF configuration (CF VAD for LV/single ventricle + PF VAD for RV/cavo-pulmonary connection) vs. RCF + LPF configuration (PF VAD for LV/single ventricle + CF VAD for RV/cavo-pulmonary connection) was evaluated on Hemodynamic parameters including cardiac output, artero-ventricular coupling, and pulsatility index. In numerical simulations of pediatric VAD support, the LCF + RPF configuration maximized hemodynamic benefits, increasing cardiac output by 21% in biventricular and 35% in Fontan physiology.
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