Key result
In vitro, LVAD assistance deteriorates LV mechanical efficiency while BVAD deteriorates RV efficiency.
Why the study?
Does mono- and bi-ventricular mechanical assistance improve ventricular energetics in an in vitro model of ventricular dysfunction?
Does mono- and bi-ventricular mechanical assistance improve ventricular energetics in an in vitro model of ventricular dysfunction?
In an in vitro model, mechanical circulatory support improves hemodynamics but can deteriorate cardiac mechanical efficiency, highlighting a disconnect between hemodynamic and energetic benefits.
Highlights energetic trade-offs of LVAD support despite hemodynamic gains; leaves open translation to clinical ventricular dysfunction.
When mono- and bi-ventricular mechanical assistance is used for heart recovery, its control strategy and circulatory variables affect ventricular energetics (external work-EW, oxygen consumption-VO2, cardiac mechanical efficiency-CME). This study is based on the data obtained in vitro and presents an analysis of the effects of the mono- and bi-ventricular mechanical assistance on ventricular energetics. The assistance was conducted on the principle of counterpulsation with atrio-arterial connection. It includes the following stages: 1) the characterisation of the isolated ventricle model in terms of EW, VO2 and CME as a function of the filling pressure and peripheral resistance, 2) modelling of left ventricular and pulmonary dysfunction, followed by left ventricular and bi-ventricular assistance. Experimental data enable us to draw the following conclusions: * in general, the greatest hemodynamic improvement does not correspond to the highest energetic improvement, * LVAD assistance deteriorates left ventricular CME while its effect on right ventricular energetics depends on the value of right ventricular elastance (Emax). Right ventricular CME is deteriorated by BVAD assistance irrespective of right Emax, * the energetics optimisation in bi-ventricular assistance is closely related to the right Emax, which could probably be a deciding factor in the choice of the assistance mode.
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Ferrari et al. (2001) studied Left ventricular and pulmonary dysfunction. Mono- and bi-ventricular mechanical assistance vs. Isolated ventricle model was evaluated on Ventricular energetics (external work, oxygen consumption, cardiac mechanical efficiency). In an in vitro model, LVAD assistance deteriorated left ventricular cardiac mechanical efficiency, while bi-ventricular assistance deteriorated right ventricular efficiency irrespective of elastance.
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