Key result
Simulated simultaneous continuous and pulsatile flow VADs increase cardiac output by ~20%.
Why the study?
The feasibility and hemodynamic effects of simultaneous implantation of pulsatile and continuous flow VADs in the same patient were not well studied.
Does simultaneous implantation of a continuous flow VAD and a pulsatile flow VAD improve hemodynamic parameters in pediatric BIVAD patients?
Does simultaneous implantation of a continuous flow VAD and a pulsatile flow VAD improve hemodynamic parameters in pediatric BIVAD patients?
Answers are grounded in this paper and cite their sources.
A lumped parameter model demonstrates the hemodynamic feasibility and potential benefits of simultaneously implanting continuous and pulsatile flow VADs in pediatric patients.
The aim of this work is to develop and test a lumped parameter model of the cardiovascular system to simulate the simultaneous use of pulsatile (P) and continuous flow (C) ventricular assist devices (VADs) on the same patient. Echocardiographic and hemodynamic data of five pediatric patients undergoing VAD implantation were retrospectively collected and used to simulate the patients' baseline condition with the numerical model. Once the baseline hemodynamic was reproduced for each patient, the following assistance modalities were simulated: (a) CVAD assisting the right ventricle and PVAD assisting the left ventricle (RCF + LPF), (b) CVAD assisting the left ventricle and PVAD assisting the right ventricle (LCF + RPF). The numerical model can well reproduce patients' baseline. The cardiac output increases in both assisted configurations (RCF + LPF: +17%, LCF + RPF: +21%, P = ns), left (right) ventricular volumes decrease more evidently in the configuration LCF + RPF (RCF + LPF), left (right) atrial pressure decreases in the LCF + RPF (RCF + LPF) modality. The pulmonary arterial pressure slightly decreases in the configuration LCF + RPF and it increases with RCF + LPF. Left and right ventricular external work increases in both configurations probably because of the total cardiac output increment. However, left and right artero-ventricular coupling improves especially in the LCF + RPF (-36% for the left ventricle and -21% for the right ventricle, P = ns). The pulsatility index decreases by 8.5% in the configuration LCF + RPF and increases by 6.4% with RCF + LPF (P = 0.0001). A numerical model could be useful to tailor on patients the choice of the VAD that could be implanted to improve the hemodynamic benefits. Moreover, a model could permit to simulate extreme physiological conditions and innovative configurations, as the implantation of both CVAD and PVAD on the same patient.
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Molfetta et al. (2017) studied Pediatric patients undergoing VAD implantation (n=5). Simulated simultaneous continuous and pulsatile flow VADs (RCF+LPF and LCF+RPF) vs. Baseline condition was evaluated on Pulsatility index (p=0.0001). Simulated simultaneous use of continuous and pulsatile flow VADs increased cardiac output by 17-21%, with the pulsatility index decreasing by 8.5% in LCF+RPF and increasing by 6.4% in RCF+LPF (P=0.0001).
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