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Hemodynamic Benefits of Counterpulsation, Implantable, Percutaneous, and Intraaortic Rotary Blood Pumps: An In-Silico and In Vitro Study

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Abstract

Mechanical circulatory support (MCS) devices have become a standard therapy for heart failure (HF) patients. MCS device designs may differ by level of support, inflow and/or outflow cannulation sites, and mechanism(s) of cardiac unloading and blood flow delivery. Investigation and direct comparison of hemodynamic parameters that help characterize performance of MCS devices has been limited. We quantified cardiac and vascular hemodynamic responses for different types of MCS devices. Continuous flow (CF) left ventricular (LV) assist devices (LVAD) with LV or left atrial (LA) inlet, counterpulsation devices, percutaneous CF LVAD, and intra-aortic rotary blood pumps (IARBP) were quantified using established computer simulation and mock flow loop models. Hemodynamic data were analyzed on a beat-to-beat basis at baseline HF and over a range of MCS support. Results demonstrated that all LVAD greatly diminished vascular pulsatility (P) and LV external work (LVEW). LVAD with LA inflow provided a greater reduction in LVEW compared to LVAD with LV inflow, but at the potential risk for blood stasis/thrombosis in the LV at high support. Counterpulsation provided greater coronary flow (CoF) augmentation, but had a lower reduction in LVEW compared to partial percutaneous LVAD support. IARBP diminished LVEW, but at the expense of diminished CoF due to coronary steal. The hemodynamic benefits for each type of mechanical circulatory support system are unique and clinical decisions on device selection to maximize end organ perfusion and minimize invasiveness needs to be considered for an individual patients’ presentation.

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Acknowledgments

Funding for this project was provided in part by NIH R15 Grant (1R15HL115556–01A1), and the University of Louisville Cardiac Implant Science Endowment.

Conflict of interest

All authors declare that they have no conflict of interest.

Human Studies/Informed Consent

No human studies were carried out by the authors for this article.

Animal Studies

No animal studies were carried out by the authors for this article.

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Authors and Affiliations

  1. Department of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, Liaoning, China

    Yu Wang

  2. Department of Bioengineering, Cardiovascular Innovation Institute, University of Louisville, Louisville, KY, USA

    Steven C. Koenig & Guruprasad A. Giridharan

  3. Department of Cardiovascular and Thoracic Surgery, Cardiovascular Innovation Institute, University of Louisville, Louisville, KY, USA

    Steven C. Koenig, Michael A. Sobieski & Mark S. Slaughter

  4. Department of Bioengineering, Cardiovascular Innovation Institute, University of Louisville, Room 407, 302 East Muhammad Ali Blvd, Louisville, KY, 40202, USA

    Guruprasad A. Giridharan

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  1. Yu Wang
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  2. Steven C. Koenig
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  3. Michael A. Sobieski
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  4. Mark S. Slaughter
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  5. Guruprasad A. Giridharan
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Correspondence to Guruprasad A. Giridharan.

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Associate Editors John Timothy Baldwin and Ajit P. Yoganathan oversaw the review of this article.

Associate Editor John Timothy Baldwin and Ajit P. Yoganathan oversaw the review of this article.

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Wang, Y., Koenig, S.C., Sobieski, M.A. et al. Hemodynamic Benefits of Counterpulsation, Implantable, Percutaneous, and Intraaortic Rotary Blood Pumps: An In-Silico and In Vitro Study. Cardiovasc Eng Tech 8, 439–452 (2017). https://doi.org/10.1007/s13239-017-0314-1

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  • DOI: https://doi.org/10.1007/s13239-017-0314-1

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