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Mitral Valve Regurgitation with a Rotary Left Ventricular Assist Device: The Haemodynamic Effect of Inlet Cannulation Site and Speed Modulation

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Abstract

Mitral valve regurgitation (MVR) is common in patients receiving left ventricular assist device (LVAD) support, however the haemodynamic effect of MVR is not entirely clear. This study evaluated the haemodynamic effect of MVR with LVAD support and the influence of inflow cannulation site and LVAD speed modulation. Left atrial (LAC) and ventricular (LVC) cannulation was evaluated in a mock circulation loop with no, mild, moderate and severe MVR with constant speed and speed modulation (±600 RPM) modes. The use of an LVAD relieved pulmonary congestion during severe MVR, by reducing left atrial pressure from 20.5 to 10.8 (LAC) and 11.5 (LVC) mmHg. However, LAC resulted in decreased left ventricular stroke work (−0.08 J), ejection fraction (−7.9%) and higher MVR volume (+12.7 mL) and pump speed (+100 RPM) compared to LVC. This suggests that LVC, in addition to reducing MVR severity, also improves ventricular washout over LAC. LVAD speed modulation in synchrony with ventricular systole reduced MVR volume and increased ejection fraction with LAC and LVC, thus demonstrating the potential benefits of this mode, despite a reduction in cardiac output.

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Acknowledgments

The authors would like to recognize the financial assistance provided by The Prince Charles Hospital Foundation (PRO2014-08), the National Health and Medical Research Council Centre for Research Excellence (APP1079421), The University of Queensland, Queensland University of Technology and Griffith University. John F. Fraser acknowledges his fellowship support from the Office of Health and Medical Research, Queensland Health.

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Authors and Affiliations

  1. School of Medicine, University of Queensland, Brisbane, QLD, Australia

    Shaun D. Gregory, Eric L. Wu & John F. Fraser

  2. Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia

    Shaun D. Gregory, Michael C. Stevens, Eric L. Wu, Jo P. Pauls, Matthias Kleinheyer & John F. Fraser

  3. Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW, Australia

    Michael C. Stevens

  4. School of Engineering, Griffith University, Southport, QLD, Australia

    Jo P. Pauls & Matthias Kleinheyer

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  1. Shaun D. Gregory
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Correspondence to Shaun D. Gregory.

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Associate Editor Peter E. McHugh oversaw the review of this article.

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Gregory, S.D., Stevens, M.C., Wu, E.L. et al. Mitral Valve Regurgitation with a Rotary Left Ventricular Assist Device: The Haemodynamic Effect of Inlet Cannulation Site and Speed Modulation. Ann Biomed Eng 44, 2674–2682 (2016). https://doi.org/10.1007/s10439-016-1579-5

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  • DOI: https://doi.org/10.1007/s10439-016-1579-5

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