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Continuous-Flow Left Ventricular Assist Device Support Improves Myocardial Supply:Demand in Chronic Heart Failure

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Abstract

Continuous-flow left ventricular assist devices (CF LVADs) are rotary blood pumps that improve mean blood flow, but with potential limitations of non-physiological ventricular volume unloading and diminished vascular pulsatility. In this study, we tested the hypothesis that left ventricular unloading with increasing CF LVAD flow increases myocardial flow normalized to left ventricular work. Healthy (n = 8) and chronic ischemic heart failure (IHF, n = 7) calves were implanted with CF LVADs. Acute hemodynamics and regional myocardial blood flow were measured during baseline (LVAD off, clamped), partial (2–4 L/min) and full (>4 L/min) LVAD support. IHF calves demonstrated greater reduction of cardiac energy demand with increasing LVAD support compared to healthy calves, as calculated by rate-pressure product. Coronary artery flows (p < 0.05) and myocardial blood flow (left ventricle (LV) epicardium and myocardium, p < 0.05) decreased with increasing LVAD support in normal calves. In the IHF model, blood flow to the septum, LV, LV epicardium, and LV myocardium increased significantly with increasing LVAD support when normalized to cardiac energy demand (p < 0.05). In conclusion, myocardial blood flow relative to cardiac demand significantly increased in IHF calves, thereby demonstrating that CF LVAD unloading effectively improves cardiac supply and demand ratio in the setting of ischemic heart failure.

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Acknowledgments

The authors thank the following individuals for their support of this study: Karen Lott, Laura Lott, Cary Woolard, and Leslie Sherwood, DVM. This study was completed, in part, in support of the doctoral thesis and dissertation of C.R. Bartoli, MD, PhD entitled Partial vs. Full Support of the Heart with a Continuous-Flow Left Ventricular Assist Device: Implications for Myocardial Recovery. Funding for this project was provided, in part, by Roger M. Prizant Research Trust Fund, University of Louisville Clinical Translational Science Pilot Grant Program, and University of Louisville Cardiac Implant Science Endowment. Dr. Slaughter and Dr. Koenig have received funding unrelated to this study from industry sponsors for training and pre-clinical testing (HeartWare, Miami Lakes FL; St. Jude Medical, Minneapolis MN; Thoratec, Pleasanton CA). The authors have no other conflicts of interest to disclose. The left ventricular assist devices were provided by HeartWare (Miami Lakes, FL) and Thoratec (Pleasanton, CA) under material transfer agreements (MTA).

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    Authors and Affiliations

    1. Department of Cardiovascular and Thoracic Surgery, Cardiovascular Innovation Institute, University of Louisville, Louisville, KY, 40202, USA

      Kevin G. Soucy, Michael A. Sobieski, Zhongjun J. Wu, Mark S. Slaughter & Steven C. Koenig

    2. Department of Bioengineering, University of Louisville, Louisville, KY, 40202, USA

      Kevin G. Soucy, Dustin Phillips, Guruprasad A. Giridharan, Mark S. Slaughter & Steven C. Koenig

    3. Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA

      Carlo R. Bartoli

    4. Department of Physiology and Biophysics, School of Medicine, University of Louisville, Louisville, KY, 40202, USA

      William B. Wead

    5. Dowling Consulting, PSC, Louisville, KY, 40202, USA

      Robert D. Dowling

    6. Division of Cardiovascular Disease and Comprehensive Cardiovascular Center, University of Alabama at Birmingham, Birmingham, AL, 35294, USA

      Sumanth D. Prabhu

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    1. Kevin G. Soucy
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    Correspondence to Steven C. Koenig.

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    Associate Editor Aleksander S. Popel oversaw the review of this article.

    Kevin G. Soucy and Carlo R. Bartoli contributed equally to this work.

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    Soucy, K.G., Bartoli, C.R., Phillips, D. et al. Continuous-Flow Left Ventricular Assist Device Support Improves Myocardial Supply:Demand in Chronic Heart Failure. Ann Biomed Eng 45, 1475–1486 (2017). https://doi.org/10.1007/s10439-017-1804-x

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