Haemodynamic Effect of Left Atrial and Left Ventricular Cannulation with a Rapid Speed Modulated Rotary Blood Pump During Rest and Exercise: Investigation in a Numerical Cardiorespiratory Model

Abstract

Purpose

The left atrium and left ventricle are the primary inflow cannulation sites for heart failure patients supported by rotary blood pumps (RBPs). Haemodynamic differences exist between inflow cannulation sites and have been well characterized at rest, yet the effect during exercise with the same centrifugal RBP has not been previously well established. The purpose of this study was to investigate the hemodynamic effect of inflow cannulation site during rest and exercise with the same centrifugal RBP.

Methods

In a numerical cardiorespiratory model, a simulated heart failure patient was supported by a HeartWare HVAD RBP in left atrial (LAC) and left ventricular cannulation (LVC). The RBP was operated at constant speed and sinusoidal co- and counter-pulse and was investigated in cardiovascular conditions of steady state rest and 80-watt bike graded exercise.

Results

Cardiac output was 5.0 L min−1 during rest and greater than 6.9 L min−1 during exercise for all inflow cannulation sites and speed operating modes. However, during exercise, LAC demonstrated greater pressure-volume area and lower RBP flow (1.41, 1.37 and 1.37 J and 5.03, 5.12 and 5.03 L min−1 for constant speed and co- and counter-pulse respectively) when compared to LVC (pressure-volume area: 1.30, 1.27 and 1.32 J and RBP flow: 5.56, 5.71 and 5.59 L min−1 for constant speed and co- and counter-pulse respectively).

Conclusion

For a simulated heart failure patient intending to complete exercise, LVC seems to assure a better hemodynamic performance in terms of pressure-volume area unloading and increasing RBP flow.

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Acknowledgments

The authors would like to recognize the financial assistance provided by The Prince Charles Hospital Foundation (TM2017-04 and EMR2017-01), the National health and Medical Research Council Centre for Research Excellence (APP1079421), The University of Queensland and Griffith University. ELW acknowledges his Advance Queensland PhD scholarship and Australian Government Scholarship stipend. JFF acknowledges his fellowship support from the Office of Health and Medical Research, Queensland health. SDG was supported by a Future Leader Fellowship (102062) from the National Heart Foundation of Australia. LF was supported by KU Leuven C1 Project C1I-18-00576 and by the Frans Van de Werf Scholarship.

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Wu, E.L., Fresiello, L., Kleinhyer, M. et al. Haemodynamic Effect of Left Atrial and Left Ventricular Cannulation with a Rapid Speed Modulated Rotary Blood Pump During Rest and Exercise: Investigation in a Numerical Cardiorespiratory Model. Cardiovasc Eng Tech 11, 350–361 (2020). https://doi.org/10.1007/s13239-020-00471-1

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Keywords

  • Rotary blood pump
  • Left ventricular assist device
  • Inflow cannulation
  • Speed modulation
  • Pulsing
  • Exercise
  • In silico