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HVAD Flow Waveform Morphologies: Theoretical Foundation and Implications for Clinical Practice

Rich, Jonathan D.*; Burkhoff, Daniel

doi: 10.1097/MAT.0000000000000557
Review Article

Continuous-flow ventricular assist device (cfVAD) performance and patient hemodynamic conditions are intimately interrelated and dynamic, changing frequently with alterations in physiologic conditions, particularly pre- and afterloading conditions. The Heartware cfVAD (HVAD) provides a unique feature among currently approved VADs of providing an estimated instantaneous flow waveform, the characteristics of which can provide significant insights into patient and device properties. Despite being readily available, HVAD waveforms are poorly understood, underutilized, and insufficiently leveraged, even by clinicians who regularly manage HVAD patients. The purpose of this review is to provide the theoretical foundation for understanding the determinants of HVAD waveform characteristics and to provide practical examples illustrating how to interpret and integrate changes of HVAD waveforms into clinical practice. Heartware cfVAD waveforms should be considered a complimentary tool for the optimization of medical therapies and device speed in HVAD patients.

From the *Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois; and Cardiovascular Research Foundation, New York, NY.

Submitted for consideration January 2017; accepted for publication in revised form February 2017.

Disclosures: J.D.R. has served as a consultant for Heartware (currently Medtronic) and Thoratec (currently Abbott). D.B. was previously an employee by Heartware and is currently a consultant to Medtronic.

Correspondence: Jonathan D. Rich, Mechanical Circulatory Support Program, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 600, Chicago, IL 60611. Email: jonathan.rich@northwestern.edu.

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Copyright © 2017 by the American Society for Artificial Internal Organs