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Ventricular Energetics in Pediatric Left Ventricular Assist Device Patients: A Retrospective Clinical Study

Di Molfetta, Arianna*; Ferrari, Gianfranco; Iacobelli, Roberta*; Filippelli, Sergio*; Di Chiara, Luca*; Guccione, Paolo*; Amodeo, Antonio*

doi: 10.1097/MAT.0000000000000595
Pediatric Circulatory Support

The aim of this study is to estimate the trend of right and left energetic parameters in left ventricular assist device (LVAD) pediatric patients. Echocardiographic data were retrospectively collected at the baseline, in the acute phase after and at the monthly follow-ups till the LVAD explantation to estimate left and right ventricular energetic parameters. A significant relationship between the left and right ventricular energetic parameter trends was found along all the study period. Left ventricular end-systolic pressure–volume relationship improved till the follow-up of 2 months and then progressively decreases. Left arteroventricular coupling decreases after the LVAD, and right arteroventricular coupling decreases at the short-term follow-up. Left ventricular external work, potential energy, and pressure–volume area decrease at the short-term follow-up and then increase progressively. Right ventricular external work, potential energy, and pressure–volume area increase after the LVAD implantation. Left (right) cardiac mechanical efficiency is improved (worsened) by the LVAD. Energetic variables show that the LVAD benefits could decrease over time. A continuous and patient tailored LVAD setting could contribute to prolong LVAD benefits. The introduction of energetic parameters could lead to a more complete evaluation of LVAD patients’ outcome which is a multiparametric process.

From the *Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy; and Department of Cardiovascular Engineer-Institute of Clinical Physiology-CNR, Pisa, Italy.

Submitted for consideration August 2016; accepted for publication in revised form April 2017.

Disclosure: The authors have no conflicts of interest to report.

Correspondence: Arianna Di Molfetta, Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Piazza Sant’Onofrio, 4-00165 Rome, Italy. Email: arianna.dimolfetta@gmail.com.

Copyright © 2017 by the American Society for Artificial Internal Organs