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LVAD Pulsatility Assesses Cardiac Contractility

In Vitro Model Utilizing the Total Artificial Heart and Mock Circulation

Mikail, Philemon*; Crosby, Jessica R.; Slepian, Marvin J.‡,§; Smith, Richard; Khalpey, Zain*,‡,¶,‖

doi: 10.1097/MAT.0000000000000861
Original Article: PDF Only
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There is a need for a consistent, reproducible, and cost-effective method of determining cardiac recovery in patients who receive emerging novel therapeutics for advanced and end-stage heart failure (HF). With the increasing use of ventricular assist devices (VADs) in end-stage HF, objective device diagnostics are available for analysis. Pulsatility, one of the accessible diagnostic measures, is a variable gage of the differential between peak systolic and minimum diastolic flow during a single cardiac cycle. Following implantation of the VAD, HeartWare’s HVAD records pulsatility regularly. Thus, we hypothesize that this measurement relates to the contractility of the heart and could be utilized as a metric for determining patient response to various therapeutics. In this study, therefore, we develop a translatable and effective predictive model characterizing pulsatility to determine HF status and potential HF recovery using the SynCardia Total Artificial Heart (TAH) in conjunction with a Donovan Mock Circulation System to create a simulation platform for the collection of pulsatility data. We set the simulation platform to patient conditions ranging from critical heart failure to a normal operating condition through the variation preload, afterload, and left ventricular (LV) pumping force or TAHcontractility.” By manipulating these variables, pulsatility was found to accurately indicate significant (p < 0.05) improvements in LV contractility at every recorded afterload and preload, suggesting that it is a valuable parameter for the assessment of cardiac recovery in patients.

From the *College of Biomedical Engineering, University of Arizona, Tucson, Arizona

Syncardia, Inc., Tucson, Arizona

Sarver Heart Center, University of Arizona, Tucson, Arizona

§Department of Medicine, College of Medicine-Tucson, University of Arizona, Tucson, Arizona

Department of Surgery, College of Medicine-Tucson, University of Arizona, Tucson, Arizona

Department of Cellular and Molecular Medicine, College of Medicine-Tucson, University of Arizona, Tucson, Arizona.

Submitted for consideration February 2018; accepted for publication in revised form May 2018.

P.M. is a current employee in the Cardiac Rhythm Division of Medtronic. At the time of research, he was a graduate researcher at the University of Arizona. He has no professional affiliation or involvement in Medtronic’s mechanical circulatory support division. Research occurred prior to Medtronic’s acquisition of Heartware. J.R.C. is an employee of Syncardia Systems. M.J.S. is a previous employee of Syncardia Systems. R.S. and Z.K. report no potential conflicts of interests.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Zain Khalpey, MD, PhD, Division of Cardiothoracic Surgery, University of Arizona College of Medicine, Tucson, AZ. Email: zkhalpey@surgery.arizona.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs