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Superior performance of continuous over pulsatile flow ventricular assist devices in the single ventricle circulation: A computational study
Affiliation:1. Department of Mechanical Engineering, Clemson University, Clemson, SC, USA;2. School of Medicine, Stanford University, Stanford, CA, USA;3. Department of Pediatric Cardiothoracic Surgery, Stanford University, Stanford, CA, USA;4. Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK;5. Department of Pediatrics, Stanford University, Stanford, CA, USA;6. Department of Bioengineering, Clemson University, Clemson, SC, USA;2. University of New South Wales, Sydney, Australia;3. Department of Lung Transplantation, St. Vincent’s Hospital, Sydney, Australia;1. Children’s Mercy Hospital and Clinics, Department of Surgery, Kansas City, Missouri 64108;2. University of Wisconsin – Madison, Department of Surgery Madison, Wisconsin 53792;1. Division of Cardiology, Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada;2. Division of Pediatric Cardiac Surgery, Stollery Children’s Hospital, Edmonton, Alberta, Canada;3. Divisions of Division of Pediatric Critical Care, Cardiac Surgery;4. Stollery Children’s Hospital, Pediatric Cardiac Critical Care, University of Alberta, Edmonton, Alberta, Canada;1. Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois;2. Division of Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois;3. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois;4. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois;1. Congenital Heart Surgery, Texas Children’s Hospital, Houston, Texas;2. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas;3. Pediatric Critical Care, Texas Children’s Hospital, Houston, Texas;4. Pediatrics, Baylor College of Medicine, Houston, Texas;5. Pediatric Cardiology, Texas Children’s Hospital, Houston, Texas;1. Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York;2. Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
Abstract:This study compares the physiological responses of systemic-to-pulmonary shunted single ventricle patients to pulsatile and continuous flow ventricular assist devices (VADs). Performance differences between pulsatile and continuous flow VADs have been clinically observed, but the underlying mechanism remains poorly understood. Six systemic-to-pulmonary shunted single ventricle patients (mean BSA=0.30 m2) were computationally simulated using a lumped-parameter network tuned to match patient specific clinical data. A first set of simulations compared current clinical implementation of VADs in single ventricle patients. A second set modified pulsatile flow VAD settings with the goal to optimize cardiac output (CO). For all patients, the best-case continuous flow VAD CO was at least 0.99 L/min greater than the optimized pulsatile flow VAD CO (p=0.001). The 25 and 50 mL pulsatile flow VADs exhibited incomplete filling at higher heart rates that reduced CO as much as 9.7% and 37.3% below expectations respectively. Optimization of pulsatile flow VAD settings did not achieve statistically significant (p<0.05) improvement to CO. Results corroborate clinical experience that continuous flow VADs produce higher CO and superior ventricular unloading in single ventricle patients. Impaired filling leads to performance degradation of pulsatile flow VADs in the single ventricle circulation.
Keywords:Ventricular assist device  Single ventricle  Pediatric  Ventricular suction  Lumped-parameter network
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