TY - JOUR
T1 - Right ventricular assist device in end-stage pulmonary arterial hypertension
T2 - Insights from a computational model of the cardiovascular system
AU - Punnoose, Lynn
AU - Burkhoff, Daniel
AU - Rich, Stuart
AU - Horn, Evelyn M.
N1 - Funding Information:
This work was supported by a grant from the Cardiovascular Medical Research and Education Fund (Philadelphia, PA) awarded to DB. DB is also an employee of CircuLite Inc, the manufacturer of the Synergy micro-pump. The remaining authors have no conflicts of interest to disclose.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2012/9
Y1 - 2012/9
N2 - Background: The high mortality rate of pulmonary arterial hypertension (PAH) mainly relates to progressive right ventricular (RV) failure. With limited efficacy of medical therapies, mechanical circulatory support for the RV has been considered. However, there is lack of understanding of the hemodynamic effects of mechanical support in this setting. Methods: We modeled the cardiovascular system, simulated cases of PAH and RV dysfunction and assessed the theoretical effects of a continuous flow micro-pump as an RV assist device (RVAD). RVAD inflow was sourced either from the RV or RA and outflow was to the pulmonary artery. RVAD support was set at various flow rates and additional simulations were carried out in the presence of atrial septostomy (ASD) and tricuspid regurgitation (TR). Results: RVAD support increased LV filling, thus improving cardiac output and arterial pressure, unloading the RA and RV, while raising pulmonary arterial and capillary pressures in an RVAD flow-dependent manner. These effects diminished with increasing disease severity. The presence of TR did not significantly impact the hemodynamic effects of RVAD support. ASD reduced the efficacy of RVAD support, since right-to-left shunting decreased and ultimately reversed with increasing RVAD support due to the progressive drop in RA pressure. Conclusions: The results of this theoretical analysis suggest that RVAD support can effectively increase cardiac output and decreases RA pressure with the consequence of increasing pulmonary artery and capillary pressures. Especially in advanced PAH, low RVAD flow rates may mitigate these potentially detrimental effects while effectively increasing systemic hemodynamics.
AB - Background: The high mortality rate of pulmonary arterial hypertension (PAH) mainly relates to progressive right ventricular (RV) failure. With limited efficacy of medical therapies, mechanical circulatory support for the RV has been considered. However, there is lack of understanding of the hemodynamic effects of mechanical support in this setting. Methods: We modeled the cardiovascular system, simulated cases of PAH and RV dysfunction and assessed the theoretical effects of a continuous flow micro-pump as an RV assist device (RVAD). RVAD inflow was sourced either from the RV or RA and outflow was to the pulmonary artery. RVAD support was set at various flow rates and additional simulations were carried out in the presence of atrial septostomy (ASD) and tricuspid regurgitation (TR). Results: RVAD support increased LV filling, thus improving cardiac output and arterial pressure, unloading the RA and RV, while raising pulmonary arterial and capillary pressures in an RVAD flow-dependent manner. These effects diminished with increasing disease severity. The presence of TR did not significantly impact the hemodynamic effects of RVAD support. ASD reduced the efficacy of RVAD support, since right-to-left shunting decreased and ultimately reversed with increasing RVAD support due to the progressive drop in RA pressure. Conclusions: The results of this theoretical analysis suggest that RVAD support can effectively increase cardiac output and decreases RA pressure with the consequence of increasing pulmonary artery and capillary pressures. Especially in advanced PAH, low RVAD flow rates may mitigate these potentially detrimental effects while effectively increasing systemic hemodynamics.
KW - Mechanical circulatory support
KW - Pulmonary arterial hypertension
KW - Right ventricular failure
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U2 - 10.1016/j.pcad.2012.07.008
DO - 10.1016/j.pcad.2012.07.008
M3 - Article
C2 - 23009919
AN - SCOPUS:84866619038
VL - 55
SP - 234-243.e2
JO - Progress in Cardiovascular Diseases
JF - Progress in Cardiovascular Diseases
SN - 0033-0620
IS - 2
ER -