4.2 Article

An in silico study of the effects of left ventricular assist device on right ventricular function and inter-ventricular interaction

Journal

ARTIFICIAL ORGANS
Volume -, Issue -, Pages -

Publisher

WILEY
DOI: 10.1111/aor.14649

Keywords

computational modeling; inter-ventricular interactions; LVAD; right ventricular failure

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This study investigated the impact of the HeartMate 3 LVAD on right ventricular (RV) function using computer modeling. The results showed that the LVAD reduced RV chamber contractility at a higher pump speed, especially with a thinner septal wall or lower myocardial contractility.
Background: Left ventricular assist device (LVAD) is associated with a high incidence of right ventricular (RV) failure, which is hypothesized to be caused by the occurring inter-ventricular interactions when the LV is unloaded. Factors contributing to these interactions are unknown. Methods: We used computer modeling to investigate the impact of the HeartMate 3 LVAD on RV functions. The model was first calibrated against pressure-volume (PV) loops associated with a heart failure ( HF) patient and validated against measurements of inter-ventricular interactions in animal experiments. The model was then applied to investigate the effects of LVAD on (1) RV chamber contractility indexed by V60 derived from its end-systolic PV relationship, and (2) RV diastolic function indexed by V20 derived from its end-diastolic PV relationship. We also investigated how septal wall thickness and regional contractility affect the impact of LVAD on RV function. Results: The impact of LVAD on RV chamber contractility is small at a pump speed lower than 4k rpm. At a higher pump speed between 4k and 9k rpm, however, RV chamber contractility is reduced (by similar to 3% at 6k rpm and similar to 10% at 9k rpm). The reduction of RV chamber contractility is greater with a thinner septal wall or with a lower myocardial contractility at the LV free wall, septum, or RV free wall. Conclusion: RV chamber contractility is reduced at a pump speed higher than 4k rpm, and this reduction is greater with a thinner septal wall or lower regional myocardial contractility. Findings here may have clinical implications in identifying LVAD patients who may suffer from RV failure.

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