title: Precise quantification of pressure flow waveforms of a pulsatile ventricular assist device.
abstract: Unreliable quantification of flow pulsatility has hampered many efforts to assess the importance of pulsatile perfusion. Generation of pulsatile flow depends upon an energy gradient. It is necessary to quantify pressure flow waveforms in terms of hemodynamic energy levels to make a valid comparison between perfusion modes during chronic support. The objective of this study was to quantify pressure flow waveforms in terms of energy equivalent pressure (EEP) and surplus hemodynamic energy (SHE) levels in an adult mock loop using a pulsatile ventricle assist system (VAD). A 70 cc Pierce-Donachy pneumatic pulsatile VAD was used with a Penn State adult mock loop. The pump flow rate was kept constant at 5 L/min with pump rates of 70 and 80 bpm and mean aortic pressures (MAP) of 80, 90, and 100 mm Hg, respectively. Pump flows were adjusted by varying the systolic pressure, systolic duration, and the diastolic vacuum of the pneumatic drive unit. The aortic pressure was adjusted by varying the systemic resistance of the mock loop EEP (mm Hg) = (integral of fpdf)/(integral of fdt) SHE (ergs/cm3) = 1,332 [((integral of fpdt)/(integral of fdt))--MAP] were calculated at each experimental stage. The difference between the EEP and the MAP is the extra energy generated by this device. This difference is approximately 10% in a normal human heart. The EEP levels were 88.3 +/- 0.9 mm Hg, 98.1 +/- 1.3 mm Hg, and 107.4 +/- 1.0 mm Hg with a pump rate of 70 bpm and an aortic pressure of 80 mm Hg, 90 mm Hg, and 100 mm Hg, respectively. Surplus hemodynamic energy in terms of ergs/cm3 was 11,039 +/- 1,236 ergs/cm3, 10,839 +/- 1,659 ergs/cm3, and 9,857 +/- 1,289 ergs/cm3, respectively. The percentage change from the mean aortic pressure to EEP was 10.4 +/- 1.2%, 9.0 +/- 1.4%, and 7.4 +/- 1.0% at the same experimental stages. Similar results were obtained when the pump rate was changed from 70 bpm to 80 bpm. The EEP and SHE formulas are adequate to quantify different levels of pulsatility for direct and meaningful comparisons. This particular pulsatile VAD system produces near physiologic hemodynamic energy levels at each experimental stage.
authors.affiliation: Department of Pediatrics, Penn State College of Medicine, Penn State Children's Hospital, Penn State Milton S. Hershey Medical Center, 500 University Drive, P.O. Box 850, Hershey, PA 17033-0850, USA.
authors.forename: Akif
authors.initials: A
authors.lastname: Undar
authors.forename: Conrad M
authors.initials: CM
authors.lastname: Zapanta
authors.forename: John D
authors.initials: JD
authors.lastname: Reibson
authors.forename: Matthew
authors.initials: M
authors.lastname: Souba
authors.forename: Branka
authors.initials: B
authors.lastname: Lukic
authors.forename: William J
authors.initials: WJ
authors.lastname: Weiss
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Snyder
authors.forename: Allen R
authors.initials: AR
authors.lastname: Kunselman
authors.forename: William S
authors.initials: WS
authors.lastname: Pierce
authors.forename: Gerson
authors.initials: G
authors.lastname: Rosenberg
authors.forename: John L
authors.initials: JL
authors.lastname: Myers
mesh_terms: D000328:Adult; D001011:Aorta; D001783:Blood Flow Velocity; D001794:Blood Pressure / Q000502:physiology*; D004734:Energy Metabolism; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D011673:Pulsatile Flow