Improved left ventricular unloading and circulatory support with synchronized pulsatile left ventricular assistance compared with continuous-flow left ventricular assistance in an acute porcine left ventricular failure model.
OBJECTIVE
Controversy exists regarding the optimal pumping method for left ventricular assist devices. The purpose of this investigation was to test the hypothesis that pulsatile left ventricular assist synchronized to the cardiac cycle provides superior left ventricular unloading and circulatory support compared with continuous-flow left ventricular assist devices at the same level of ventricular assist device flow.


METHODS
Seven male pigs were used to evaluate left ventricular assist device function using the TORVAD synchronized pulsatile-flow pump (Windmill Cardiovascular Systems, Inc, Austin, Tex) compared with the Bio-Medicus BPX-80 continuous-flow centrifugal pump (Medtronic, Inc, Minneapolis, Minn). Experiments were carried out under general anesthesia, and animals were instrumented via a median sternotomy. Hemodynamic measurements were obtained in the control state and with left ventricular assistance using the TORVAD and BPX-80 individually. Left ventricular failure was induced with suture ligation of the mid-left anterior descending coronary artery, and hemodynamic measurements were repeated.


RESULTS
During left ventricular assist device support, mean aortic pressure and total cardiac output were higher and left atrial pressure was lower with pulsatile compared with continuous flow at the same ventricular assist device flow rate. During ischemic left ventricular failure, pulsatile left ventricular support resulted in higher total cardiac output (5.58 ± 1.58 vs 5.12 ± 1.19, P < .05), higher mean aortic pressure (67.8 ± 14 vs 60.2 ± 10, P < .05), and lower left atrial pressure (11.5 ± 3.5 vs 13.9 ± 6.0, P < .05) compared with continuous flow at the same left ventricular assist device flow rate.


CONCLUSIONS
Synchronized, pulsatile left ventricular assistance produces superior left ventricular unloading and circulatory support compared with continuous-flow left ventricular assist at the same flow rates.
Letsou
George V
GV
Division of Cardiovascular Medicine, The University of Texas Medical School at Houston and The Memorial Hermann Heart and Vascular Institute, Houston, TX, USA.
Pate
Thomas D
TD
Gohean
Jeffrey R
JR
Kurusz
Mark
M
Longoria
Raul G
RG
Kaiser
Larry
L
Smalling
Richard W
RW
D000208:Acute Disease; D000818:Animals; D001011:Aorta / Q000503:physiopathology; D016279:Atrial Function, Left; D001794:Blood Pressure; D002302:Cardiac Output; D004195:Disease Models, Animal; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006439:Hemodynamics; D008297:Male; D011474:Prosthesis Design; D011673:Pulsatile Flow; D034421:Sus scrofa; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left