title: Numerical Simulation of a Biventricular Assist Device with Fixed Right Outflow Cannula Banding During Pulmonary Hypertension.
abstract: As a left ventricular assist device is designed to pump against the systemic vascular resistance (SVR), pulmonary congestion may occur when using such device for right ventricular support. The present study evaluates the efficacy of using a fixed right outflow banding in patients receiving biventricular assist device support under various circulatory conditions, including variations in the SVR, pulmonary vascular resistance (PVR), total blood volume (BV), as well as ventricular contractility. Effect of speed variation on the hemodynamics was also evaluated at varying degrees of PVR. Pulmonary congestion was observed at high SVR and BV. A reduction in right ventricular assist device (RVAD) speed was required to restore pulmonary pressures. Meanwhile, at a high PVR, the risk of ventricular suction was prevalent during systemic hypotension due to low SVR and BV. This could be compensated by increasing RVAD speed. Isolated right heart recovery may aggravate pulmonary congestion, as the failing left ventricle cannot accommodate the resultant increase in the right-sided flow. Compared to partial assistance, the sensitivity of the hemodynamics to changes in VAD speed increased during full assistance. In conclusion, our results demonstrated that the introduction of a banding graft with a 5 mm diameter guaranteed sufficient reserve of the pump speed spectrum for the regulation of acceptable hemodynamics over different clinical scenarios, except under critical conditions where drug administration or volume management is required.
authors.affiliation: Department of Biomedical Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia.|Asian Cardiac Engineering Laboratory, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: K
authors.initials: K
authors.lastname: Nadeem
authors.affiliation: Department of Biomedical Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia.|Asian Cardiac Engineering Laboratory, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: B C
authors.initials: BC
authors.lastname: Ng
authors.affiliation: Department of Biomedical Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia. einly_lim@um.edu.my.|Asian Cardiac Engineering Laboratory, University of Malaya, Kuala Lumpur, Malaysia. einly_lim@um.edu.my.
authors.forename: E
authors.initials: E
authors.lastname: Lim
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Australia.|Critical Care Research Group, Innovative Cardiovascular Engineering and Technology Laboratory, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: S D
authors.initials: SD
authors.lastname: Gregory
authors.affiliation: Intensive Care Unit, Alfred Hospital, Melbourne, Australia.|Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, Australia.
authors.forename: R F
authors.initials: RF
authors.lastname: Salamonsen
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Australia.|Critical Care Research Group, Innovative Cardiovascular Engineering and Technology Laboratory, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: M C
authors.initials: MC
authors.lastname: Stevens
authors.affiliation: Deparment of Electrical Engineering, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: M
authors.initials: M
authors.lastname: Mubin
authors.affiliation: Graduate School of Biomedical Engineering, University of South Wales, Sydney, NSW, Australia.
authors.forename: N H
authors.initials: NH
authors.lastname: Lovell
mesh_terms: D001810:Blood Volume; D000072601:Cannula; D003198:Computer Simulation; D006352:Heart Ventricles / Q000503:physiopathology; D006353:Heart-Assist Devices; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology*; D008955:Models, Cardiovascular; D014655:Vascular Resistance
keywords: Heart failure; Pulmonary artery banding; Pulmonary vascular resistance; Systemic vascular resistance; Ventricular assist device