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Numerical Simulation of a Biventricular Assist Device with Fixed Right Outflow Cannula Banding During Pulmonary Hypertension

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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.

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Acknowledgment

The authors thank the Ministry of Higher Education of Malaysia (UM.C/HIR/MOHE/ENG/50) and the University of Malaya Research Grant (RP028-14HTM) for financial support.

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Authors and Affiliations

  1. Department of Biomedical Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia

    K. Nadeem, B. C. Ng & E. Lim

  2. Asian Cardiac Engineering Laboratory, University of Malaya, Kuala Lumpur, Malaysia

    K. Nadeem, B. C. Ng & E. Lim

  3. School of Medicine, University of Queensland, Brisbane, Australia

    S. D. Gregory & M. C. Stevens

  4. Critical Care Research Group, Innovative Cardiovascular Engineering and Technology Laboratory, The Prince Charles Hospital, Brisbane, QLD, Australia

    S. D. Gregory & M. C. Stevens

  5. Intensive Care Unit, Alfred Hospital, Melbourne, Australia

    R. F. Salamonsen

  6. Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, Australia

    R. F. Salamonsen

  7. Deparment of Electrical Engineering, University of Malaya, Kuala Lumpur, Malaysia

    M. Mubin

  8. Graduate School of Biomedical Engineering, University of South Wales, Sydney, NSW, Australia

    N. H. Lovell

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  1. K. Nadeem
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Correspondence to E. Lim.

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Associate Editor Estefanía Peña oversaw the review of this article.

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Nadeem, K., Ng, B.C., Lim, E. et al. Numerical Simulation of a Biventricular Assist Device with Fixed Right Outflow Cannula Banding During Pulmonary Hypertension. Ann Biomed Eng 44, 1008–1018 (2016). https://doi.org/10.1007/s10439-015-1388-2

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  • DOI: https://doi.org/10.1007/s10439-015-1388-2

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