Impact of Pump Speed on Hemodynamics With Exercise in Continuous Flow Ventricular Assist Device Patients.

Lai, JV; Muthiah, K; Robson, D; Prichard, R; Walker, R; Pin Lim, C; Wang, LW; Macdonald, PS; Jansz, P; Hayward, CS

Impact of Pump Speed on Hemodynamics With Exercise in Continuous Flow Ventricular Assist Device Patients.

Lai, JV Muthiah, K Robson, D Prichard, R

Walker, R Pin Lim, C Wang, LW Macdonald, PS Jansz, P Hayward, CS

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Publisher:: Lippincott, Williams & Wilkins
Publication Type:: Journal Article
Citation:: ASAIO Journal, 2020, 66, (2), pp. 132-138
Issue Date:: 2020-02

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Field	Value	Language
dc.contributor.author	Lai, JV
dc.contributor.author	Muthiah, K
dc.contributor.author	Robson, D
dc.contributor.author	Prichard, R https://orcid.org/0000-0001-8057-6605
dc.contributor.author	Walker, R
dc.contributor.author	Pin Lim, C
dc.contributor.author	Wang, LW
dc.contributor.author	Macdonald, PS
dc.contributor.author	Jansz, P
dc.contributor.author	Hayward, CS
dc.date.accessioned	2020-08-19T04:24:45Z
dc.date.available	2020-08-19T04:24:45Z
dc.date.issued	2020-02
dc.identifier.citation	ASAIO Journal, 2020, 66, (2), pp. 132-138
dc.identifier.issn	1058-2916
dc.identifier.issn	1538-943X
dc.identifier.uri	http://hdl.handle.net/10453/142220
dc.description.abstract	At fixed speed, the spontaneous increase in pump flow accompanying exercise in patients with continuous flow left ventricular assist devices (cfLVADs) is slight in comparison to normal physiologic response, limiting exercise capacity. We systematically exercised 14 patients implanted with an isolated HeartWare HVAD undergoing routine right heart catheterization at baseline and at maximal safe pump speed. In addition to hemodynamics, mixed venous oxygen saturation (SvO2), echocardiography and noninvasive mean arterial pressure, and heart rate were measured. Significantly greater pump flows were achieved with maximum pump speed compared with baseline speed at rest (mean ± standard deviation [SD]: 5.0 ± 0.7 vs. 4.6 ± 0.8 L/min) and peak exercise (6.7 ± 1.0 vs. 5.9 ± 0.9 L/min, p = 0.001). Pulmonary capillary wedge pressure was significantly reduced with maximum pump speed compared to baseline pump speed at rest (10 ± 4 vs. 15 ± 5 mmHg, p < 0.001) and peak exercise (27 ± 8 vs. 30 ± 8 mmHg, p = 0.002). Mixed venous oxygen saturation decreased with exercise (p < 0.001) but was unaffected by changes in pump speed. In summary, although higher pump speeds synergistically augment the increase in pump flow associated with exercise and blunt the exercise-induced rise in left heart filling pressures, elevated filling pressures and markedly diminished SvO2 persist at maximal safe pump speed, suggesting that physiologic flow increases are not met by isolated cfLVADs in the supported failing heart.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Lippincott, Williams & Wilkins
dc.relation.ispartof	ASAIO Journal
dc.relation.isbasedon	10.1097/mat.0000000000000975
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	0903 Biomedical Engineering
dc.subject.classification	Biomedical Engineering
dc.title	Impact of Pump Speed on Hemodynamics With Exercise in Continuous Flow Ventricular Assist Device Patients.
dc.type	Journal Article
utslib.citation.volume	66
utslib.location.activity	United States
utslib.for	0903 Biomedical Engineering
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	closed_access	*
pubs.consider-herdc	true
dc.date.updated	2020-08-19T04:24:21Z
pubs.issue	2
pubs.publication-status	Published
pubs.volume	66
utslib.citation.issue	2

Abstract:

At fixed speed, the spontaneous increase in pump flow accompanying exercise in patients with continuous flow left ventricular assist devices (cfLVADs) is slight in comparison to normal physiologic response, limiting exercise capacity. We systematically exercised 14 patients implanted with an isolated HeartWare HVAD undergoing routine right heart catheterization at baseline and at maximal safe pump speed. In addition to hemodynamics, mixed venous oxygen saturation (SvO2), echocardiography and noninvasive mean arterial pressure, and heart rate were measured. Significantly greater pump flows were achieved with maximum pump speed compared with baseline speed at rest (mean ± standard deviation [SD]: 5.0 ± 0.7 vs. 4.6 ± 0.8 L/min) and peak exercise (6.7 ± 1.0 vs. 5.9 ± 0.9 L/min, p = 0.001). Pulmonary capillary wedge pressure was significantly reduced with maximum pump speed compared to baseline pump speed at rest (10 ± 4 vs. 15 ± 5 mmHg, p < 0.001) and peak exercise (27 ± 8 vs. 30 ± 8 mmHg, p = 0.002). Mixed venous oxygen saturation decreased with exercise (p < 0.001) but was unaffected by changes in pump speed. In summary, although higher pump speeds synergistically augment the increase in pump flow associated with exercise and blunt the exercise-induced rise in left heart filling pressures, elevated filling pressures and markedly diminished SvO2 persist at maximal safe pump speed, suggesting that physiologic flow increases are not met by isolated cfLVADs in the supported failing heart.

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http://hdl.handle.net/10453/142220