Pulsatile flow in patients with a novel nonpulsatile implantable ventricular assist device

Evgenij V. Potapov, Matthias Loebe, Boris A. Nasseri, Hendryk Sinawski, Andreas Koster, Hermann Kuppe, George P. Noon, Michael E. DeBakey, Roland Hetzer

Research output: Contribution to journalArticle

97 Citations (Scopus)

Abstract

Background - Ventricular assist devices (VADs) are an accepted therapy for patients with end-stage heart failure. The implantable devices that are available produce a pulsatile flow and are very large. In 6 patients, beginning in November 1998, we started to use the continuous-flow implantable DeBakey VAD device, which weighs 93 g. To detect the flow in peripheral vessels, we measured transcranial Doppler signals in patients after implantation. Methods and Results - Transcranial Doppler studies were performed with the MULTI-DOP X4 device with two 2-MHz probes (for the middle cranial arteries) in 4 patients for up to 12 weeks twice weekly after implantation. The blood velocity was measured, and the pulsation index (PI) calculated. The measured pump flow and rotations per minute were registered. The preoperative echocardiographic assessment values were compared with those acquired 6 weeks after implantation. The PI increased continually in all patients after VAD implantation, left ventricular (LV) ejection fraction did not improve, but right ventricular (RV) ejection fraction after implantation improved compared with preoperative values. The LV end-diastolic diameter after implantation decreased between 11% and 46% intraindividually. There was no correlation between PI and blood pressure or, except in 1 patient, between PI and blood flow through the VAD. Conclusions - The DeBakey VAD unloads the LV, which leads to a decrease in LV end-diastolic LV diameter and to the restoration of RV function. The unloaded LV and partially recovered RV provide a nearly physiological pulsatile flow despite the continuous flow of the VAD. Pulsatility is independent of peripheral vascular resistance. The first clinical experience with the DeBakey VAD was positive and has resulted in its continued use.

Original languageEnglish (US)
JournalCirculation
Volume102
Issue number19
StatePublished - Nov 7 2000
Externally publishedYes

Fingerprint

Pulsatile Flow
Heart-Assist Devices
Vascular Resistance
Equipment and Supplies
Stroke Volume
Right Ventricular Function
Heart Failure
Arteries
Blood Pressure

Keywords

  • Blood flow
  • Echocardiography
  • Heart failure
  • Ventricular assist device

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Potapov, E. V., Loebe, M., Nasseri, B. A., Sinawski, H., Koster, A., Kuppe, H., ... Hetzer, R. (2000). Pulsatile flow in patients with a novel nonpulsatile implantable ventricular assist device. Circulation, 102(19).

Pulsatile flow in patients with a novel nonpulsatile implantable ventricular assist device. / Potapov, Evgenij V.; Loebe, Matthias; Nasseri, Boris A.; Sinawski, Hendryk; Koster, Andreas; Kuppe, Hermann; Noon, George P.; DeBakey, Michael E.; Hetzer, Roland.

In: Circulation, Vol. 102, No. 19, 07.11.2000.

Research output: Contribution to journalArticle

Potapov, EV, Loebe, M, Nasseri, BA, Sinawski, H, Koster, A, Kuppe, H, Noon, GP, DeBakey, ME & Hetzer, R 2000, 'Pulsatile flow in patients with a novel nonpulsatile implantable ventricular assist device', Circulation, vol. 102, no. 19.
Potapov EV, Loebe M, Nasseri BA, Sinawski H, Koster A, Kuppe H et al. Pulsatile flow in patients with a novel nonpulsatile implantable ventricular assist device. Circulation. 2000 Nov 7;102(19).
Potapov, Evgenij V. ; Loebe, Matthias ; Nasseri, Boris A. ; Sinawski, Hendryk ; Koster, Andreas ; Kuppe, Hermann ; Noon, George P. ; DeBakey, Michael E. ; Hetzer, Roland. / Pulsatile flow in patients with a novel nonpulsatile implantable ventricular assist device. In: Circulation. 2000 ; Vol. 102, No. 19.
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abstract = "Background - Ventricular assist devices (VADs) are an accepted therapy for patients with end-stage heart failure. The implantable devices that are available produce a pulsatile flow and are very large. In 6 patients, beginning in November 1998, we started to use the continuous-flow implantable DeBakey VAD device, which weighs 93 g. To detect the flow in peripheral vessels, we measured transcranial Doppler signals in patients after implantation. Methods and Results - Transcranial Doppler studies were performed with the MULTI-DOP X4 device with two 2-MHz probes (for the middle cranial arteries) in 4 patients for up to 12 weeks twice weekly after implantation. The blood velocity was measured, and the pulsation index (PI) calculated. The measured pump flow and rotations per minute were registered. The preoperative echocardiographic assessment values were compared with those acquired 6 weeks after implantation. The PI increased continually in all patients after VAD implantation, left ventricular (LV) ejection fraction did not improve, but right ventricular (RV) ejection fraction after implantation improved compared with preoperative values. The LV end-diastolic diameter after implantation decreased between 11{\%} and 46{\%} intraindividually. There was no correlation between PI and blood pressure or, except in 1 patient, between PI and blood flow through the VAD. Conclusions - The DeBakey VAD unloads the LV, which leads to a decrease in LV end-diastolic LV diameter and to the restoration of RV function. The unloaded LV and partially recovered RV provide a nearly physiological pulsatile flow despite the continuous flow of the VAD. Pulsatility is independent of peripheral vascular resistance. The first clinical experience with the DeBakey VAD was positive and has resulted in its continued use.",
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AU - Loebe, Matthias

AU - Nasseri, Boris A.

AU - Sinawski, Hendryk

AU - Koster, Andreas

AU - Kuppe, Hermann

AU - Noon, George P.

AU - DeBakey, Michael E.

AU - Hetzer, Roland

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N2 - Background - Ventricular assist devices (VADs) are an accepted therapy for patients with end-stage heart failure. The implantable devices that are available produce a pulsatile flow and are very large. In 6 patients, beginning in November 1998, we started to use the continuous-flow implantable DeBakey VAD device, which weighs 93 g. To detect the flow in peripheral vessels, we measured transcranial Doppler signals in patients after implantation. Methods and Results - Transcranial Doppler studies were performed with the MULTI-DOP X4 device with two 2-MHz probes (for the middle cranial arteries) in 4 patients for up to 12 weeks twice weekly after implantation. The blood velocity was measured, and the pulsation index (PI) calculated. The measured pump flow and rotations per minute were registered. The preoperative echocardiographic assessment values were compared with those acquired 6 weeks after implantation. The PI increased continually in all patients after VAD implantation, left ventricular (LV) ejection fraction did not improve, but right ventricular (RV) ejection fraction after implantation improved compared with preoperative values. The LV end-diastolic diameter after implantation decreased between 11% and 46% intraindividually. There was no correlation between PI and blood pressure or, except in 1 patient, between PI and blood flow through the VAD. Conclusions - The DeBakey VAD unloads the LV, which leads to a decrease in LV end-diastolic LV diameter and to the restoration of RV function. The unloaded LV and partially recovered RV provide a nearly physiological pulsatile flow despite the continuous flow of the VAD. Pulsatility is independent of peripheral vascular resistance. The first clinical experience with the DeBakey VAD was positive and has resulted in its continued use.

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