Abstract
Mechanical circulatory support (MCS) devices are currently under development to improve the physiology and hemodynamics of patients with heart failure with preserved ejection fraction (HFpEF). Most of these devices, however, are designed to provide continuous-flow support. While it has been shown that pulsatile support may overcome some of the complications hindering the clinical translation of these devices for other heart failure phenotypes, the effects that it may have on the HFpEF physiology are still unknown. Here, we present a multi-domain simulation study of a pulsatile pump device with left atrial cannulation for HFpEF that aims to alleviate left atrial pressure, commonly elevated in HFpEF. We leverage lumped-parameter modeling to optimize the design of the pulsatile pump, computational fluid dynamic simulations to characterize hydraulic and hemolytic performance, and finite element modeling on the Living Heart Model to evaluate effects on arterial, left atrial, and left ventricular hemodynamics and biomechanics. The findings reported in this study suggest that pulsatile-flow support can successfully reduce pressures and associated wall stresses in the left heart, while yielding more physiologic arterial hemodynamics compared to continuous-flow support. This work therefore supports further development and evaluation of pulsatile support MCS devices for HFpEF.
Highlights
Heart failure with preserved ejection fraction (HFpEF) is a complex and multi-factorial condition of diverse etiology, arising from the inability of the heart to relax and fill adequately (Borlaug and Paulus, 2011; Borlaug, 2020)
We investigate the feasibility of a pulsatile-flow pump with left atrium (LA) cannulation for heart failure with preserved ejection fraction (HFpEF) (Figure 1) and compare its performance with an analogous continuous-flow device, using a broad array of computational tools, including lumpedparameter (LP), computational fluid dynamics (CFD), and finite element analysis (FEA) platforms
We demonstrate that, for the HFpEF physiology, hemodynamic support with LA cannulation and in co-pulsation with aortic ejection yields better LA and arterial hemodynamics compared to left ventricular (LV) cannulation or other pulsation modalities
Summary
Heart failure with preserved ejection fraction (HFpEF) is a complex and multi-factorial condition of diverse etiology, arising from the inability of the heart to relax and fill adequately (Borlaug and Paulus, 2011; Borlaug, 2020). Pulsatile-Flow Mechanical Support for HFpEF derangements associated with HFpEF arise from profound structural changes of the heart, primarily due to loss of ventricular compliance (Weber et al, 1993; Borbély et al, 2005), and often exacerbated by autonomic imbalance (Florea and Cohn, 2014) and other comorbidities (Mishra and Kass, 2021). These changes primarily result in elevations in the end-diastolic pressure-volume relationship (EDPVR), indicative of LV stiffening, and in the corresponding rise in end-diastolic pressure and drop in end-diastolic volume and cardiac output (CO; Borlaug et al, 2009). Elevated LV end-diastolic pressures are transmitted retrogradely to the left atrium (LA) driving LA remodeling and symptoms of atrial fibrillation, and to the pulmonary circulation, resulting in congestion and exercise intolerance (Upadhya et al, 2015)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
