A Novel Numerical Study on the Development and Implementation of a Physiological Control Strategy for HeartMate 3 LVAD.

Over the last 2 decades, numerous advancements in medical therapies have improved patient outcomes in heart failure (HF). However, a significant number of patients still progress to end-stage HF, in which treatment options are largely limited to cardiac transplantation. As patient demands for transplant continue to exceed the supply of available organs, mechanical assist devices—specifically, the left ventricular assist device (LVAD)—were initially introduced as a bridge to cardiac transplantation. LVADs have 2 important beneficial effects. First, LVADs are placed in parallel to the native left ventricle (LV), causing pressure and volume unloading of the LV. Second, LVADs restore cardiac output and subsequent perfusion to the organs. As a result of these 2 effects, it became evident that some patients had actual improvement in LV function after LVAD placement. The term reverse remodeling was used to describe the improvement in myocardial function that was observed in patients with a seemingly end-stage disease. With reverse remodeling, a new hope for the treatment of HF was born—using LVADs as a bridge to recovery; however, to date, this promise has largely been unrealized. This probably is reflective of the fact that the sequela of mechanical ventricular unloading are quite complex and appear to involve the engagement of competing biological pathways including regression of cardiomyocyte hypertrophy as well as progressive cell atrophy. Although the promise of ventricular recovery still persists, its actualization will await a more comprehensive dissection of these competing biological processes. This review will discuss the beneficial clinical effects of LVAD support as well as review what is known about the cellular and molecular response to mechanical unloading and mechanisms of reverse remodeling. Key research findings have been summarized in the Table. View this table: Table. Summary of Research of LVAD Support on Clinical Effects and the Cellular and Molecular Changes That May Contribute to Reverse …

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ID: 66 Edgar Allan Poe, "The Pit and the Pendulum", and Ventricular Assist Devices Author Information: Authors List: Presenting Author: Cheryl Zambroski Additional Author: Pamela Combs Additional Author: Sherill Cronin Additional Author: Carol Pfeffer Presenting Author: Cheryl Hoyt Zambroski Address: University of South Florida College of Nursing 12901 Bruce B. Downs MDC 22 Tampa, FL 33647 USA Ph: 813-774-6436 Fax: Email: czambros@health.usf.edu Institution: University of South Florida Additional Author: Pamela S. Combs Address: University of Louisville 12901 Bruce B. Downs MDC 22 Louisville, KY 42092 USA Ph: 812-949-7289 Fax: Email: pscombs)1@louisville.edu Institution: University of Louisville Additional Author: Sherill N Cronin Address: Bellarmine University 12901 Bruce B. Downs MDC 22 Louisville, KY 40206 USA Ph: 502-425-5504 Fax: Email: scronin@bellarmine.edu Institution: Additional Author: Carol Pfeffer Address: Bellarmine University 12901 Bruce B. Downs MDC 22 Louisville, KY 40206 USA Ph: 502-425-5504 Fax: Email: scronin@bellarmine.edu Institution: Abstract InformationInformation Presentation Preference: SNRS Poster Presentation Abstract Categories: Interest Group: Researchers in Clinical Settings Thematic Areas: Chronic illness Introduction: Ventricular Assist Devices (VADs) are being used with increasing frequency in patients with heart failure. VADs are not without adversity, however, as high post-operative morbidity and mortality are of major concern. For those who survive, little is known about the experience from the patients' perspective. The purpose of this qualitative, descriptive study was to gain a better understanding of the experience of living with a VAD Method(s): Through the process of open-ended interviewing, data were collected and analyzed on an ongoing basis to generate conceptual categories. A key informant articulated his experience of living with a VAD through his analogy to Edgar Allen Poe's The Pit and the Pendulum. Furthermore, language of co-informants corresponded closely with themes emerging in Poe's short story. During analysis, a consultant from the English Department provided additional analysis of The Pit and the Pendulum as it related to each theme. Results: Six adults with an average age of 58.8 years participated. Both men were Caucasian; two women were Caucasian and two were African-American. There was wide variation in the length of device implantation. Four key themes: Facing the Unknown, Feeling Confined, Living with Fear, and Hope for the Future emerged. Discussion: Comparison of the experience of living with a VAD to the tale of Poe's Narrator does not provide an easy image for nurses who care for this population. Yet, diagnosis of heart failure can, in fact, be a sentence of sorts: a sentence to an uncertain future, physical decline, even to death. The findings of this study can help clinicians to target interventions toward reducing the uncertainty associated with living with a VAD, providing opportunities to reduce the sense of confinement, recognizing and reducing patient fears, and providing and supporting hope for the future through reduction of symptoms and extending life or through providing a peaceful death. Research Completed : Yes Abstract History: -This material has been presented or accepted for presentation in whole or in part at this or another scientific meeting. -Details: USF (local presentation) Financial Disclosure: Have a financial arrangement or affiliation with commercial companies whose products may be mentioned in this material? No FDA Disclosure: Cleared: Yes Non-Exclusive License: Accepted Terms: Yes Submitted By: czambros@health.usf.edu

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Anaesthesia for heart transplantation

The success of left ventricular assist device (LVAD) therapy is hampered by complications such as thrombosis and bleeding. Understanding blood flow interactions between the heart and the LVAD might help optimize treatment and decrease complication rates. We hypothesized that LVADs modify shear stresses and blood transit in the left ventricle (LV) by changing flow patterns and that these changes can be characterized using 2D echo color Doppler velocimetry (echo-CDV). We used echo-CDV and custom postprocessing methods to map blood flow inside the LV in patients with ongoing LVAD support (Heartmate II, N = 7). We compared it to healthy controls (N = 20) and patients with dilated cardiomyopathy (DCM, N = 20). We also analyzed intraventricular flow changes during LVAD ramp tests (baseline ± 400 rpm). LVAD support reversed the increase in blood stasis associated with DCM, but it did not reduce intraventricular shear exposure. Within the narrow range studied, the ventricular flow was mostly insensitive to changes in pump speed. Patients with significant aortic insufficiency showed abnormalities in blood stasis and shear indices. Overall, this study suggests that noninvasive flow imaging could potentially be used in combination with standard clinical methods for adjusting LVAD settings to optimize flow transport and minimize stasis on an individual basis.