Abstract 12771: A Novel Rotational Speed Modulation System Used With an Implantable Continuous-flow Left Ventricular Assist Device Provides Good Pulsatility on Peripheral Organ Perfusion

Abstract

Introduction: Continuous-flow left ventricular assist devices (CFLVAD) is widely used to treat patients with end-stage heart failure. Even though the continuous flow is not physiologic, outcomes of CFLVAD have been improved. We have developed a novel rotational speed (RS) modulation system used with CFLVAD (EVAHEART), which can change RS in synchronization with the native cardiac cycle. We have reported that the system can change cardiac load and optimize coronary artery flow. We conducted the present study to investigate the influence of our system on peripheral perfusion. Methods: We implanted EVAHEART devices by the left ventricular apex drainage and the descending aortic perfusion via left thoracotomy in seven adult goats (56.8 ± 8.1 kg). Cardiogenic shock was induced by a beta adrenergic antagonist and coronary artery ligations. We evaluated blood flow, pulsatility index (PI), and maximum time derivative of flow rate (max dQ/dt) of carotid artery (CA), mesenteric artery (MA), renal artery (RA), respectively, using ultrasonic flow meters directly placed on the arteries. Mean tissue blood flow (TBF) of the heart and omentum and PIs of TBF were measured using the TBF meter. Venous lactate level, cerebral oxygen extraction rate (ExO2) and regional saturation of oxygen (rSO2) of brain, kidney, and leg muscle were also evaluated. Those data were collected with a bypass rate of 100% under four conditions: circuit clamp, continuous mode (constant RS), co-pulse mode (increase RS during systole), and counter-pulse mode (increase RS during diastole). Results: PIs of CA and RA in the copulse mode were significantly higher than those in the other modes. Max dq/dt of CA and MA were significantly higher in the copulse mode than those in the counter-pulse mode. Max dq/dt of the three arteries in the copulse mode tended to be higher than those in the other modes. PIs of TBF of the heart and the omentum in the copulse mode tended to be higher than those in the other modes. As for the metabolic changes in each mode, there were no significant differences in levels of lactate, cerebral ExO2, or rSO2. Conclusions: The copulse mode of our novel RS modulation system may provide better pulsatility not only in the large vessels but also in the peripheral perfusion.