Abstract
Valvular insufficiency affects cardiac responses and the pumping efficacy of left ventricular assist devices (LVADs) when patients undergo LVAD therapy. Knowledge of the effect of valvular regurgitation on the function of LVADs is important when treating heart failure patients. The goal of this study was to examine the effect of valvular regurgitation on the ventricular mechanics of a heart under LVAD treatment and the pumping efficacy of an LVAD using a computational model of the cardiovascular system. For this purpose, a 3D electromechanical model of failing ventricles in a human heart was coupled with a lumped-parameter model of valvular regurgitation and an LVAD-implanted vascular system. We used the computational model to predict cardiac responses with respect to the severity of valvular regurgitation in the presence of LVAD treatment. An LVAD could reduce left ventricle (LV) pressure (up to 34%) and end-diastolic ventricular volume (up to 80%) and maintain cardiac output at the estimated flow rate from the LVAD under the condition of mitral regurgitation (MR); however, the opposite would occur under the condition of aortic regurgitation (AR). Considering these physiological responses, we conclude that AR, and not MR, diminishes the pumping function of LVADs.
Highlights
Left ventricular assist devices (LVADs) are mechanical devices that assist the function of a failed heart by facilitating blood circulation in the body
The goal of this study was to examine the effect of valvular regurgitation on the ventricular mechanics in a heart under LVAD and the pumping efficacy of an LVAD using a computational model of the cardiovascular system
The first row shows myocardial strain in the control group, which was not treated by LVAD; the second row shows myocardial strain in the LVAD therapy group; and the third row shows the difference between the control and LVAD therapy groups
Summary
Left ventricular assist devices (LVADs) are mechanical devices that assist the function of a failed heart by facilitating blood circulation in the body. Regurgitation can affect the pumping efficacy in LVAD therapy [3]. Several studies have focused on determining regurgitation volume using medical imaging techniques [2, 8,9,10,11] and on predicting the effect of regurgitant volume on ventricular mechanical function [12]. The effect of a specific valvular regurgitation on the function of an LVAD in the failing ventricles of patients treated with LVAD therapy has not been studied. Experiments that predict the pumping efficacy of an LVAD for different degrees of valvular insufficiency can be performed, measurement of cardiac responses such as the ventricular unloading effect of an LVAD is hampered by low spatiotemporal resolution
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