Impact of Pump Speed on Hemodynamics With Exercise in Continuous Flow Ventricular Assist Device Patients

Jacqueline V Lai; Kavitha Muthiah; Desiree Robson; Ros Prichard; Robyn Walker; Choon Pin Lim; Louis W Wang; Peter S Macdonald; Paul Jansz; Christopher S Hayward

doi:10.1097/MAT.0000000000000975

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Impact of Pump Speed on Hemodynamics With Exercise in Continuous Flow Ventricular Assist Device Patients

Journal article

Peer reviewed

Impact of Pump Speed on Hemodynamics With Exercise in Continuous Flow Ventricular Assist Device Patients

Jacqueline V Lai, Kavitha Muthiah, Desiree Robson, Ros Prichard, Robyn Walker, Choon Pin Lim, Louis W Wang, Peter S Macdonald, Paul Jansz and Christopher S Hayward

ASAIO Journal, Vol.66(2), pp.132-138

2020

DOI: https://doi.org/10.1097/MAT.0000000000000975

PMID: 30913099

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Abstract

left ventricular assist device

speed

exercise

hemodynamics

At fixed speed, the spontaneous increase in pump flow accompanying exercise in patients with continuous flow left ventricular assist devices (cfLVADs) is slight in comparison to normal physiologic response, limiting exercise capacity. We systematically exercised 14 patients implanted with an isolated HeartWare HVAD undergoing routine right heart catheterization at baseline and at maximal safe pump speed. In addition to hemodynamics, mixed venous oxygen saturation (SvO2), echocardiography and noninvasive mean arterial pressure, and heart rate were measured. Significantly greater pump flows were achieved with maximum pump speed compared with baseline speed at rest (mean ± standard deviation [SD]: 5.0 ± 0.7 vs. 4.6 ± 0.8 L/min) and peak exercise (6.7 ± 1.0 vs. 5.9 ± 0.9 L/min, p = 0.001). Pulmonary capillary wedge pressure was significantly reduced with maximum pump speed compared to baseline pump speed at rest (10 ± 4 vs. 15 ± 5 mmHg, p < 0.001) and peak exercise (27 ± 8 vs. 30 ± 8 mmHg, p = 0.002). Mixed venous oxygen saturation decreased with exercise (p < 0.001) but was unaffected by changes in pump speed. In summary, although higher pump speeds synergistically augment the increase in pump flow associated with exercise and blunt the exercise-induced rise in left heart filling pressures, elevated filling pressures and markedly diminished SvO2 persist at maximal safe pump speed, suggesting that physiologic flow increases are not met by isolated cfLVADs in the supported failing heart.

Details

Title: Impact of Pump Speed on Hemodynamics With Exercise in Continuous Flow Ventricular Assist Device Patients
Authors: Jacqueline V Lai (Author) - UNSW Australia
Kavitha Muthiah (Author) - UNSW Australia
Desiree Robson (Author) - St Vincent's Hospital Sydney
Ros Prichard (Author) - St Vincent's Hospital Sydney
Robyn Walker (Author) - St Vincent's Hospital Sydney
Choon Pin Lim (Author) - St Vincent's Hospital Sydney
Louis W Wang (Author) - St Vincent's Hospital Sydney
Peter S Macdonald (Author) - St Vincent's Hospital Sydney
Paul Jansz (Author) - St Vincent's Hospital Sydney
Christopher S Hayward (Author) - St Vincent's Hospital Sydney
Publication details: ASAIO Journal, Vol.66(2), pp.132-138
Publisher: Lippincott Williams & Wilkins
DOI: 10.1097/MAT.0000000000000975
ISSN: 1538-943X
PMID: 30913099
Organisation Unit: University of the Sunshine Coast, Queensland; School of Nursing, Midwifery and Paramedicine - Legacy; School of Health - Nursing
Language: English
Record Identifier: 99512707802621
Output Type: Journal article

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Collaboration types: Domestic collaboration
Web Of Science research areas: Engineering, Biomedical; Transplantation

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