Abstract
The effect of rotary left ventricular assist devices (LVADs) on myocardial perfusion has yet to be clearly elucidated, and several studies have shown decreased coronary flow under rotary LVAD support. We have developed a novel pump controller that can change its rotational speed (RS) in synchronization with the native cardiac cycle. The aim of our study was to evaluate the effect of counterpulse mode, which increases the RS in diastole, during coronary perfusion. Experiments were performed on ten adult goats. The EVAHEART LVAD was installed by the left ventricular uptake and the descending aortic return. Ascending aortic flow, pump flow, and coronary flow of the left main trunk were monitored. Coronary flow was compared under four conditions: circuit-clamp, continuous mode (constant pump speed), counterpulse mode (increased pump speed in diastole), and copulse mode (increased pump speed in systole). There were no significant baseline changes between these groups. In counterpulse mode, coronary flow increased significantly compared with that in continuous mode. The waveform analysis clearly revealed that counterpulse mode mainly resulted in increased diastolic coronary flow. In conclusion, counterpulse mode of rotary LVADs can enhance myocardial perfusion. This novel drive mode can provide great benefits to the patients with end-stage heart failure, especially those with ischemic etiology.
Similar content being viewed by others
References
Thalmann M, Schima H, Wieselthaler G, Wolner E. Physiology of continuous blood flow in recipients of rotary cardiac assist devices. J Heart Lung Transplant. 2005;24:237–45.
Ootaki Y, Kamohara K, Akiyama M, Zahr F, Kopcak MW Jr, Dessoffy R, Fukamachi K. Phasic coronary blood flow pattern during a continuous flow left ventricular assist support. Eur J Cardiothorac Surg. 2005;28:711–6.
Tuzun E, Eya K, Chee HK, Conger JL, Bruno NK, Frazier OH, Kadipasaoglu KA. Myocardial hemodynamics, physiology, and perfusion with an axial flow left ventricular assist device in the calf. ASAIO J. 2004;50:47–53.
Noda H, Takano H, Taenaka Y, Kinoshita M, Tatsumi E, Yagura A, Sekii H, Sasaki E, Akutsu T. Regulation of coronary circulation during left ventricular assist. ASAIO Trans. 1989;35:445–7.
Xydas S, Rosen RS, Pinney S, Hickey KT, Wasserman H, Mancini DM, Naka Y, Oz MC, Bergmann SR, Maybaum S. Reduced myocardial blood flow during left ventricular assist device support: a possible cause of premature bypass graft closure. J Heart Lung Transplant. 2005;24:1976–9.
Yamazaki K, Kihara S, Akimoto T, Tagusari O, Kawai A, Umezu M, Tomioka J, Kormos RL, Griffith BP, Kurosawa H. EVAHEART: an implantable centrifugal blood pump for long-term circulatory support. Jpn J Thorac Cardiovasc Surg. 2002;50:461–5.
Grundeman PF, Borst C, van Herwaarden JA, Verlaan CW, Jansen EW. Vertical displacement of the beating heart by the octopus tissue stabilizer: influence on coronary flow. Ann Thorac Surg. 1998;65:1348–52.
Nakamura T, Hayashi K, Seki J, Nakatani T, Noda H, Takano H, Akutsu T. Effect of drive mode of left ventricular assist device on the left ventricular mechanics. Artif Organs. 1988;12:56–66.
Feigl EO. Coronary physiology. Physiol Rev. 1983;63:1–205.
Weber KT, Janicki JS. Intraaortic balloon counterpulsation. A review of physiological principles, clinical results, and device safety. Ann Thorac Surg. 1974;17:602–36.
Shimizu T, Kyo S, Imanaka K, Nakaoka K, Nishimura E, Okumura T, Ishii M, Hisagi M, Nishimura T, Motomura N, Ono M, Takamoto S. A novel external counterpulsation system for coronary artery disease and heart failure: pilot studies and initial clinical experiences. J Artif Organs. 2010;13:161–9.
Elhabyan AK, Reyes BJ, Hallak O, Broce M, Rosencrance JG, Lucas BD, Fazal H. Subendocardial ischemia without coronary artery disease: is elevated left ventricular end diastolic pressure the culprit? Curr Med Res Opin. 2004;20:773–7.
Yamazaki K, Saito S, Kihara S, Tagusari O, Kurosawa H. Completely pulsatile high flow circulatory support with a constant-speed centrifugal blood pump: mechanisms and early clinical observations. Gen Thorac Cardiovasc Surg. 2007;55:158–62.
Nakata K, Shiono M, Orime Y, Hata M, Sezai A, Saitoh T, Sezai Y. Effect of pulsatile and nonpulsatile assist on heart and kidney microcirculation with cardiogenic shock. Artif Organs. 1996;20:681–4.
Voitl P, Vollkron M, Bergmeister H, Wieselthaler G, Schima H. Coronary hemodynamics and myocardial oxygen consumption during support with rotary blood pumps. Artif Organs. 2009;33:77–80.
Smalling RW, Cassidy DB, Barrett R, Lachterman B, Felli P, Amirian J. Improved regional myocardial blood flow, left ventricular unloading, and infarct salvage using an axial-flow, transvalvular left ventricular assist device. A comparison with intra-aortic balloon counterpulsation and reperfusion alone in a canine infarction model. Circulation. 1992;85:1152–9.
Hata M, Shiono M, Orime Y, Nakata K, Sezai A, Yamada H, Saito T, Sezai Y. Coronary microcirculation during left heart bypass with a centrifugal pump. Artif Organs. 1996;20:678–80.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ando, M., Takewa, Y., Nishimura, T. et al. A novel counterpulsation mode of rotary left ventricular assist devices can enhance myocardial perfusion. J Artif Organs 14, 185–191 (2011). https://doi.org/10.1007/s10047-011-0573-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10047-011-0573-9