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Evaluation of inflow cannulation site for implantation of right-sided rotary ventricular assist device

机译：右侧旋转室辅助装置植入流动插管部位的评价

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摘要

Right heart dysfunction is one of the most serious complications following implantation of a left ventricular assist device, often leading to the requirement for short- or long-term right ventricular assist device (RVAD) support. The inflow cannulation site induces major hemodynamic changes and so there is a need to optimize the site used depending on the patient's condition. Therefore, this study evaluated and compared the hemodynamic influence of right atrial cannulation (RAC) and right ventricular cannulation (RVC) inflow sites. An in vitro variable heart failure mock circulation loop was used to compare RAC and RVC in mild and severe biventricular heart failure (BHF) conditions. In the severe BHF condition, higher ventricular ejection fraction (RAC: 13.6%, RVC: 32.7%) and thus improved heart chamber and RVAD washout were observed with RVC, which suggested this strategy might be preferable for long-term support (i.e., bridge-to-transplant or destination therapy) to reduce the risk of thrombus formation. In the mild BHF condition, higher pulmonary valve flow (RAC: 3.33L/min, RVC: 1.97L/min) and lower right ventricular stroke work (RAC: 0.10W, RVC: 0.13W) and volumes were recorded with RAC. These results indicate an improved potential for myocardial recovery, thus RAC should be chosen in this condition. This in vitro study suggests that RVAD inflow cannulation site should be chosen on a patient-specific basis with a view to the support strategy to promote myocardial recovery or reduce the risk of long-term complications.
机译：右心功能障碍是植入左心室辅助装置后最严重的并发症之一，通常导致短期或长期右心室辅助装置（RVAD）支持的要求。流入插管部位诱导重大血液动力学变化，因此需要优化根据患者的状况使用的遗址。因此，该研究评估并比较了右心房插管（RAC）和右心室插管（RVC）流入位点的血流动力学影响。在体外可变心力衰竭模拟循环回路用于将RAC和RVC进行轻度和严重的前心性心力衰竭（BHF）条件。在严重的BHF条件下，用RVC观察到较高的心室喷射部分（RAC：13.6％，RVC：32.7％）和改进的心室和RVAD冲洗，这表明该策略可能是长期支持（即桥梁移植或目的地疗法）以降低血栓形成的风险。在温和的BHF条件下，肺瓣膜流量更高（RAC：3.33L / min，RVC：1.97L / min）和右下室中风工作（RAC：0.10W，RVC：0.13W）和卷被RAC记录。这些结果表明了心肌恢复的改善潜力，因此应该在这种情况下选择RAC。这种体外研究表明，RVAD流入插管现场应选择特定患者的基础，以促进促进心肌恢复或降低长期并发症的风险。

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