Control of ventricular unloading using an electrocardiogram-synchronized Thoratec paracorporeal ventricular assist device Raffael Amacher, MSc, Alberto.

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Presentation transcript:

Control of ventricular unloading using an electrocardiogram-synchronized Thoratec paracorporeal ventricular assist device Raffael Amacher, MSc, Alberto Weber, MD, Henriette Brinks, MD, Shannon Axiak, DVM, Antonio Ferreira, PhD, Lino Guzzella, PhD, Thierry Carrel, MD, James Antaki, PhD, Stijn Vandenberghe, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 146, Issue 3, Pages 710-717 (September 2013) DOI: 10.1016/j.jtcvs.2012.12.048 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A and B, The procedure of data preparation for statistical analysis is illustrated for the example of stroke work in animal number 8, protocol 3 (decreased contractility). The beat-to-beat variables are assigned to 1 of 10 phase shift groups according to the actual phase shift. Group 0: 0% to 5% and 95% to 100%. Group 1: 5% to 15%. Group 2: 15% to 25%. Group 3: 25% to 35%. Group 4: 35% to 45%. Group 5: 45% to 55%. Group 6: 55% to 65%. Group 7: 65% to 75%. Group 8: 75% to 85%. Group 9: 85% to 95%. C, The definition of phase shift with respect to the RR duration is illustrated. The systolic duration of the pulsatile VAD is chosen to be constant (35%). PS, Phase shift; RR, RR duration; SD, systolic duration. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 710-717DOI: (10.1016/j.jtcvs.2012.12.048) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 The left plot shows a representative example of LV pressure-volume loops in baseline (VAD off and clamped) from animal number 2 for the 3 different pharmacologic protocols applied (standard, increased afterload, and decreased contractility). For each of these cases, pressure-volume loops from 3 consecutive heartbeats are shown. On the right side, 2 boxplots show the response of LV stroke work and mean arterial pressure in baseline to the pharmacologic interventions. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 710-717DOI: (10.1016/j.jtcvs.2012.12.048) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 LV pressure-volume loops for animal number 8, protocol 3 (decreased contractility). Baseline 1 and 2 are recorded immediately before and after applying the different VAD settings. The PV loops for the different phase shifts are ordered by increasing phase shifts from top left to bottom right. The symbol x denotes the start of VAD systole; o denotes the start of pump filling. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 710-717DOI: (10.1016/j.jtcvs.2012.12.048) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Boxplots of analyzed variables clustered according to their phase shift are shown (each box represents the median value and 25th and 75th percentiles; + denotes outliers). Data points are normalized by the baseline values of the individual data sets. Panel A through J show cardiac output, stroke work, end-diastolic volume, mean wall stress, LV stroke volume, peak wall stress, peak LV pressure, mean arterial pressure, LV pressure at aortic valve opening, and mean left atrial pressure. The outcome of the paired t test is shown below the corresponding data (o: significant decrease compared with baseline, x: significant increase compared with baseline, no symbol: no significant difference compared with baseline). Mean left atrial pressure was available for only 8 different data sets. LV, Left ventricle. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 710-717DOI: (10.1016/j.jtcvs.2012.12.048) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Boxplots of analyzed variables clustered according to their phase shift are shown (each box represents the median value and 25th and 75th percentiles; + denotes outliers). Panels A through D show pump flow, flow through the aortic valve, assistance ratio, and regurgitation to the left ventricle. Data points are normalized by the median values of the individual data sets because at baseline the pump is turned off. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 710-717DOI: (10.1016/j.jtcvs.2012.12.048) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions