Creating an ideal “off-test mode” for rotary left ventricular assist devices: Establishing a safe and appropriate weaning protocol after myocardial recovery

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Date of download: 9/16/2016 Copyright © The American College of Cardiology. All rights reserved. From: Oxygen-Saving Effect of a New Cardiotonic Agent,

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Creating an ideal “off-test mode” for rotary left ventricular assist devices: Establishing a safe and appropriate weaning protocol after myocardial recovery Masahiko Ando, MD, PhD, Takashi Nishimura, MD, PhD, Yoshiaki Takewa, MD, PhD, Shunei Kyo, MD, PhD, Minoru Ono, MD, PhD, Yoshiyuki Taenaka, MD, PhD, Eisuke Tatsumi, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 143, Issue 5, Pages 1176-1182 (May 2012) DOI: 10.1016/j.jtcvs.2011.07.065 Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Experimental settings. B, PV loop. PVA is the sum of external work and potential energy. LMT, Left main trunk (of the coronary artery); IVC, inferior vena cava; ECG, electrocardiogram; ESPVR, end-systolic pressure volume relationship; LV, left ventricular; EW, external work; PE, potential energy; PVA, pressure volume area; EDPVR, end-diastolic pressure volume relationship; V0, X axis intercept of the end-systolic PV relationship slope. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1176-1182DOI: (10.1016/j.jtcvs.2011.07.065) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Pressure and flow waveforms. In continuous mode, diastolic reverse PF was observed. However in off-test mode, diastolic RPM increased and the reversal of PF disappeared completely. ECG, Electrocardiogram; AoP, aortic pressure; CVP, central venous pressure; LVP, left ventricular pressure; PF, pump flow; AoF, ascending aortic flow; CoF, coronary flow; RPM, revolution per minute. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1176-1182DOI: (10.1016/j.jtcvs.2011.07.065) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 PV loops. End-systolic point (black dot) and end-diastolic point (white circle). In continuous mode, end-systolic and end-diastolic points are shifted rightward compared with circuit-clamp conditions. End-diastolic points are shifted upward. In off-test mode, the loop is similar to that in circuit-clamp condition. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1176-1182DOI: (10.1016/j.jtcvs.2011.07.065) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 LV pressure and volume data. These parameters are shown as percentages of values under circuit-clamp conditions as baseline (100%). %EDP was significantly increased in continuous mode compared with circuit-clamp conditions. ESP, End-systolic pressure; ESV, end-systolic volume; EDP, end-diastolic pressure; EDV, end-diastolic volume. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1176-1182DOI: (10.1016/j.jtcvs.2011.07.065) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 A, PVA and MVO2. There were no significant changes in PVA or MVO2 in any of the 3 modes. B, Retrograde PF. In continuous mode, the amount of reverse PF was 1.38 L/min. However, this was significantly decreased to 0.66 L/min in off-test mode. PVA, Pressure volume area; MVO2, myocardial oxygen consumption. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1176-1182DOI: (10.1016/j.jtcvs.2011.07.065) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions