Weaning of rotary blood pump recipients after myocardial recovery: a computer study of changes in cardiac energetics Heinrich Schima, PhD, Michael Vollkron,

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Weaning of rotary blood pump recipients after myocardial recovery: a computer study of changes in cardiac energetics Heinrich Schima, PhD, Michael Vollkron, MS, Herbert Boehm, MS, Wilfried Röthy, MD, Markus Haisjackl, MD, Georg Wieselthaler, MD, Ernst Wolner, MD The Journal of Thoracic and Cardiovascular Surgery Volume 127, Issue 6, Pages 1743-1750 (June 2004) DOI: 10.1016/j.jtcvs.2003.09.029

Figure 1 Comparison of flow patterns and pressure-volume (PV) loops of the unassisted left ventricle with left ventricular assistance by implanted and paracorporeally placed rotary pumps at a mean flow of 0 L/min. Compared with the unassisted heart, the flow pattern and PV loops for an implanted pump with short cannulas considerably increases the area of the PV loop because of pendulular flow. The paracorporeally positioned pump with long cannulas provides a load to the heart similar to that in the unassisted case. EW, External work; PE, potential energy; PVA, pressure-volume area; Qavo, flow through the aortic valve orifice; Qpump, flow through the pump; Qmvo, flow through the mitral valve orifice. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1743-1750DOI: (10.1016/j.jtcvs.2003.09.029)

Figure 2 Model structure used for simulation. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1743-1750DOI: (10.1016/j.jtcvs.2003.09.029)

Figure 3 Pressure and flow patterns and PV loop for full assist by the implanted pump (heart rate 80 beats/min, contractility 60%, pump flow 4.6 L/min). ESV, End-systolic volume; EDV, end-diastolic volume; LVP, left ventricular pressure; AOP, aortic pressure; LAP, left atrial pressure. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1743-1750DOI: (10.1016/j.jtcvs.2003.09.029)

Figure 4 Pressure and flow patterns and PV loop for a mean flow of 1.8 L/min through the implanted pump (point of load equivalent to occluded pump). The pump flow pattern Qpump includes a considerable backflow during diastole. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1743-1750DOI: (10.1016/j.jtcvs.2003.09.029)

Figure 5 EW, PE, and PVA for implanted rotary pump at occlusion, zero speed, and various levels of pump flow from 0% to 100% (ie, 0-5 L/min) The PVA at pump support decreases with increasing pump flow, but because of the pendulum volume, the effect of pump removal on PVA is equivalent to the PVA at 1.8 L/min positive mean flow. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1743-1750DOI: (10.1016/j.jtcvs.2003.09.029)

Figure 6 EW, PE, and PVA for paracorporeally placed rotary pump with long inflow and outflow cannulas (both 1 m). Because of the lower pendulum volume resulting from the damping effect of the tubing, the PVA without pump is equivalent to the situation at zero flow through the paracorporeal pump. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1743-1750DOI: (10.1016/j.jtcvs.2003.09.029)

Figure 7 Pressure and flow patterns and PV loops for a pulsatile assist device in 1:1 assist mode (resulting mean pump flow 2.55 L/min). The pump supports every second heart beat, leading to a complex shape of the PV loop. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1743-1750DOI: (10.1016/j.jtcvs.2003.09.029)