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Mitral Valve Regurgitation in the LVAD-Assisted Heart Studied in a Mock Circulatory Loop

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Abstract

Permanent closure of the aortic valve (AVC) is sometimes performed In LVAD patients, usually when a mechanical valve prosthesis or significant aortic insufficiency is present. Mitral valve regurgitation (MVR) present at the time of LVAD implantation can remain unresolved, representing a limitation for exercise tolerance and a potential predictor of mortality. To investigate the effect of MVR on hemodynamics of the LVAD-supported heart following AVC, studies were performed using a mock circulatory loop. Pressure and flow measured for a range of cardiac function, LVAD speed, and MVR show that cardiac contraction augments aortic pressure by 10–27% over nonpulsatile conditions when the mitral valve functions normally, but decreases with MVR until it reaches the nonpulsatile level. Aortic flow displays a similar trend, demonstrating a 25% decrease from fully functioning to open at 7 krpm, a 5% decrease at 9 krpm, and no observable effect at 11 krpm. Pulsatility decreases with increased LVAD speed and MVR. The data indicate that a modest level of cardiac output (1.5–2 L/min) can be maintained by the native heart through the LVAD when the LVAD is off. These results demonstrate that MVR decreases the augmentation of forward flow by improved cardiac function at lower LVAD speeds. While some level of MVR can be tolerated in LVAD recipients, this condition represents a risk, particularly in those patients that undergo AVC closure, and may warrant repair at the time of surgery.

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Acknowledgments

The authors wish to thank Fernando Olea, Phanthiwa Posuwattanakul, and Annamarie Mendoza for their assistance with the experimental studies, and Varsha Ramesh for preparation of the manuscript. Many thanks to Thoratec, Inc. (Pleasanton,CA) for providing a HeartMate II LVAD for these studies, as well as to Medtronic, who provided bioprosthetic heart valves (Medtronic Mosaic porcine aortic valves).

Authors’ Contributions

BF and MH carried out the cardiac simulator studies and analyzed the experimental data. KMN designed the study, and participated in conducting experiments, analyzing the data, and wrote the manuscript. WD and RA conceived of the study and participated in the design as well as assisting with interpretation of the results. All authors read and approved the final manuscript.

Conflict of interest

K. May-Newman is a consultant for Thoratec, Inc, but was not at the time that the study was performed. W. Dembitsky and R. Adamson are both consultants for Thoratec, Inc. Funding for these studies was provided by internal sources at SDSU and the Sharp Memorial Hospital Foundation. No human or animal subjects were used.

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Authors and Affiliations

  1. Bioengineering Program, Department of Mechanical Engineering, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182-1323, USA

    K. May-Newman, B. Fisher & M. Hara

  2. Mechanical Circulatory Support, Cardiothoracic Surgery, Sharp Memorial Hospital, San Diego, CA, 92123, USA

    W. Dembitsky & R. Adamson

Authors
  1. K. May-Newman
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  2. B. Fisher
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  3. M. Hara
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  4. W. Dembitsky
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  5. R. Adamson
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Corresponding author

Correspondence to K. May-Newman.

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Associate Editor Ajit P. Yoganathan oversaw the review of this article.

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May-Newman, K., Fisher, B., Hara, M. et al. Mitral Valve Regurgitation in the LVAD-Assisted Heart Studied in a Mock Circulatory Loop. Cardiovasc Eng Tech 7, 139–147 (2016). https://doi.org/10.1007/s13239-016-0261-2

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  • DOI: https://doi.org/10.1007/s13239-016-0261-2

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