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In‐Series Versus In‐Parallel Mechanical Circulatory Support for the Right Heart: A Simulation Study
Author(s) -
Hsu PoLin,
McIntyre Madeleine,
Boehning Fiete,
Dang Weiguo,
Parker Jack,
Autschbach Rüdiger,
SchmitzRode Thomas,
Steinseifer Ulrich
Publication year - 2016
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12601
Subject(s) - afterload , ventricle , cardiology , hemodynamics , medicine , pulmonary artery , cardiac output , circulatory system , blood flow , heart failure
Right heart failure ( RHF ) is a serious health issue with increasing incidence and high mortality. Right ventricular assist devices ( RVADs ) have been used to support the end‐stage failing right ventricle ( RV ). Current RVADs operate in parallel with native RV , which alter blood flow pattern and increase RV afterload, associated with high tension in cardiac muscles and long‐term valve complications. We are developing an in‐series RVAD for better RV unloading. This article presents a mathematical model to compare the effects of RV unloading and hemodynamic restoration on an overloaded or failing RV . The model was used to simulate both in‐series (sR VAD ) and in‐parallel (pR VAD ) (right atrium‐pulmonary artery cannulation) support for severe RHF . The results demonstrated that s RVAD more effectively unloads the RV and restores the balance between RV oxygen supply and demand in RHF patients. In comparison to simulated p RVAD and published clinical and in silico studies, the s RVAD was able to provide comparable restoration of key hemodynamic parameters and demonstrated superior afterload and volume reduction. This study concluded that in‐series support was able to produce effective afterload reduction and preserve the valve functionality and native blood flow pattern, eliminating complications associated with in‐parallel support.