Recovery From Exhaustion of the Frank-Starling Mechanism by Mechanical Unloading With a Continuous-Flow Ventricular Assist Device

• Published in: Circulation Journal 2020/06/25, Vol.84(7), pp.1124-1131
• Main Authors: Saito, Shunsuke, Toda, Koichi, Miyagawa, Shigeru, Yoshikawa, Yasushi, Hata, Hiroki, Yoshioka, Daisuke, Sera, Fusako, Nakamoto, Kei, Daimon, Takashi, Sakata, Yasushi, Sawa, Yoshiki
• Format: Article
• Language: English
• Subjects: Adaptation, Physiological; Adolescent; Adult; Bridge to recovery; Device Removal; Exercise Tolerance; Female; Frank-Starling mechanism; Heart Failure - diagnosis; Heart Failure - physiopathology; Heart Failure - therapy; Heart-Assist Devices; Humans; Left ventricular assist device; Male; Middle Aged; Models, Cardiovascular; Prosthesis Design; Prosthesis Implantation - instrumentation; Recovery of Function; Retrospective Studies; Time Factors; Treatment Outcome; Ventricular Function, Left
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-20-0070

Background:We describe our original left ventricular assist device (LVAD) speed ramp and volume loading test designed to evaluate native heart function under continuous-flow LVAD support.Methods and Results:LVAD speed was decreased in 4 stages from the patient’s optimal speed to the minimum setting for each device. Under minimal LVAD support, patients were subjected to saline loading (body weight [kg]×10 mL in 15 min). Echocardiographic and hemodynamic data were obtained at each stage of the LVAD speed ramp and every 3 min during saline loading. Patients were divided into Recovery (with successful LVAD removal; n=8) and Non-recovery (others; n=31) groups. During testing, increased pulmonary capillary wedge pressure caused by volume loading was milder in the Recovery than Non-recovery group (repeated measures analysis of variance; group effect, P=0.0069; time effect, P