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(Circulation. 1998;97:1212-1213.)
© 1998 American Heart Association, Inc.

Correspondence

Effects of Exercise During Long-term Support With a Left Ventricular Assist Device

Mario C. Deng, MD; Markus J. Wilhelm, MD; ; Hans H. Scheld, MD

Muenster University Hospital, Muenster, Germany

To the Editor:

Jaski et al,¹ in their article in Circulation, provide important information regarding exercise physiology during long-term TCI Heartmate left ventricular assist device (LVAD) support. They indicate that the native left ventricle contributes directly to systemic cardiac output during exercise yet do not attempt to quantify left ventricular contribution.

In our institution, of more than 660 patients referred for cardiac transplantation between 1990 and 1997, 50 patients had to receive LVAD support, 39 by the Novacor,² 7 by the TCI Heartmate, and 4 by the Medos system. We have reported a protocol for the Novacor LVAD that allows for quantitation of native left ventricular function.³ A similar protocol was developed for the TCI Heartmate LVAD with the purpose of (a) quantifying left ventricular contribution and (b) assessing left ventricular functional reserve. A 7.5F thermodilution Swan-Ganz catheter was placed in the pulmonary artery. Cardiac output, pulmonary capillary wedge pressure, pulmonary artery pressure, and right atrial pressure as well as arterial pressure (by cuff inflation) were recorded at rest, during upright bicycle exercise after 5 minutes on the 25-, 50-, and 75-W levels as well as 3 and 10 minutes after exercise. Simultaneously, TCI Heartmate LVAD hemodynamic data (pump rate, pump stroke volume, pump output) were automatically recorded. Data were compared by subtraction. Two different LVAD settings were chosen. In setting 1 ("fill-to-empty"), we achieved maximal pump washout in conjunction with optimal pump output, as did Jaski et al.¹ In this setting, the aortic valve remained largely closed as assessed . . . [Full Text of this Article]

Brian E. Jaski, MD; ; Joseph Kim, BS

San Diego Cardiac Center, San Diego, Calif

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