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Galbas MC, Meissner F, Asmussen A, Straky HC, Schimmel M, Reuter J, Grundmann S, Czerny M, Bothe W. A systematic methodology for epicardial and epiaortic echocardiography in swine research models. Health Sci Rep 2024; 7:e1777. [PMID: 38186934 PMCID: PMC10767764 DOI: 10.1002/hsr2.1777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/26/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024] Open
Abstract
Background Perioperative echocardiography is of paramount importance during cardiac surgery. Nonetheless, in the experimental large-animal setting, it might be challenging obtaining optimal imaging when using conventional imaging acquisition techniques, such as transthoracic and transesophageal screenings. Open-chest surgery allows epicardial echocardiographic assessment with direct contact between probe and heart, thus providing superior quality. Standard protocols regarding the use of epicardial ultrasound in swine for research purposes are lacking. Methods Epicardial echocardiography was performed in 10 female German Landrace pigs undergoing cardiac surgery. A structured and comprehensive protocol for epicardial echocardiography was elaborated including apical, ventricular long and short axis, as well as epiaortic planes. All experiments were approved by the local board for animal welfare and conducted in accordance with the German animal protection law (TierSchG) and the ARRIVE guidelines. Conclusions Systematic protocols using epicardial echocardiography may serve as an additional tool to assess cardiac dimensions and function in experimental scenarios with swine models.
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Affiliation(s)
- Michelle C. Galbas
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Florian Meissner
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Alexander Asmussen
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Hendrik C. Straky
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Marius Schimmel
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Johanna Reuter
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Sebastian Grundmann
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Wolfgang Bothe
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
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Lilja D, Schalit I, Espinoza A, Fiane AE, Dahle G, Littorin-Sandbu H, Pettersen FJ, Russell KE, Thiara APS, Elle OJ, Halvorsen PS. Detection of inflow obstruction in left ventricular assist devices by accelerometer: A porcine model study. J Heart Lung Transplant 2023; 42:1005-1014. [PMID: 37023840 DOI: 10.1016/j.healun.2023.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/10/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Left ventricular assist devices (LVAD) provide circulatory blood pump support for severe heart failure patients. Pump inflow obstructions may lead to stroke and pump malfunction. We aimed to verify in vivo that gradual inflow obstructions, representing prepump thrombosis, are detectable by a pump-attached accelerometer, where the routine use of pump power (PLVAD) is deficient. METHOD In a porcine model (n = 8), balloon-tipped catheters obstructed HVAD inflow conduits by 34% to 94% in 5 levels. Afterload increases and speed alterations were conducted as controls. We computed nonharmonic amplitudes (NHA) of pump vibrations captured by the accelerometer for the analysis. Changes in NHA and PLVAD were tested by a pairwise nonparametric statistical test. Detection sensitivities and specificities were investigated by receiver operating characteristics with areas under the curves (AUC). RESULTS NHA remained marginally affected during control interventions, unlike PLVAD. NHA elevated during obstructions within 52-83%, while mass pendulation was most pronounced. Meanwhile, PLVAD changed far less. Increased pump speeds tended to amplify the NHA elevations. The corresponding AUC was 0.85-1.00 for NHA and 0.35-0.73 for PLVAD. CONCLUSION Elevated NHA provides a reliable indication of subclinical gradual inflow obstructions. The accelerometer can potentially supplement PLVAD for earlier warnings and localization of pump.
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Affiliation(s)
- Didrik Lilja
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Itai Schalit
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway
| | - Andreas Espinoza
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway
| | - Arnt Eltvedt Fiane
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Gry Dahle
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Helen Littorin-Sandbu
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway
| | - Fred-Johan Pettersen
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway; Department of Physics, University of Oslo, Oslo, Norway
| | | | - Amrit P S Thiara
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Ole Jakob Elle
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway; Department of Informatics, University of Oslo, Norway
| | - Per Steinar Halvorsen
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Lilja D, Schalit I, Espinoza A, Pettersen FJ, Elle OJ, Halvorsen PS. Detection of inflow obstruction in left ventricular assist devices by accelerometer: An in vitro study. Med Eng Phys 2022; 110:103917. [PMID: 36564132 DOI: 10.1016/j.medengphy.2022.103917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Abstract
Inflow obstruction in left ventricular assist devices (LVAD) may lead to embolic stroke and pump malfunction. We investigated if an accelerometer detected graded LVAD inflow obstructions. Detection performances were compared to the current continuous surveillance routine based on the pump power consumption (PLVAD). In ten mock circuit experiments, four different-sized pendulating balloons obstructed HVAD™ inflow conduits cross-section areas by 14%-75%. Nonharmonic amplitudes (NHA) of continuous signals from a triaxial accelerometer attached to the LVAD were compared against single-point PLVAD values, using load and speed alterations as control interventions. We analyzed the NHA band power with a pairwise nonparametric statistical test. The detection performances were analyzed by receiver operating characteristics with areas under the curves (AUC). The NHA remained unaffected during load alterations. In contrast, NHA increased significantly from the 27% obstruction level (AUC≥0.82), an effect amplified by increased pump speed. PLVAD did not change significantly below the maximal 75% obstruction level (AUC≤0.36). In conclusion, NHA detected the inflow obstructions much better than PLVAD. The technique may provide a future monitoring modality of any pendulating obstructive inflow pathology.
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Affiliation(s)
- Didrik Lilja
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Itai Schalit
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Andreas Espinoza
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo Norway
| | - Fred-Johan Pettersen
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway; Department of Physics, University of Oslo, Norway
| | - Ole Jakob Elle
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo Norway; Department of Informatics, The University of Oslo, Norway
| | - Per Steinar Halvorsen
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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