HeartWare® Ventricular Assist System
HVAD® Pump Waveforms
TM00017 Rev03 02/14 Module 8/10
© 2016 HeartWare, Inc.
CAUTION: Federal
CAUTION:
Law (USA)
Federal
restricts
Law (USA)
this device
restricts
to sale
thisby
device
or ontothe
sale
order
by or
of on
a physician.
the order of a physician.
Refer to the “Instructions
Refer to the
For
“Instructions
Use” for complete
For Use”
Indications
for complete
for Use,
Indications
Contraindications,
for Use, Contraindications,
1
Warnings, Precautions,
Warnings,
Adverse
Precautions,
EventsAdverse
and Instructions
Events and
prior
Instructions
to using this
prior
device.
to using this device.
Objectives
• Review HVAD® Pump Waveform Characteristics
• Review sample waveforms
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
2
HVAD® Pump Waveform Overview
• The HVAD® Pump is a continuous flow, centrifugal pump, capable
of full support
• The HeartWare® Ventricular Assist System has a system monitor
which displays real-time waveforms of the HVAD pump
Pump power (W)
Pump flow (L/min)
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
3
HVAD® Pump Performance Overview
• Waveforms are a tool to provide insight into the patient’s condition and
help with patient management
• Pump flow waveform depicts the rate of blood flowing through the pump
• The shape of the waveform varies with clinical changes
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
4
HVAD® Pump Waveform: How It’s Derived
Inputs
Speed
Power
Processing
Viscosity Input
Outputs
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
5
HVAD® Pump Waveform:
Waveform Characteristics
Heart rate
• Flow Waveform: difference
between afterload (AP) and
preload (VP)
• Pulsatility: Variation in pump flow
relative to native systole and
diastole
– Dependent on heart contractility
and HVAD operating points
– Systole  max HVAD flow
– Diastole  min HVAD flow
• Waveform Trough: minimum
value of the flow waveform
Beginning
of diastole
Pulsatility
Waveform
Trough
Beginning
of systole
Trough should be
>2 L/min
There should be
>2 L/min of pulsatility
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
6
HVAD® Pump Waveform:
Waveform Characteristics
• As the heart ejects,
additional blood leaves
ventricle and enters pump
• Despite a constant
speed, pump flow
increases during systole
• Power increases in
response to increased
blood volume to keep the
speed at its
pre-set level
• Increased power
calculates into an
increased estimated flow
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
7
HVAD® Pump Waveform: Sample
Suction Condition
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
8
HVAD® Pump Waveform:
Preload and Afterload
• Preload: Volume of blood returning to the RV, LV, or LVAS
(RAP, LAP, or LVAS Fill Rate)
• Afterload: Arterial pressure or resistance the RV, LV, or LVAS has to
pump against to empty (PAP, MAP, SVR, or MAP/residual volume)
Contributing Factors
– Heart rate and arrhythmias
– Hypovolemia
• Bleeding
• Diuretics
• Third spacing
– RV dysfunction
– Vasodilatation
– Vasoconstriction
– Elevated MAP and/or SVR
– Electrolyte or
acid-base imbalance
– Tamponade
– Pneumothorax
– Inflow/outflow obstruction
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
9
Sample Waveform Interpretations
Flow waveform analysis is based solely on data provided to the monitor from the
controller without independent verification. The assessments of the flow waveform may
be indicative of certain patient conditions.
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
10
Waveform Interpretation:
What Do These Waveforms Represent?
Scenario
• 68 yr old female, s/p HVAD implant
• POD 2, patient stable
• On morning rounds, this is what is displayed on the monitor
A. Ventricular Fibrillation
B. Normal Waveform
C. Suction Event
D. Concurrent IABP
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
11
Waveform Interpretation:
What Do These Waveforms Represent?
Scenario
•
•
•
•
52yr old male, s/p HVAD implant
POD 0, admitted originally with AMI
Initially supported by IABP, but remained in shock with no recovery of LV
You were told the case went smoothly, except “some Vfib when coming off
pump”; patient was shocked x3 with success
• This is what is displayed on the monitor
A. Ventricular Tachycardia
B. Normal Waveform
C. Suction Event
D. Concurrent IABP 1:1
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
12
Waveform Interpretation:
What Do These Waveforms Represent?
Scenario
• 63yr old male, in OR for HVAD implant
• Pump started 15 min ago, all was fine
• This is what is displayed on the monitor
A. Supraventricular Tachycardia
B. Normal Waveform
C. Artifact
D. Suction Event
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
13
Waveform Interpretation:
What Do These Waveforms Represent?
•
•
•
•
Scenario
67 yr old female, s/p HVAD implant
POD 0, has been in ICU for 7 hours
Patient is stable and being weaned from ventilator - she is waking up, you
go in check on her
This is what is displayed on the monitor
A. Ventricular Tachycardia
B. Normal Waveform
C. Artifact
D. Thrombus
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
14
Waveform Interpretation:
What Do These Waveforms Represent?
Scenario
• 73yr old female, s/p HVAD implant
• POD 3, on Milrinone 0.375mcg/kg/min and currently weaning epinephrine
• This is what is displayed on the monitor
A. Low Mean Arterial Pressure
(MAP)
B. Hypovolemia
C. Excessive Pump Speed
D. All of the Above
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
15
Waveform Interpretation:
What Do These Waveforms Represent?
•
•
•
•
Scenario
56yr old male, s/p HVAD implant
POD 4, patient has been doing well, all infusions have been weaned except
milrinone which is being weaned, currently at 0.25mcg/kg/min
He has been out of bed and moving around, and has been aggressively
diuresed after surgery
This is what is displayed on the monitor
A. Ventricular Tachycardia
B. Suction Event
C. Normal Waveform
D. Artifact
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
16
Waveform Interpretation:
What Do These Waveforms Represent?
•
•
•
•
Scenario
33yr old female, s/p HVAD implant for peripartum CMO
POD 0, originally supported by IABP, but continued to deteriorate which led to
her HVAD implant
She has just returned from the OR - you are told case went smoothly
This is what is displayed on the monitor.
A. Ventricular Fibrillation
B. Normal Waveform
C. Suction Event
D. Concurrent IABP 1:2
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
17
Waveform Interpretation:
What Do These Waveforms Represent?
Scenario
• 72yr old, female, given new antibiotics by primary doctor for upper respiratory
infection, on Day 5 of those she calls and says she is experiencing alarms, you
bring her to clinic.
• This is what is displayed on the monitor.
A. Low Flow
B. Normal Waveform
C. High Watts
D. Suction Event
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
18
Waveform Interpretation:
What Do These Waveforms Represent?
Scenario
• 67yr male, comes to clinic and reports he is getting more tired and short of breath
than usual, but no other complaints
• This is what is displayed on the monitor.
A. IABP
B. Artifact
C. Normal Waveform
(Irregular Heart Rate)
D. Suction
CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Refer to the “Instructions For Use” for complete Indications for Use, Contraindications,
Warnings, Precautions, Adverse Events and Instructions prior to using this device.
19