Author + information
- Anna Mara Scandroglio, MD∗ (, )
- Friedrich Kaufmann, DIPL ING,
- Marina Pieri, MD,
- Alexandra Kretzschmar, MD,
- Marcus Müller, MD,
- Panagiotis Pergantis, MD,
- Stephan Dreysse, MD,
- Volkmar Falk, MD, PhD,
- Thomas Krabatsch, MD, PhD and
- Evgenij V. Potapov, MD, PhD
- ↵∗Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
We thank Dr. Iacovoni and colleagues for their positive comments.
We agree with them that a “ramp test” for the HeartWare HVAD (HeartWare, Framingham, Massachusetts) is not standardized. However, we performed a short version, increasing the revolutions per minute (rpm) from 2,200 to up to 3,200 to 3,500 rpm to diagnose pre-pump or post-pump blood flow obstruction. Unlike the HeartMate II system (Thoratec, Pleasanton, California), the blood flow signal on the monitor of the HeartWare HVAD provides important information. If the amplitude and morphology of the blood flow curve do not change despite the increase in rpm, it is a sign of blood flow obstruction. In this case, the rpm increase produces an increase in power consumption caused by increased fluid friction inside the pump, which leads to a shift of the blood flow curve without a change in amplitude and morphology. Conversely, a change in the amplitude and morphology of the curve from pulsatile form to a flat line suggests the absence or insignificance of pre-pump or post-pump blood flow obstruction, which makes additional echocardiographic assessment of changes in the size of the left ventricle unnecessary.
However, 3-dimensional echocardiography should be used independently of the ramp test to detect thrombi inside the left ventricle that obstruct the inflow cannula (pre-pump thrombosis).
In conclusion, we agree with the authors that part of our statement, “Treatment depended on the diagnosis of the type of blood flow obstruction based on clinical status, hemodynamic values, echocardiographic evaluation including ‘ramp test,’ level of hemolysis, and end organ function” would be better phrased as “…echocardiographic evaluation, ramp test…” and similarly in the algorithm.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation